Names and pronunciation
(lyse-in′oh-pril/hye-droe-klor-oh- thye′a-zide) Zestoretic
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Drug reference
(lyse-in′oh-pril/hye-droe-klor-oh- thye′a-zide) Zestoretic
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Func. class.: Antihypertensive, angiotensin-converting enzyme 1 (ACE) inhibitor/diuretic, thiazide
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Chem. class.: Enalaprilat lysine analog
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ACTION: Lisinopril: Competitive inhibitor of ACE; prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor; results in lower levels of angiotensin II, which causes an increase in plasma renin activity and a reduction in aldosterone secretion Hydrochlorothiazide: Inhibits sodium reabsorption in the distal tubules causing increased excretion of sodium, water, potassium
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USES: Hypertension not controlled by monotherapy
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CONTRAINDICATIONS: Hyper- sensitivity to lisinopril, hydrochlorothia- zide, sulfonamide-derived drugs, or any component, angioedema related to use with an ACE inhibitor; idiopathic/heredi- tary angioedema; use with aliskiren in patients with diabetes mellitus; coadmin- istration with or within 36 hr of switching to or from a neprilysin inhibitor (sacubi- tril); anuria
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Black Box Warning: Pregnancy Precautions: Breastfeeding, renal dis- ease, hyperkalemia, renal artery stenosis, HF, aortic stenosis Black Box Warning: Pregnancy/ breastfeeding: assess pregnancy, breastfeeding status before giving this product; if pregnant, do not use; do not breastfeed
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SIDE EFFECTS CNS: Vertigo, depression, insomnia, paresthesias, headache, fatigue, asthe- nia, dizziness CV: Chest pain, hypotension, sinus tachycardia EENT: Blurred vision, nasal congestion GI: Nausea, vomiting, anorexia, constipa- tion, flatulence, GI irritation, diarrhea GU: Sexual dysfunction, impotence INTEG: Rash, pruritus MISC: Muscle cramps, hyperkalemia, hypokalemia RESP: Dry cough, dyspnea
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INTERACTIONS Increase: hyperkalemia—potassium salt substitutes, potassium-sparing diuretics, potassium supplements, cycloSPORINE Increase: possible toxicity—lithium Increase: hypotensive effect—diuretics, other antihypertensives, probenecid, phenothiazines, nitrates, acute alcohol ingestion Increase: hypersensitivity—allopurinol Decrease: lisinopril effects—aspirin, indomethacin, NSAIDs; dose may need adjustment Drug/Food • High-potassium diet (bananas, orange juice, avocados, nuts, spinach) should be avoided; hyperkalemia may occur; moni- tor potassium levels Drug/Lab Test Interference: glucose/insulin tolerance tests, LFTs, BUN, creatinine NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Adult: PO Initial: lisinopril 10 mg/hydro- chlorothiazide 12.5 mg or lisinopril 20 mg/hydrochlorothiazide 12.5 mg daily in those not controlled on monotherapy; titrate dosage after 2 to 3 wk; max lisino- pril 80 mg/hydrochlorothiazide 50 mg per day
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Available forms: Tablets: 10/12.5: Lisinopril 10 mg and hydrochlorothia- zide 12.5 mg; 20/12.5: Lisinopril 20 mg and hydrochlorothiazide 12.5 mg; 20/25: Lisinopril 20 mg and hydrochlorothia- zide 25 mg
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Administer: • Without regard to food
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Assess: • Hypertension: B/P, pulse q4hr dur- ing beginning treatment and periodically; black patients should take in combina- tion with diuretics thereafter; note rate, rhythm, quality; apical/pedal pulse be- fore administration; notify prescriber of any significant changes • Baselines of renal, hepatic studies be- fore therapy begins, periodically; LFTs, uric acid, glucose may be increased • Angioedema, anaphylaxis, toxic epi- dermal necrolysis: facial swelling, dys- pnea, tongue swelling (rare); have emer- gency equipment nearby; may be more common in black patients • Electrolytes: potassium, sodium, chlo- rine
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Evaluate: • Therapeutic response: decreased B/P
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Patient and caregiver information: • Not to discontinue product abruptly; to taper • To rise slowly to sitting or standing posi- tion to minimize orthostatic hypotension • To avoid increasing potassium in the diet • To report dry cough Pregnancy/ Warning: Black Box breastfeeding: to report if pregnancy is planned or suspected; not to breastfeed L
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PHARMACOKINETICS Lisinopril: Onset 1 hr, peak 6-8 hr, duration 24 hr, excreted unchanged in urine, half-life 12 hr Hydrochlorothiazide: Onset 2 hr, peak 4 hr, duration 6-12 hr, half-life 5.6-14.8 hr
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