Lisinopril and Hydrochlorothiazide

WHY is this medicine prescribed?

The combination of lisinopril and hydrochlorothiazide is used to treat high blood pressure. Lisinopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It works by decreasing certain chemicals that tighten the blood vessels, so blood flows more smoothly. Hydrochlorothiazide is in a class of medications called diuretics ('water pills'). It works by causing the kidneys to get rid of unneeded water and salt from the body into the urine.

High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation.

HOW should this medicine be used?

The combination of lisinopril and hydrochlorothiazide comes as a tablet to take by mouth. It is usually taken once a day with or without food. To help you remember to take lisinopril and hydrochlorothiazide, take it around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lisinopril and hydrochlorothiazide exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Lisinopril and hydrochlorothiazide controls high blood pressure but does not cure it. Continue to take lisinopril and hydrochlorothiazide even if you feel well. Do not stop taking lisinopril and hydrochlorothiazide without talking to your doctor.

Are there OTHER USES for this medicine?

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What SPECIAL PRECAUTIONS should I follow?

Before taking lisinopril and hydrochlorothiazide,

• tell your doctor and pharmacist if you are allergic to lisinopril; hydrochlorothiazide (HCTZ, Microzide, Oretic); angiotensin-converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec, in Vaseretic), fosinopril (Monopril), lisinopril (in Prinzide, in Zestoretic), moexipril (Univasc, in Uniretic), quinapril (Accupril, in Accuretic, in Quinaretic), ramipril (Altace), and trandolapril (Mavik, in Tarka); sulfa drugs; any other medications, or any ingredients in lisinopril and hydrochlorothiazide tablets. Ask your pharmacist for a list of the ingredients.
• tell your doctor or pharmacist if you are taking valsartan and sacubitril (Entresto) or if you have stopped taking it within the last 36 hours. Your doctor will probably tell you not to take lisinopril and hydrochlorothiazide, if you are also taking valsartan and sacubitril. Also, tell your doctor if you have diabetes and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take lisinopril and hydrochlorothiazide if you have diabetes and you are also taking aliskiren.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking lisinopril and hydrochlorothiazide. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• the following nonprescription products may interact with lisinopril and hydrochlorothiazide: aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn); potassium supplements. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking lisinopril and hydrochlorothiazide. Do not start any of these medications while taking lisinopril and hydrochlorothiazide without discussing with your healthcare provider.
• tell your doctor if you are on dialysis or are being treated with desensitization (a process to reduce your reaction to an allergen) and if you have or have ever had allergies; asthma; diabetes; gout; high cholesterol; collagen vascular disease such as lupus or scleroderma (a condition in which extra tissue grows on the skin and some organs); heart failure; any condition that causes you to urinate less than you normally do; a stroke or 'mini-stroke'; heart, kidney, or liver disease; or angioedema (condition that causes difficulty swallowing or breathing and painful swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs).
• tell your doctor if you are breast-feeding.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lisinopril and hydrochlorothiazide.
• ask your doctor about the safe use of alcoholic beverages while you are taking lisinopril and hydrochlorothiazide. Alcohol can make the side effects from lisinopril and hydrochlorothiazide worse.
• you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.
• you should know that lisinopril and hydrochlorothiazide may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking lisinopril and hydrochlorothiazide. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

What SPECIAL DIETARY instructions should I follow?

Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, or an exercise program, follow these directions carefully.

What should I do IF I FORGET to take a dose?

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Lisinopril and hydrochlorothiazide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness
• headache
• cough
• excessive tiredness
• pain, burning, or tingling in the hands or feet
• decrease in sexual ability
• heartburn

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• hoarseness
• difficulty breathing or swallowing
• stomach pain
• upset stomach
• vomiting
• fever, sore throat, chills, and other signs of infection
• muscle pain, cramps, or weakness
• yellowing of the skin or eyes
• dry mouth
• thirst
• weakness
• restlessness
• confusion
• seizures
• decrease in urination
• lightheadedness
• fainting
• chest pain
• rapid, pounding, slow, or irregular heartbeat
• pain in big toe
• tingling in arms and legs
• loss of muscle tone
• weakness or heaviness in legs
• lack of energy
• cold, gray skin

Lisinopril and hydrochlorothiazide may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location — one that is up and away and out of their sight and reach. https://www.upandaway.org

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include:

• lightheadedness
• fainting
• blurred vision
• dry mouth
• thirst
• weakness
• drowsiness
• restlessness
• confusion
• seizures
• muscle pains or cramps
• infrequent urination
• upset stomach
• vomiting
• rapid or pounding heartbeat

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your blood pressure should be checked regularly to determine your response to lisinopril and hydrochlorothiazide. Your doctor may order certain lab tests to check your body's response to lisinopril and hydrochlorothiazide.

Before having any laboratory test, tell your doctor and the laboratory personnel that you are taking lisinopril and hydrochlorothiazide.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: June 20, 2024.