Health Centres - Zestoretic
How does it work?
Zestoretic tablets contain two active ingredients, lisinopril and hydrochlorothiazide. Lisinopril is a type of medicine called an ACE inhibitor. Hydrochlorothiazide is a type of medicine called a thiazide diuretic. These are both medicines used to lower high blood pressure.
ACE inhibitors such as lisinopril work by blocking the action of a compound in the body called angiotensin converting enzyme (ACE). Normally ACE produces another compound called angiotensin II, as part of the body's natural control of blood pressure. Angiotensin II causes blood vessels to constrict and narrow, which increases the pressure within the blood vessels.
As lisinopril blocks the action of ACE, it reduces the production of angiotensin II. This means that the blood vessels are allowed to relax and widen. The overall effect of this is a drop in blood pressure, hence lisinopril can be used to lower high blood pressure.
Diuretics such as hydrochlorothiazide are sometimes referred to as ‘water tablets’. They remove excess fluid from the body by increasing the production of urine.
Diuretics act in the kidneys. They work by causing the kidneys to increase the amount of salts, such as potassium and sodium, that are filtered out of the blood and into the urine. When these salts are filtered out of the blood by the kidneys, they draw water alongside them. As diuretics increase the removal of salts from the blood, they also cause more water to be drawn out of the blood and into the urine.
Removing water from the blood decreases the volume of fluid circulating through the blood vessels. This subsequently decreases the pressure within the blood vessels. Diuretics can therefore be used to lower high blood pressure.
The combination of lisinopril with hydrochlorothiazide is used when blood pressure has not been lowered sufficiently using lisinopril on its own.
What is it used for?
- Mild to moderate high blood pressure .
Warning!
- This medicine may make you feel dizzy as a result of the drop in your blood pressure. If you feel dizzy this can usually be relieved by lying down until the symptoms pass. If affected you should avoid performing potentially hazardous tasks such as driving or operating machinary. If you frequently feel dizzy you should let your doctor know, as your dose of this medicine may need reducing.
- Alcohol may enhance the blood pressure lowering effect of this medicine, which can increase dizziness and may increase the risk of fainting.
- ACE inhibitors can sometimes cause an allergic reaction called angioedema. This is more likely to occur in black patients. Stop taking this medicine and consult your doctor immediately if you experience difficulty breathing or swallowing, or swelling of your face, lips, tongue, throat, hands, feet or ankles while taking this medicine.
- Your blood pressure, kidney function and the amount of potassium in your blood should be regularly monitored while you are taking this medicine.
- If you need a test to assess the functioning of your parathyroid gland your doctor may ask you to stop taking this medicine beforehand, as it may interfere with the test results.
Use with caution in
- Elderly people
- Decreased liver function
- Decreased kidney function
- Narrowing of the arteries that supply blood to the kidneys (renal artery stenosis)
- People with low fluid volume or salt levels in the body, eg due to diuretic therapy, low-sodium diet, diarrhoea or vomiting
- People taking other medicines for high blood pressure, particularly diuretics (see end of factsheet)
- People with hardening of the arteries, eg in the heart (cardiovascular disease), brain (cerebrovascular disease) or legs (peripheral vascular disease)
-
Heart failure
-
Diabetes
-
Gout
- Diseases affecting connective tissue, eg scleroderma, systemic lupus erythematosus (collagen vascular diseases)
- People receiving therapy to remove certain types of fat from the blood using a machine (LDL apheresis)
- People undergoing therapy to decrease allergy to bee or wasp stings (desensitisation).
Not to be used in
- Allergy to medicines from the sulphonamide group, eg the antibiotic sulphamethoxazole
- History of swelling of the lips, face or tongue (angioedema) with no known cause, or caused by previous use of an ACE inhibitor medicine
-
Hereditary angioedema
- People whose kidneys are not producing urine (anuria)
- Narrowing of the main artery of the body (aortic stenosis)
- Heart disease characterised by thickening of the internal heart muscle and a blockage inside the heart (hypertrophic obstructive cardiomyopathy)
- People with kidney failure who need dialysis
-
Pregnancy
-
Breastfeeding.
- This medicine is not recommended for children.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
Pregnancy and Breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine should not be used in pregnancy, particularly in the second and third trimesters, as it may be harmful to the unborn baby. Seek further medical advice from your doctor. If you get pregnant while taking this medicine, stop taking it and consult your doctor immediately. However, in some cases, where this medicine is considered to be life-saving to the mother, treatment may be continued.
- It is not known if lisinopril passes into breast milk, however hydrochlorothiazide does pass into breast milk. Breastfeeding mothers should therefore either stop breastfeeding while taking this medicine, or not take this medicine. Seek medical advice from your doctor.
Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.
- Dizziness
- Headache
- Disturbances of the gut such as diarrhoea, constipation, nausea, vomiting or abdominal pain
- Fatigue
- Dry cough
- Low blood pressure (hypotension)
- Feeling of weakness (asthenia)
- Rash
- Dry mouth
- Increased level of potassium in the blood (hyperkalaemia)
- Chest pain (angina)
- Faster than normal heart beat (tachycardia)
- Changes in mood
- Difficulty in sleeping (insomnia)
- Pins and needles sensations (paraesthesia)
- Shortness of breath (dyspnoea)
- Impotence
- Alteration in taste
- Increased level of uric acid in the blood (hyperuricaemia)
- Severe swelling of lips, face, tongue or throat (angioedema - see warning above)
- Disorders of the kidney, liver or blood
The side effects listed above may not include all of the side effects reported by the drug's manufacturer.
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