Zestril (lisinopril)

Indications

Zestril is indicated for the treatment of three conditions, namely, hypertension, heart failure, and to increase survival chances after a heart attack. It may be used in combination with other drugs as part of a treatment regimen.

1. Zestril is indicated for use to treat hypertension in adults and children over six years of age. Lowering the blood pressure reduces the risk of heart attack, stroke, and other vascular events. For maximum benefit, blood pressure medication should be part of a comprehensive risk management regime that, where necessary, includes cholesterol control, diabetes management, anti-clotting medication, stopping smoking, an exercise program, and limiting salt intake. Most patients will need more than one drug alone to achieve good blood pressure control. Raised systolic pressure increases cardiovascular risk and even a modest reduction can give substantial benefits. Zestril can be used on its own or with other blood pressure medications.
2. Zestril is also used to reduce signs and symptoms of systolic heart failure.
3. This drug is also sometimes used to reduce the mortality risk in cases of a sudden heart attack. It is most effective if given within 24 hours of the heart attack. As appropriate, such patients are also given other recommended treatments such as anti-clotting medications and beta-blockers.

Dosage & Administration

Your doctor will decide on an appropriate dose depending on your age, the condition that’s being treated, your weight, and other medications you may be on along with other medical conditions.

Zestril comes in oral tablet form in strengths of 2,5 mg, 5 mg, 10 mg, 20 mg, 30 mg, and 40 mg.

For hypertension

Adult (18 to 64 years) dosage for high blood pressure: Starting dosage is usually 10 mg once a day which is usually increased to 20-40 mg once a day. The maximum dosage is 80 mg once a day.

Children (6-17 years) starting dosage is 0.07 mg/kg of body weight to a maximum of 5 mg once a day. Adjustments will be made according to the response. The maximum dosage is 0.61 mg/kg of body weight to a maximum of 40 mg once a day.

This medication hasn’t been studied in children under six years old and should not be used in this age group.

Senior (65 years and older) Although there are no specific recommendations for senior dosages, the doctor will bear in mind that seniors may metabolize drugs more slowly so may need lower dosages or different schedules.

For heart failure

Adult (18 to 64 years) dosage for heart failure: Starting dosage is usually 5 mg once a day to a maximum of 40 mg once a day.

Children (6-17 years) This drug has not been studied for heart failure in children under 18 years and should not be used.

Senior (65 years and older) As for hypertension, although there are no specific recommendations for senior dosages, the doctor will bear in mind that seniors may metabolize drugs more slowly so may need lower dosages or different schedules.

For heart attack (acute myocardial infarction)

Adult (18 to 64 years) dosage for heart attack is 5 mg orally within the first 24 hours of the symptoms. Another 5 mg is given after 24 hours. Thereafter, 10 mg is given 48 hours after the myocardial infarction and 10 mg once a day for six weeks.

Children under 18 – this medication hasn’t been studied in this age group for heart attack and should not be used.

Senior (65 years and older) Although there are no specific recommendations for senior dosages, the doctor will bear in mind that seniors may metabolize drugs more slowly so may need lower dosages or different schedules.

Special dosage considerations

In cases of heart failure, if low blood sodium levels are present, the starting dose might be 2.5 mg once a day.

In cases of myocardial infarction, if the patient has low blood pressure, the starting dose might be 2.5 mg once a day for the first three days.

Warnings and Special Precautions

• Zestril must be taken as directed. It is formulated for long-term treatment and comes with serious risks if it is not taken as prescribed.
• If it is not taken after being prescribed, your blood pressure will remain elevated, increasing the risk of a stroke or heart attack.
• If it is stopped suddenly after starting, the blood pressure might spike, causing sweating, anxiety, and a rapid heart rate.
• If the drug is not taken regularly on schedule, your blood pressure will not be well managed. It is important to take it at the same time every day.
• The tablet may be crushed or cut.

How to Identify the Different Zestril Tablets

Here is a list of the different dosage forms and strengths, and how to identify Zestril tablets:

• 2,5 mg tabs are white, round, biconvex, and uncoated. On the one side is stamped “ZESTRIL 2 ½” and on the other “135”.
• 5 mg tabs are pink, capsule-shaped, biconvex, bisected, and uncoated. On the one side is stamped “ZESTRIL” and on the other “130”.
• 10 mg tabs are pink, round, biconvex, and uncoated. On the one side is stamped “ZESTRIL 10” and on the other “131”.
• 20 mg are pale brownish-red, round, biconvex, and uncoated. On the one side is stamped “ZESTRIL 20” and on the other “132”.
• 30 mg are also pale brownish-red, round, biconvex, and uncoated. On the one side is stamped “ZESTRIL 30” and on the other “133”.
• 40 mg tabs are yellow, round, biconvex, and uncoated. They have “ZESTRIL 40” stamped on one side and “134” on the other.

Contraindications

• Zestril is contraindicated in combination with neprilysin inhibitors.
• History of angioedema or hypersensitivity related to previous treatment with an angiotensin-converting enzyme inhibitor.
• Diabetic patients must not be given aliskiren with Zestril
• Contraindicated in pregnancy due to fetal toxicity

How Does it Work?

Zestril (lisinopril) is an angiotensin-converting enzyme (ACE) inhibitor. It relaxes the blood vessels in the body, thereby reducing stress on the heart and decreasing blood pressure.

How Should Zestril be Taken?

Zestril should be taken once a day in the dose recommended by your doctor at the same time every day. It may be taken with or without food. The tablets may be swallowed whole or crushed.

Storage & Traveling

• Store the tablets in their original labeled, airtight container.
• Store the medication between 59 and 86 ºF (15 and 30ºC)
• Store them in a dry place
• When traveling, always keep the tablets in your carry-on luggage. Airport security may want to see the original prescription-labeled container so always keep the tablets in this. Do not leave this medication in a vehicle as it will be exposed to extremes of temperature.

Side Effects

Adverse Reactions

Common adverse reactions include

• Headache
• Dizziness
• Cough
• Hypotension (low blood pressure)
• Chest pain

Report suspected adverse reactions to Almatica Pharma LLC at 877-447-7979 or to the FDA at 1-800-FDA-1088 or www.fda.gov/medwatch

Mild Side Effects

• Zestril may cause low blood pressure which can cause faintness or dizziness. Patients should not drive or use machinery until they know how the medication affects them.
• Headache
• Persistent cough
• Chest pain

Serious Side Effects

Any of the above are considered serious if they do not resolve after a few weeks. Call your doctor or 911 if you experience serious side effects.

• Allergic reaction with symptoms such as swelling of face, lips, tongue, or throat; difficulty breathing, difficulty swallowing; abdominal pain; nausea and vomiting
• Kidney problems with symptoms including tiredness; swelling of hands, feet, and ankles; shortness of breath
• Liver failure with symptoms including yellowing of the skin, yellowing of the whites of the eyes, raised liver enzymes on blood tests, abdominal pain, nausea, and vomiting.
• High potassium levels lead to arrhythmia. The risk of this is higher in diabetics or those with kidney disease.
• These are not all the possible side effects of ZESTRIL. For more information, ask your doctor or pharmacist. Please report serious side effects of prescription drugs to the FDA. Visit fda.gov/medwatch or call 1-800-FDA-1088.

Warnings & Special Precautions

• Zestril can cause harm to the unborn fetus if given to pregnant women. Medications that act on the renin-angiotensin system when given in the second and third trimesters reduce fetal renal functioning. Zestril must be discontinued as soon as pregnancy is discovered.
• It is unknown whether this medication passes into the breastmilk. It should be used with caution or not at all in breastfeeding women.
• Zestril must be used with caution in patients with kidney disease or who are on dialysis.
• Zestril can affect blood sugar levels in diabetics. The diabetes medication doses may need to be adjusted and blood sugar levels closely monitored.
• Zestril has a more limited blood-pressure-lowering effect on Black patients.

Contraindications

• Pregnancy
• Angioedema
• Hypersensitivity

Interactions

Zestril can interact with other medications including herbal or vitamin preparations. Make sure your doctor is aware of anything else you’re taking. A list of some drugs that interact with Zestril is as follows:

• Blood pressure medications: angiotensin receptor blockers such as candesartan, irbesartan, losartan, valsartan; angiotensin-converting enzyme inhibitors such as benazepril, captopril, enalapril; renin inhibitors such as aliskiren.
• Diabetes medications: All insulins and oral diabetes drugs such as metformin can lower blood sugar too much in combination with Zestril.
• Diuretics: Taking these with Zestril can drop the blood pressure too low. These drugs include hydrochlorothiazide, furosemide and bumetanide.
• Potassium supplements: These include spironolactone, amiloride, and triamterene
• Mood stabilizers: Lithium’s effects are increased by Zestril
• Analgesics: Taking some analgesics together with Zestril can decrease kidney function. These include nonsteroidal anti-inflammatories like ibuprofen and diclofenac
• Drugs to prevent organ transplant rejection: Taking these with Zestril increases the risk of angioedema. These drugs include temsirolimus and everolimus.
• Injectable gold: Using these preparations with Zestril increases the risk of a nitritoid reaction. Symptoms include facial flushing, nausea, and low blood pressure.
• Neprilysin inhibitors: These heart failure drugs, for instance, sacubitril, should not be used with Zestril as using them together increases the risk of angioedema.

Frequently Asked Questions