Zestoretic represents a cornerstone in modern antihypertensive therapy, combining two well-established active ingredients into a single, convenient formulation. This fixed-dose combination product contains lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, and hydrochlorothiazide, a thiazide diuretic, working synergistically to address multiple pathways in blood pressure regulation. Clinically proven to provide superior blood pressure reduction compared to monotherapy, Zestoretic offers healthcare providers an effective tool for managing moderate to severe hypertension while potentially improving medication adherence through simplified dosing regimens. The combination mechanism targets both the renin-angiotensin-aldosterone system and volume overload, making it particularly valuable for patients requiring multi-mechanism intervention.

Features

• Contains lisinopril (ACE inhibitor) and hydrochlorothiazide (thiazide diuretic) in fixed-dose combinations
• Available in multiple strength variations: 10/12.5 mg, 20/12.5 mg, and 20/25 mg tablets
• Once-daily dosing regimen for improved patient compliance
• Bioequivalent to co-administered individual components
• Film-coated tablets for ease of swallowing
• Stable at room temperature with standard storage conditions

Benefits

• Provides synergistic blood pressure reduction through dual mechanism of action
• Demonstrates superior efficacy compared to monotherapy in clinical trials
• Reduces pill burden through fixed-dose combination therapy
• May improve medication adherence through simplified dosing schedule
• Offers flexible dosing options to accommodate individual patient needs
• Cost-effective alternative to prescribing separate medications

Common use

Zestoretic is indicated for the treatment of hypertension in patients for whom combination therapy is appropriate. This medication is typically prescribed when blood pressure remains uncontrolled on monotherapy with either an ACE inhibitor or thiazide diuretic, or when clinical assessment suggests that multiple mechanisms of action are required to achieve target blood pressure goals. The combination is particularly useful in patients with volume overload components to their hypertension or those who demonstrate an inadequate response to single-agent therapy. Clinical guidelines support the use of such combinations as second-line therapy or as initial treatment for patients with significantly elevated blood pressure.

Dosage and direction

The dosage of Zestoretic must be individualized based on patient response and tolerability. Therapy should generally be initiated with the 10/12.5 mg formulation once daily. Dosage may be increased after 2-3 weeks of therapy based on blood pressure response. The maximum recommended daily dose is 80 mg lisinopril and 50 mg hydrochlorothiazide. Tablets should be taken orally, with or without food, at approximately the same time each day. Dose titration should be performed cautiously in patients with renal impairment or those taking diuretics. Healthcare providers should consider the individual components’ dosing when adjusting therapy.

Precautions

Patients should be monitored regularly for blood pressure response, renal function, and electrolyte levels, particularly during initial therapy and following dosage adjustments. Caution is advised in patients with impaired renal function, hepatic disease, or diabetes. Potassium levels should be monitored periodically due to the potential for hyperkalemia (from lisinopril) and hypokalemia (from hydrochlorothiazide). Patients should be advised to avoid potassium supplements or salt substitutes containing potassium unless specifically recommended by their physician. Adequate hydration should be maintained, especially during hot weather or vigorous exercise.

Contraindications

Zestoretic is contraindicated in patients with known hypersensitivity to any component of this product or other sulfonamide-derived drugs. Additional contraindications include history of angioedema related to previous ACE inhibitor therapy, anuria, and coadministration with aliskiren in patients with diabetes. The medication is contraindicated during pregnancy due to potential fetal harm, particularly during the second and third trimesters. Patients with bilateral renal artery stenosis or solitary kidney with renal artery stenosis should not receive this combination therapy.

Possible side effects

Common adverse reactions may include dizziness (6.5%), headache (5.2%), cough (3.9%), fatigue (3.0%), and orthostatic effects (2.4%). Less frequent but potentially serious side effects include angioedema (0.1%), which requires immediate medical attention, and symptomatic hypotension. Metabolic effects may include hyperuricemia, gout, hyperglycemia, and electrolyte imbalances such as hypokalemia, hyponatremia, and hypomagnesemia. Renal function impairment may occur, particularly in volume-depleted patients or those with pre-existing renal disease. Rare cases of pancreatitis, hepatic impairment, and blood dyscrasias have been reported.

Drug interaction

Zestoretic may interact with several medication classes. Concomitant use with other antihypertensive agents may potentiate blood pressure-lowering effects. Nonsteroidal anti-inflammatory drugs may reduce the antihypertensive efficacy and increase renal impairment risk. Lithium levels may increase due to reduced renal clearance. Diabetic patients requiring insulin or oral hypoglycemics may need dosage adjustments. Potassium-sparing diuretics or potassium supplements may increase hyperkalemia risk. Alcohol, barbiturates, or narcotics may potentiate orthostatic hypotension. The thiazide component may increase responsiveness to nondepolarizing muscle relaxants.

Missed dose

If a dose is missed, it should be taken as soon as remembered on the same day. However, if it is nearly time for the next scheduled dose, the missed dose should be skipped, and the regular dosing schedule resumed. Patients should not double the dose to make up for a missed tablet. Consistent daily administration is important for maintaining stable blood pressure control. Healthcare providers should educate patients about the importance of adherence while providing guidance on managing occasional missed doses without compromising safety.

Overdose

Symptoms of overdose may include severe hypotension, electrolyte disturbances, dehydration, and renal impairment. Bradycardia, tachycardia, and circulatory shock may occur in severe cases. Management involves supportive care with volume expansion with normal saline for hypotension. Gastric lavage may be considered if ingestion was recent. Hemodialysis may be effective for removing lisinopril but is less effective for hydrochlorothiazide removal. Serum electrolytes and creatinine should be monitored closely, and appropriate corrective measures implemented based on clinical findings. Symptomatic treatment should be provided for specific manifestations.

Storage

Store at controlled room temperature between 20°C to 25°C (68°F to 77°F), with excursions permitted between 15°C to 30°C (59°F to 86°F). Keep container tightly closed and protect from moisture and light. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Tablets should be kept in their original container with the desiccant provided to maintain stability. Do not transfer to other containers that may not provide adequate protection from moisture.

Disclaimer

This information is provided for educational purposes only and does not constitute medical advice. Healthcare professionals should consult full prescribing information before initiating therapy. Patients should not make changes to their medication regimen without consulting their physician. Individual response to therapy may vary, and appropriate medical supervision is essential throughout treatment. The safety and efficacy in pediatric patients have not been established. Regular monitoring and follow-up with healthcare providers are necessary for safe and effective use.

Reviews

Clinical studies demonstrate that Zestoretic provides effective blood pressure control in approximately 70-80% of patients with moderate hypertension. In comparative trials, the combination therapy showed significantly greater blood pressure reduction than either component alone. Patient satisfaction surveys indicate improved adherence rates with fixed-dose combinations compared to free combinations. Healthcare providers report the convenience of dose titration and the pharmacological synergy make this combination valuable in clinical practice. Long-term outcome studies suggest consistent blood pressure control contributes to reduced cardiovascular risk profiles.