Lisinopril/Hydrochlorothiazide: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Uses

What is lisinopril/hydrochlorothiazide used for?

Lisinopril/hydrochlorothiazide is commonly used to lower high blood pressure (hypertension). Lowering high blood pressure has been shown to reduce the risk of stroke, heart attack, and death.

Lisinopril/hydrochlorothiazide may also be used for other conditions as determined by your healthcare provider.

How does lisinopril/hydrochlorothiazide work (mechanism of action)?

Lisinopril/hydrochlorothiazide is a combination of two medicines that work by different mechanisms to lower blood pressure.

Lisinopril blocks the angiotensin-converting enzyme (ACE) from producing a hormone called angiotensin II. When angiotensin II binds to receptors, it causes your blood vessels to constrict, and kidneys to retain more sodium. Blocking the formation of angiotensin II helps your blood vessels relax so that blood can move through them more easily. These effects can help your heart work better, lower blood pressure, and may reduce your risk for heart attack and stroke.
Hydrochlorothiazide works by increasing how much you pee. It does this by helping the kidneys remove electrolytes, such as sodium (salt), and water from the body. It also appears to allow blood to flow more freely (less resistance to flow), which may help with lowering blood pressure.

How is lisinopril/hydrochlorothiazide supplied (dosage forms)?

Brands and other names

Zestoretic

Dosage forms and strengths

10 mg/12.5 mg oral tablets
20 mg/25 mg oral tablets
20 mg/25 mg oral tablets

How should I store lisinopril/hydrochlorothiazide?

Lisinopril/hydrochlorothiazide should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C), for shorter periods of time, such as when transporting it. Store in a cool, dry place. Protect from light. Keep tightly closed.

Side Effects

What are the most common side effects of lisinopril/hydrochlorothiazide?

The most common side effects of lisinopril/hydrochlorothiazide are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

Dizziness or feeling lightheaded, especially upon standing
Headache
Cough
Tiredness, fatigue, or weakness
Diarrhea and/or stomach pain
Nausea/vomiting
Infection of the nose or throat, sore throat, or common cold symptoms
Muscle cramps
Numbness, tingling, or burning in your arms, feet, or face
Low blood pressure
Muscle spasms
Rash
Problems getting or keeping an erection
An increase in how much you pee

There may be other side effects of lisinopril/hydrochlorothiazide that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of lisinopril/hydrochlorothiazide?

While less common, the most serious side effects of lisinopril/hydrochlorothiazide are described below, along with what to do if they happen.

Severe Allergic Reactions. Lisinopril/hydrochlorothiazide may cause allergic reactions, which can be serious. Stop taking lisinopril/hydrochlorothiazide and get help right away if you have any of the following symptoms of a serious allergic reaction.

Breathing problems or wheezing
Racing heart
Fever or general ill feeling
Swollen lymph nodes
Swelling of the face, lips, mouth, tongue, or throat
Trouble swallowing or throat tightness
Itching, skin rash, or pale red bumps on the skin called hives
Nausea or vomiting
Dizziness, feeling lightheaded, or fainting
Stomach cramps
Joint pain

Low Blood Pressure with Worsening Kidney Function. Lisinopril/hydrochlorothiazide can lower your blood pressure too much (hypotension) and cause dehydration. Both may lead to problems that are more serious than light-headedness. Poor blood flow to important organs such as your kidneys can occur, especially if you are elderly. Drink enough water to stay hydrated, especially if you have excess sweating, vomiting, or diarrhea. Get out of bed or from a seated position slowly. Tell your healthcare provider right away if you have any of the following symptoms.

Dizziness, feeling lightheaded, or fainting
Confusion
Feeling weak or tired
Sudden weight gain
Confusion
Reduced need to pee
Increased thirst
Dark or strong-smelling pee
Dry mouth
Sunken eyes
Headache
Fast heartbeat

Electrolyte Changes and Increased Blood Sugar. Lisinopril/hydrochlorothiazide may increase your blood sugar (glucose) levels and cause changes to the levels of certain minerals in your body, called electrolytes. For example, it may cause low potassium levels (hypokalemia), high potassium levels (hyperkalemia), low sodium levels (hyponatremia), low magnesium levels (hypomagnesemia), high calcium levels (hypercalcemia), or low chloride levels (hypochloremia). These changes can be serious. Your healthcare provider will do bloodwork to check your glucose and electrolyte levels, especially if you take certain other medicines. Keep your appointments to have your blood checked. Call your healthcare provider if you have any of the following symptoms.

Weakness
Unusual tiredness
Muscle cramps or twitching
Constipation
Nausea, vomiting, or loss of appetite
Dizziness
Restlessness or irritability
Trouble breathing
Confusion or decreased alertness
Abnormal heart rhythm (for example, slow or fast beats, skipped beats)
Seizures

Angioedema. Lisinopril/hydrochlorothiazide may cause a rare reaction called angioedema. The usual symptoms of this reaction include swelling of the lips, face, tongue, or throat. Stop using the medicine and contact your healthcare provider if you have this type of swelling. If you are having trouble breathing, get medical attention right away.

Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking lisinopril/hydrochlorothiazide. Call your healthcare provider right away if you have any of the following symptoms of liver damage.

Nausea or vomiting
Stomach or belly pain
Fever
Weakness or unusual tiredness
Itching
Loss of appetite
Light-colored poop
Dark-colored urine
Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Low Neutrophil Levels (Neutropenia). Lisinopril/hydrochlorothiazide may cause low levels of a type of white blood cell (called neutrophils), which is known as neutropenia. Neutrophils help prevent infection. Having a low level of neutrophils may increase your risk of infection. Tell your healthcare provider if you have any of the following symptoms of low neutrophil levels.

Fever, chills, or sweats
Tiredness
Sore throat, cough, or shortness of breath
Mouth or throat sores

Short-Sightedness and Glaucoma. Lisinopril/hydrochlorothiazide may make it harder to see faraway objects (short-sightedness). It also may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. These issues may be more likely with taking lisinopril/hydrochlorothiazide if you have a sulfa or penicillin allergy. Tell your healthcare provider right away if you have any of the following symptoms.

Trouble seeing faraway objects
Loss of vision
Eye pain or redness
Severe headache or vomiting
Seeing bright, colorful circles around lights (vision halos)

Severe Skin Reactions. Lisinopril/hydrochlorothiazide can cause severe skin reactions called Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) that can lead to death if not treated. If you develop a rash, stop lisinopril/hydrochlorothiazide and call your healthcare provider right away. Get emergency help right away if you have any of the following symptoms of SJS or TEN.

Painful red or purple skin that looks burned and peels off
Flat red rash or blisters on your skin, mouth, nose, and genitals
Red, painful, watery eyes

Warnings & Precautions

Who should not use lisinopril/hydrochlorothiazide?

Allergies to Ingredients. People who are allergic to any of the following should not take lisinopril/hydrochlorothiazide.

Prinzide
Zestoretic
Zestril
Prinivil
Lisinopril
Hydrochlorothiazide
Any other medicine known as an ACE inhibitor
Any other medicine known as a sulfonamide (sulfa drug)
Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific lisinopril/hydrochlorothiazide products they stock.

History of Angioedema. Lisinopril/hydrochlorothiazide may cause a rare reaction called angioedema, where there is swelling of the lips, face, tongue, or throat. This medicine should not be used if you have previously had angioedema from any cause, including from medicines or an unknown cause.

No Urine Production. Do not take lisinopril/hydrochlorothiazide if you are making very little to no pee. This condition is also called anuria.

Drug Interactions. Lisinopril/hydrochlorothiazide should not be taken while you are using certain other medicines. Before taking lisinopril/hydrochlorothiazide, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

What should I know about lisinopril/hydrochlorothiazide before using it?

Do not take lisinopril/hydrochlorothiazide unless it has been prescribed to you by a healthcare provider. Take it as prescribed.

Do not share lisinopril/hydrochlorothiazide with other people, even if they have the same condition as you. It may harm them.

Keep lisinopril/hydrochlorothiazide out of the reach of children.

Do not use salt substitutes containing potassium without contacting your healthcare provider.

If you faint while taking this medicine, it is recommended to stop taking it and discuss your symptoms with your healthcare provider as soon as possible.

Your skin may be very sensitive to light from the sun and devices that give off similar light, such as sunlamps and tanning beds, while you are taking certain drugs, including lisinopril/hydrochlorothiazide. This is called photosensitivity. Use sunscreen and wear a hat and clothes that cover your skin if you need to be in the sunlight. Talk to your healthcare provider about checkups for skin cancer.

What should I tell my healthcare provider before using lisinopril/hydrochlorothiazide?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if lisinopril/hydrochlorothiazide is right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

Heart problems
Liver problems
High uric acid levels (gout)
Kidney problems, such as a reduced need to pee
Persistent or severe diarrhea or vomiting
Low or high electrolytes, including potassium, sodium, or magnesium (with or without muscle weakness, muscle spasms, or abnormal heart rhythm)
High calcium levels (with or without nausea, vomiting, constipation, stomach pain, frequent peeing, thirst, muscle weakness or twitching).
Abnormal heart rhythm (arrhythmias)
Diabetes
Lupus
Prostate problems

Sulfa Allergy. Some people who have a sulfa allergy may also be allergic to lisinopril/hydrochlorothiazide. A sulfa allergy is a rash or more serious reaction to sulfa, or sulfonamide, medicines. Sulfa medicines include sulfamethoxazole, sulfadiazine silver, or sulfasalazine. Tell your healthcare provider if you have any allergies to medicines.

Pregnancy. Lisinopril/hydrochlorothiazide can cause death or serious harm to an unborn baby if taken during pregnancy. Tell your healthcare provider if you are or plan to become pregnant. If you become pregnant, stop taking lisinopril/hydrochlorothiazide right away and contact your healthcare provider.

Breastfeeding. Lisinopril/hydrochlorothiazide passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should stop breastfeeding or stop lisinopril/hydrochlorothiazide.

Interactions

Does lisinopril/hydrochlorothiazide interact with foods or drinks?

There are no known interactions between lisinopril/hydrochlorothiazide and foods or drinks. However, since lisinopril/hydrochlorothiazide affects electrolytes, it is important to discuss your intake of electrolytes, including sodium and potassium, with your healthcare provider.

It is unknown if drinking alcohol will affect lisinopril/hydrochlorothiazide. The risk of dizziness may be increased if you drink alcohol while taking lisinopril/hydrochlorothiazide. It is best to limit the amount of alcohol you drink.

Does lisinopril/hydrochlorothiazide interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using lisinopril/hydrochlorothiazide.

Aliskiren (Tekturna), which is a medicine for high blood pressure
Entresto (sacubitril/valsartan), which is a medicine for heart failure
An angiotensin-converting enzyme (ACE) inhibitor, which is a medicine for high blood pressure, heart failure, and certain kidney problems
An angiotensin II receptor blocker (ARB), which is a medicine for high blood pressure, heart failure, and other heart conditions
Any other medicine for high blood pressure
A medicine such as everolimus (Afinitor, Zortress), sirolimus (Rapamune and others), or temsirolimus (Torisel), which is commonly used to treat cancer or after an organ transplant
A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
Potassium supplements or salt substitutes containing potassium
Any medicine that can increase potassium levels, including spironolactone, eplerenone, triamterene, or amiloride
A medicine for diabetes
An opioid, such as oxycodone, morphine, codeine, or fentanyl, which is a medicine used for certain types of pain
A barbiturate, such as phenobarbital, butalbital, or primidone, which is a medicine that may be used to treat insomnia, migraines, or seizures
Lithium, which is a medicine commonly used for certain mental health conditions
A nonsteroidal anti-inflammatory drug (NSAID), such as aspirin, ibuprofen, naproxen, and others, which are contained in many prescription and OTC products for pain, swelling, and fever
A corticosteroid, such as prednisone, methylprednisolone, or dexamethasone, which is a medicine for certain inflammatory conditions
Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
A bile acid sequestrant, such as colestipol (Colestid), cholestyramine, or colesevelam (Welchol), which is a medicine to lower cholesterol

This may not be a complete list of medicines that can interact with lisinopril/hydrochlorothiazide. Always check with your healthcare provider.

Does Lisinopril/Hydrochlorothiazide interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much lisinopril/hydrochlorothiazide?

If you or someone else has used too much lisinopril/hydrochlorothiazide, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of lisinopril/hydrochlorothiazide?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.