Hydrochlorothiazide + Lisinopril

Hypertension

Hypertension 10-80 mg lisinopril/6.25-50 mg hydrochlorothiazide PO qDay

Hypersensitivity to ACE inhibitors, thiazides, or sulfonamides ACE-inhibitor induced angioedema, hereditary or idiopathic angioedema Coadministration of neprilysin inhibitors (eg, sacubitril) with ACE inhibitors may increase angioedema risk; do not administer ACE inhibitors within 36 hr of switching to or from sacubitril/valsartan Anuria or renal stenosis Do not coadminister with aliskiren in patients with diabetes mellitus or with renal impairment (ie, GFR <60 mL/min/1.73 m²)

Begin combination therapy only after failed monotherapy Severe renal impairment, hepatic impairment Risk of hypotension, especially with CHF Angioedema of the face, extremities, lips, tongue, glottis, and larynx has been reported in patients treated with angiotensin-converting enzyme inhibitors If laryngeal stridor or angioedema of the face, tongue, or glottis occurs discontinue therapy and institute appropriate therapy immediately Patients receiving coadministration of ACE inhibitor and mTOR (mammalian target of rapamycin) inhibitor (e.g. temsirolimus, sirolimus, everolimus) therapy may be at increased risk for angioedema Intestinal angioedema has been reported in patients treated with ACE inhibitors Cholestatic jaundice may occur, which may progress to fulminant hepatic necrosis; discontinue is symptoms occur Dry hacking nonproductive cough may occur within few months of treatment; consider other causes of cough prior to discontinuation Hyperkalemia may occur with ACE inhibitors; risk factors include renal dysfunction, diabetes mellitus, and concomitant use of potassium sparing diuretics and potassium supplements; use cautiously if at all with these agents Thiazide diuretics may cause hypokalemia, hypochloremic alkalosis, hypomagnesemia, and hyponatremia Hydrochlorothiazide may precipitate gout in patients with familial predisposition to gout or chronic renal failure Symptomatic hypotension with or without syncope can occur with ACE inhibitors; mostly observed in volume depleted patients, correct volume depletion prior to initiation; monitor closely when initiating and increasing dosing Agranulocytosis, neutropenia, or leukopenia with myeloid hypoplasia reported with other ACE inhibitor; patients with renal impairment are at high risk; monitor CBC with differential in these patients Photosensitization may occur Hydrochlorothiazide may cause acute transient myopia and acute angle-closure glaucoma that may occur within hours of initiating therapy; disc

D Pregnancy category: D Lactation: Discontinue drug or do not nurse

>10% Lisinopril Dizziness (5-12%) 1-10% Lisinopril Cough (4-9%) Headache (4-6%) Hyperkalemia (2-5%) Diarrhea (3-4%) Hypotension (1-4%) Chest pain (3%) Fatigue (3%) Nausea/vomiting (2%) Rash (1-2%) Psoriasis (frequency unknown) Hydrochlorothiazide Hypotension Anorexia Epigastric distress Hypokalemia Phototoxicity