Zestoretic

Zestoretic is used for lowering high blood pressure.

Product dosage: 17.5mg
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Synonyms Prinizide Lisihexal

Zestoretic is a prescription medication combining two antihypertensive agents, lisinopril and hydrochlorothiazide, into a single tablet for the management of hypertension. This fixed-dose combination therapy is designed for patients whose blood pressure is not adequately controlled on monotherapy. It leverages the complementary mechanisms of an ACE inhibitor and a thiazide diuretic to provide synergistic effects on blood pressure reduction, simplifying treatment regimens and potentially improving adherence. This comprehensive profile details its pharmacological characteristics, clinical application, and essential safety information for healthcare professionals.

Features

• Fixed-dose combination of lisinopril (an ACE inhibitor) and hydrochlorothiazide (a thiazide diuretic).
• Available in multiple strength combinations (e.g., lisinopril 10 mg / HCTZ 12.5 mg, lisinopril 20 mg / HCTZ 12.5 mg, lisinopril 20 mg / HCTZ 25 mg).
• Oral tablet formulation for once-daily administration.
• Works on the renin-angiotensin-aldosterone system (RAAS) and promotes diuresis.
• Manufactured under strict pharmaceutical quality control standards.

Benefits

• Provides superior blood pressure reduction compared to either component alone, offering a synergistic therapeutic effect.
• Simplifies the treatment regimen by reducing pill burden, which can significantly enhance patient compliance and persistence.
• Offers a rational and evidence-based approach for patients who require multiple agents to achieve their target blood pressure goals.
• May be more cost-effective for patients compared to purchasing two separate medications.
• The dual mechanism addresses multiple pathways involved in hypertension pathophysiology.

Common use

Zestoretic is indicated for the treatment of hypertension. It is not indicated for initial therapy. Its use is appropriate for patients in whom the combination represents the dose titrated to an individual patient’s needs. Therapy should be initiated only after a patient has failed to achieve the desired blood pressure control with either lisinopril or hydrochlorothiazide monotherapy, or when dose titration of one component is limited by side effects. The choice of Zestoretic as a combination product should be individualized based on the patient’s response to its individual components.

Dosage and direction

Dosage is determined by the individual titration of its components. The recommended starting dose is based on the patient’s current monotherapy regimen. For example, a patient stabilized on lisinopril 10 mg but requiring additional blood pressure control may be switched to Zestoretic 10-12.5 (lisinopril 10 mg / hydrochlorothiazide 12.5 mg). The dosage may be adjusted every 2 to 3 weeks based on patient response. The maximum recommended daily dose is lisinopril 80 mg / hydrochlorothiazide 50 mg. It is typically administered once daily, with or without food. Dose adjustment is required in patients with renal impairment; it is contraindicated in patients with anuria.

Precautions

Pregnancy: Drugs that act directly on the RAAS can cause injury and death to the developing fetus. Discontinue Zestoretic as soon as pregnancy is detected. Hypotension: Symptomatic hypotension may occur, particularly in volume-depleted patients (e.g., those on diuretic therapy, with dietary salt restriction, or with diarrhea/vomiting). Correct volume depletion prior to administration. Impaired Renal Function: Monitor renal function periodically. Risk of oliguria, progressive azotemia, and acute renal failure, especially in patients with renal artery stenosis, heart failure, or volume depletion. Hyperkalemia: Elevations in serum potassium may occur. Risk factors include renal insufficiency, diabetes, and concomitant use of potassium-sparing diuretics or potassium supplements. Hypokalemia: Hydrochlorothiazide can cause hypokalemia. Monitor serum electrolytes periodically. Other Metabolic Effects: Thiazides may alter serum calcium, uric acid, glucose, magnesium, and cholesterol levels. Monitor patients with gout or diabetes closely. Cough: A persistent, non-productive cough has been reported with ACE inhibitors. Surgery/Anesthesia: ACE inhibitors may blunt the hypotensive effects of anesthesia.

Contraindications

• Known hypersensitivity to lisinopril, hydrochlorothiazide, or any other sulfonamide-derived drugs.
• History of angioedema related to previous ACE inhibitor therapy.
• Hereditary or idiopathic angioedema.
• Anuria.
• Concomitant use with aliskiren in patients with diabetes.

Possible side effect

Common side effects may include dizziness, headache, fatigue, cough, and orthostatic hypotension. Other reported side effects include:

• Gastrointestinal: Nausea, diarrhea, upset stomach.
• Metabolic: Hyperkalemia, hypokalemia, hyponatremia, hypercalcemia, hyperglycemia, hyperuricemia.
• Dermatological: Rash, photosensitivity.
• Neurological: Vertigo, paresthesia.
• Renal: Deterioration in renal function, especially in susceptible individuals.
• Other: Impotence, asthenia (weakness).

Serious but rare side effects include angioedema (swelling of the face, lips, tongue, or larynx), which requires immediate medical attention, pancreatitis, jaundice, blood dyscrasias (e.g., neutropenia, agranulocytosis), and severe skin reactions.

Drug interaction

Zestoretic has the potential for significant interactions:

• Diuretics: Concomitant use with other diuretics may potentiate the hypotensive effect and increase the risk of volume depletion.
• Lithium: Increased risk of lithium toxicity; monitor lithium levels closely.
• NSAIDs: May reduce the antihypertensive effect of Zestoretic and increase the risk of renal impairment.
• Potassium-Sparing Diuretics/Potassium Supplements/Salt Substitutes: Increase the risk of hyperkalemia.
• Antidiabetic Agents: Thiazides may decrease the effectiveness of insulin and oral hypoglycemic agents.
• Gold: Nitritoid reactions (flushing, nausea, hypotension) have been reported with injectable gold (sodium aurothiomalate) and ACE inhibitors.
• Alcohol, Barbiturates, or Narcotics: May potentiate orthostatic hypotension.
• Corticosteroids, ACTH: Intensify electrolyte depletion, particularly hypokalemia.
• Pressor Amines (e.g., norepinephrine): Possible decreased response to pressor amines, though not sufficient to preclude their use.
• Skeletal Muscle Relaxants (e.g., tubocurarine): Possible increased responsiveness to the muscle relaxant.
• Aliskiren: Do not use concomitantly in patients with diabetes.

Missed dose

If a dose is missed, it should be taken as soon as possible on the same day. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. The patient should not take a double dose to make up for the missed one. Maintaining a consistent daily schedule is important for optimal blood pressure control.

Overdose

The most likely manifestation of an overdose is hypotension, which can be severe. Other signs may include electrolyte imbalances (hypokalemia, hyponatremia), dehydration due to profound diuresis, and renal failure with oliguria. Lisinopril overdose may lead to bradycardia. Supportive measures are the mainstay of treatment. These include intravenous fluids and normal saline to correct hypotension and volume depletion. Gastric lavage or activated charcoal may be considered if ingestion was recent. Lisinopril may be removed from the body by hemodialysis. Serum electrolytes and creatinine should be monitored closely. Treatment should be symptomatic and supportive.

Storage

Store Zestoretic tablets at controlled room temperature, 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C and 30°C (59°F and 86°F). Keep the medication in its original container, tightly closed, and out of reach of children. Protect from excessive moisture and light. Do not store in the bathroom. Properly discard any medication that is outdated or no longer needed.

Disclaimer

This information is intended for educational purposes and for use by healthcare professionals. It is a summary and does not include all possible information about this product. It does not constitute medical advice. It is essential to read the full manufacturer’s prescribing information before initiating therapy. The safe and effective use of Zestoretic requires a prescription and must be determined by a qualified healthcare provider based on an individual patient’s medical history, current condition, and other factors. Patients must be instructed not to adjust their dose or stop taking this medication without first consulting their physician.

Reviews

(Note: As a prescription drug, formal “reviews” are derived from clinical trial data and post-marketing surveillance, not consumer websites.) Zestoretic has been extensively studied in clinical trials, which demonstrate its efficacy in significantly reducing both systolic and diastolic blood pressure in a broad range of hypertensive patients. The combination is consistently shown to be more effective than either monocomponent alone. In clinical practice, it is regarded as a valuable therapeutic option for patients requiring a second agent, offering the convenience of a single-tablet regimen. The side effect profile is generally predictable based on the known effects of its components, with dizziness and cough being among the more commonly reported adverse reactions. Its use is well-established in hypertension treatment guidelines as an effective strategy for achieving blood pressure targets.