Zestoretic

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Mar 20, 2023

Warnings

Zestoretic Risks, Warnings, and Complications

Zestoretic (lisinopril and hydrochlorothiazide) can cause serious health problems in some people. Talk to your doctor or pharmacist about other treatment options for high blood pressure if you are at increased risk of complications from this medication combination. Some of the risks of taking Zestoretic include:

RISK DURING PREGNANCY: Zestoretic should not be used by pregnant women because it can cause severe harm to an unborn baby. Before starting this medication, tell your doctor if you are pregnant. Stop taking Zestoretic and call your doctor immediately if you become pregnant while on the medicine.
ANGIOEDEMA: Zestoretic contains an ACE inhibitor (lisinopril). Rarely, ACE inhibitors can cause a severe allergic reaction called angioedema with swelling of the face, lips, tongue, throat, hands, lower legs, ankles, feet, or other parts of the body. Swelling in the head and neck region can be life-threatening because it can affect breathing. Angioedema can happen at any time while taking Zestoretic. Black people are at higher risk of this complication. Seek emergency medical attention if you develop swelling or difficulty breathing.
ORTHOSTATIC HYPOTENSION : Taking Zestoretic (lisinopril and hydrochlorothiazide) can sometimes lead to a drop in blood pressure. Low blood pressure can cause dizziness, lightheadedness, headache, and tiredness. This is more likely to happen when you first start the medicine and after dose adjustments. Other risk factors include dehydration, diarrhea, vomiting, low salt levels, and taking high dose diuretic therapy. Stay well hydrated while on Zestoretic. Arise slowly from a sitting or lying position to avoid falls. Tell your doctor if you experience dizziness, lightheadedness, fainting, tiredness, or confusion while on this medicine.
RENAL DAMAGE: Zestoretic can cause kidney damage and renal impairment (reduced kidney function) in a small number of people. The risk is higher in people who have pre-existing kidney problems such as renal artery stenosis, severe heart failure, or heart valve problems. The risk is also greater if you are taking other medications that can damage the kidneys. Your healthcare provider might order certain lab tests to keep an eye on renal function. You may need to stop taking this medicine if you develop kidney problems. Tell your doctor if you develop decreased urination while on Zestoretic.
FLUID AND ELECTROLYTE IMBALANCE: Zestoretic can affect electrolyte levels in the body, including serum potassium, serum calcium, serum sodium, and serum magnesium. Your healthcare provider might order regular blood tests while you are taking this medication to keep an eye on your electrolytes. Tell your doctor if you develop signs and symptoms such as fast or pounding heartbeat, fatigue, low energy, weakness, muscle pain or cramps, decreased urination, nausea, or vomiting.
CHANGES IN BLOOD SUGAR AND CHOLESTEROL LEVELS: Zestoretic can cause changes in blood sugar and cholesterol levels. Keep all your healthcare appointments during treatment with this medication. Your healthcare provider might want to check blood sugar and cholesterol levels regularly during treatment.
VISION PROBLEMS: Rarely, hydrochlorothiazide in Zestoretic can lead to vision problems. This can happen within hours or several weeks after starting the medicine. Stop taking Zestoretic and tell your doctor right away if you develop any eye pain or vision changes while on this medicine. The risk is higher in people who have an allergy to sulfa drugs or penicillin.
NEW OR WORSENING LUPUS: Very rarely, Zestoretic (lisinopril and hydrochlorothiazide) has been found to cause or worsen systemic lupus erythematosus (SLE). Tell your doctor if you develop tiredness or a rash on your cheeks.

Precautions Before Starting Zestoretic

Tell your doctor if you have ever had an allergic reaction to lisinopril (Prinivil, Zestril), hydrochlorothiazide (Microzide), other ACE inhibitors (benazepril, enalapril, captopril, perindopril, fosinopril, moexipril, ramipril, quinapril, or trandolapril), any of the active or inactive ingredients in Zestoretic, sulfa drugs, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, non-prescription medicines, vitamins, supplements, and herbal products. This can help avoid possible interactions between Zestoretic (lisinopril and hydrochlorothiazide) and your other drugs.

Specifically, tell your doctor if you are taking or have taken within the past 36 hours a medication called Entresto (valsartan and sacubitril). Also, tell your provider if you have diabetes and take aliskiren (Tekturna, Tekturna HCT, Tekamlo, in Amturnide). You should not take Zestoretic (lisinopril and hydrochlorothiazide) if you are on these drugs.

Give your doctor a complete medical history. Zestoretic may not be right for people with certain medical conditions such as diabetes, high cholesterol, gout, collagen vascular disease such as scleroderma or lupus, heart failure, conditions that cause decreased urination, stroke or mini stroke, heart disease, kidney disease, liver disease, or angioedema. Also tell your doctor if you are undergoing dialysis or desensitization treatment for allergies.

Tell your doctor if you are pregnant, could be pregnant, planning a pregnancy, or breast feeding.

Precautions During Use of Zestoretic

Keep all your healthcare appointments while taking Zestoretic (lisinopril and hydrochlorothiazide). Your doctor may want to check your clinical response to the medication and adjust your dose based on your blood pressure readings. They may order certain lab tests to check for reduced renal function or electrolyte imbalance.

Avoid drinking alcohol while on this medication. Alcohol can make side effects like dizziness and drowsiness worse.

Seek timely medical care if you develop diarrhea or vomiting or if you have excessive sweating or are not drinking enough fluids. These conditions can cause dehydration, which can cause low blood pressure, dizziness, and lightheadedness while on lisinopril and hydrochlorothiazide.

Get up slowly from a sitting or lying position to avoid dizziness and falls.

Tell your doctor if you become pregnant while on Zestoretic.

Make sure all your healthcare providers know you are on Zestoretic before any surgical procedure, including dental procedures.

Zestoretic Drug Interactions

Certain other drugs can affect how Zestoretic (lisinopril and hydrochlorothiazide) work. Possible interactions between Zestoretic and other medicines can increase the risk of severe adverse effects. Some of the medications that can have interactions with this combination of blood pressure medicines include:

Entresto (sacubitril and valsartan)
Aliskiren
Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and indomethacin (Indocin)
Cholesterol-lowering medications such as colestipol (Colestid) and cholestyramine (Prevalite)
Barbiturates such as phenobarbital (Luminal)
Heart medications like digoxin (Lanoxin)
Oral diabetes medications and insulin
Oral steroids such as methylprednisolone (Medrol), dexamethasone, and prednisone (Rayos)
Psychiatric medications such as lithium (Lithobid)
Other medications used to treat high blood pressure
Other diuretics, including potassium sparing diuretics
Pain medications
Potassium supplements
Salt substitutes

The above list may not contain all the possible interactions of lisinopril and hydrochlorothiazide. Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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