Zestril (lisinopril)

How does it work?

Zestril tablets contain the active ingredient lisinopril, which is a type of medicine called an ACE inhibitor. (NB. Lisinopril tablets are also available without a brand name, ie as the generic medicine.)

ACE inhibitors 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.

The reduced pressure within the blood vessels means that the heart doesn't have to work as hard to pump the blood around the body. This means that ACE inhibitors such as lisinopril can also be used to improve the symptoms of heart failure, where the heart is not pumping as efficiently as it should be, and to improve survival following a heart attack.

What is it used for?

High blood pressure with no known cause

High blood pressure caused by compression or blockage of the arteries that carry blood to the kidneys (renovascular hypertension)

Heart failure

Improving survival following a heart attack

Diabetic kidney disease.

Warning!

Some people may experience dizziness caused by low blood pressure in the first few days of taking this medicine and in particular the first dose. For this reason, the first dose should preferably be taken at bedtime. Your doctor may want you to take the first dose of this medicine under medical supervision in hospital if you are aged over 70 years, have low blood pressure, low levels of fluids or salt in your blood (eg due to dehydration), severe or unstable heart failure, kidney problems, or are taking high doses of diuretic medicines, multiple diuretic medicines, or certain other medicines that dilate your blood vessels.

If you feel dizzy during treatment this can 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.

Use with caution in

Elderly people

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)

Low blood pressure (hypotension)

Severe heart failure

Diabetes

Diseases affecting connective tissue, eg scleroderma, systemic lupus erythematosus (collagen vascular diseases)

People with kidney failure requiring a certain type of haemodialysis (high-flux membrane)

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

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

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)

Enlargement of a chamber of the heart (right ventricle) due to high blood pressure in the pulmonary artery (cor pulmonale)

Pregnancy.

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. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

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 this medicine passes into breast milk. It should be used with caution in nursing mothers, and only if the benefits to the mother outweigh any risks to the nursing infant. Discuss this with 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

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. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

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