This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Lisinopril with hydrochlorothiazide oral


Oral formulations of lisinopril and hydrochlorothiazide.

Drugs List

  • lisinopril 10mg and hydrochlorothiazide 12.5mg tablets
  • lisinopril 20mg and hydrochlorothiazide 12.5mg tablets
  • LISORETIC 10mg+12.5mg tablets
  • LISORETIC 20mg+12.5mg tablets
  • ZESTORETIC 10 tablets
  • ZESTORETIC 20 tablets
  • Therapeutic Indications


    Mild to moderate hypertension when stabilised on same ingreds./proportions


    Patients should be stabilised on the individual components in the same proportions before commencing treatment with the lisinopril/hydrochlorothiazide combination product.


    The usual recommended dose is one tablet once daily of the 10mg/12.5mg or the 20mg/12.5mg strength, depending on the dosage of individual components used. If the desired therapeutic effect is not achieved within 2 to 4 weeks, the dose may be increased to two tablets once daily.

    Patients with Renal Impairment

    In patients with creatinine clearance of 30 to 80ml/minute lisinopril/hydrochlorothiazide may be used but only after titration of the individual components. Lisinopril/hydrochlorothiazide should not be used as initial therapy in any patient with renal impairment.

    Additional Dosage Information

    Symptomatic hypotension may occur following the initial dose of lisinopril/hydrochlorothiazide. This is more likely in patients who are volume and/or salt depleted as a result of prior diuretic treatment. The manufacturers recommend if possible the diuretic should be discontinued 2 to 3 days before starting treatment, and if this is not possible treatment should be started with lisinopril alone at a dose of 2.5mg to 5mg. Alternatively, if high-dose diuretic therapy cannot be stopped, close observation is recommended for at least 2 hours or until blood pressure has stabilised.


    Children under 18 years
    Within 36 hours of discontinuing a sacubitril containing product
    Addison's disease
    Haemodialysis with high flux membranes
    Hereditary angioneurotic oedema
    Idiopathic angioneurotic oedema
    Kidney transplantation
    Renal impairment - creatinine clearance below 30 ml/minute
    Severe hepatic impairment
    Symptomatic hyperuricaemia

    Precautions and Warnings

    Desensitisation therapy
    Females of childbearing potential
    History of allergies including anaphylaxis
    Aortic stenosis
    Cardiac failure
    Cerebral ischaemia
    Collagen vascular disease
    Diabetes mellitus
    Electrolyte imbalance
    Hepatic cirrhosis
    Hepatic impairment
    History of angioedema
    History of skin cancer
    Hypertrophic cardiomyopathy
    Ischaemic heart disease
    Left ventricular outflow obstruction
    Mitral stenosis
    Nephrotic syndrome
    Peripheral vascular disease
    Progressive hepatic disorder
    Renal artery stenosis
    Renal impairment - creatinine clearance 30-80ml/minute
    Renovascular disorder
    Severe renin-dependent hypertension
    Systemic lupus erythematosus

    Adjustment of hypoglycaemic therapy may be necessary in diabetes mellitus
    Anaesthetist should be made aware patient is taking this medication
    Advise ability to drive/operate machinery may be affected by side effects
    Afro-Caribbean or black patients may show reduced response
    Exclude renovascular disorder before treatment
    Indigestion remedies should not be taken at the same time
    Place patient in supine position if severe hypotension occurs
    Evaluate renal function before and during treatment
    Monitor serum electrolytes before and during treatment
    Consider dose reduction if BUN and serum creatinine rise during treatment
    Consider monitoring white blood cell counts in collagen vascular disease
    Monitor patients with existing or tendency towards diabetes mellitus
    Monitor patients with renovascular disease
    Advise patient of increased risk of non-melanoma skin cancer
    Advise patient to monitor for and report any skin changes
    Advise patient to report symptoms of infection immediately
    Excess consumption of liquorice may increase the risk of hypokalaemia
    Higher incidence of angioedema in black patients
    Increased risk of hyperkalaemia with K+ suppl. and K+ sparing diuretic
    May cause anaphylactic / anaphylactoid reactions
    May precipitate gout
    Withdraw and consider hyperparathyroidism if frank hypercalcaemia develops
    Discontinue before parathyroid function tests
    May affect results of some laboratory tests
    Withdraw before apheresis
    Withdraw before desensitisation
    Advise patient to seek advice at first indications of pregnancy
    Discontinue if jaundice or other evidence of hepatic impairment occurs
    Discontinue if laryngeal stridor/angioedema of face/tongue or glottis
    Discontinue if symptoms of acute angle closure glaucoma occur
    Advise patient not to take NSAIDs unless advised by clinician
    Hypotensive effect enhanced by alcohol
    Advise on problems of salt substitutes/high intake of potassium-rich food
    Female: Ensure adequate contraception during treatment
    Advise pt. to minimise exposure to sunlight & avoid sunlamps during therapy

    First dose hypotension: Very rapid falls in blood pressure may occur especially in patients taking high doses of diuretics, on a low salt diet, on dialysis, dehydrated, have diarrhoea/vomiting, have severe renin-dependant hypertension and with heart failure. First dose hypotension is rarely seen in uncomplicated hypertensive patients but is more likely in the presence of fluid or electrolyte imbalance (e.g. hypovolaemia, hyponatraemia, hypochloraemic alkalosis, hypomagnesaemia or hypokalaemia). Initiation of treatment and dose adjustment should be carefully monitored.

    If hypotension occurs, place the patient in the supine position and if necessary administer IV infusion of normal saline. A transient hypotensive response is not a contraindication to further doses. Following restoration of effective blood volume and pressure, reinstitution of therapy at reduced dosage may be possible or either of the components may be used appropriately alone.

    In patients with ischaemic heart disease or cerebrovascular disease, severe hypotension may result in a myocardial infarction or cerebrovascular event.

    Some hypertensive patients (with no apparent pre-existing renal disease), have developed minor and transient increases in serum urea and creatinine levels when lisinopril has been given concomitantly with a diuretic. If this occurs, the combination should be discontinued. Reinstitution of therapy at reduced dosages may be possible, or either component can be used alone.

    Patients with bilateral renal artery stenosis and unilateral renal artery stenosis in the single kidney may experience increases in blood urea nitrogen and serum creatinine. Treatment in these patients should be under medical supervision with low doses and careful dose titration. Monitor renal function especially in the first few weeks of treatment.

    Lisinopril/hydrochlorothiazide is not indicated in dialysis for renal failure. There has been a high incidence of anaphylactoid reactions in patients dialysed with high flux membranes and treated with an ACE inhibitor. If dialysis is to be performed for other indications, a different membrane or a different class of antihypertensive to ACE inhibitors should be used.

    Thiazides may precipitate hyperuricaemia and/or gout. Lisinopril may increase urinary uric acid and therefore may attenuate the hyperuricaemic effect of hydrochlorothiazide.

    Thiazides have been shown to increase the urinary excretion of magnesium, which may result in hypomagnesaemia. There is an increased risk of hypomagnesaemia in hepatic cirrhosis.

    Intestinal angioedema has been reported in patients taking ACE inhibitors. This should be taken into consideration when diagnosing abdominal pain.

    Antacids may decrease the bioavailability of lisinopril with hydrochlorothiazide.

    Dose dependent increased risk of non-melanoma skin cancer with exposure to increasing cumulative doses of hydrochlorothiazide.

    Hydrochlorothiazide has been associated with an idiosyncratic reaction resulting in choroidal effusion with visual field defect, acute transient myopia and acute angle-closure glaucoma. Symptoms can occur within hours to weeks of the drug initiation, these include acute onset of decreased visual activity or ocular pain.

    If intraocular pressure remains uncontrolled, consider prompt medical or surgical treatment. Risk factors for developing acute closure glaucoma may include a history of sulfonamide or penicillin allergy.

    Pregnancy and Lactation


    Lisinopril with hydrochlorothiazide is contraindicated during pregnancy.

    The manufacturer does not recommend using lisinopril with hydrochlorothiazide during pregnancy. If pregnancy occurs during treatment, this product must be discontinued immediately and an alternative antihypertensive with greater experience in pregnancy should be considered. As this product contains two medically active ingredients these are discussed separately below.

    The exposure to ACE inhibitors during the second and third trimesters of pregnancy is known to induce human foetotoxicity and neonatal toxicity. The risk of teratogenicity due to the exposure during the first trimester cannot be excluded. An ultrasound check of renal function and the skull would be recommended in case of an exposure to ACE inhibitors in the last two trimesters of the pregnancy.

    Infants whose mothers have taken ACE inhibitors should be closely monitored for hypotension and renal function.

    Hydrochlorothiazide crosses the placenta. There is limited experience with hydrochlorothiazide use during pregnancy, especially during the first trimester. In the second and third trimesters of the pregnancy, hydrochlorothiazide may cause foetal and neonatal adverse effects.


    Lisinopril with hydrochlorothiazide is contraindicated during breastfeeding.

    The manufacturer states that the use of lisinopril with hydrochlorothiazide is not recommended during breastfeeding and alternative treatments with better established safety profiles during breastfeeding are preferable, especially whilst nursing a newborn or preterm infant. Large doses of thiazide diuretics may suppress milk production. Hydrochlorothiazide can pass into breast milk in small amounts. The effect on exposed infants to lisinopril and hydrochlorothiazide is unknown.

    Side Effects

    Accelerated erythrocyte sedimentation
    ACE inhibitor hypersensitivity complex
    Acute myopia
    Acute renal failure
    Allergic alveolitis
    Altered liver function tests
    Anaphylactic reaction
    Autoimmune disorders
    Blood dyscrasias
    Blood glucose disturbances
    Blurred vision (transient)
    Bone marrow depression
    Cerebrovascular accident
    Chest discomfort
    Choroidal effusion
    Decrease in haematocrit
    Decreased appetite
    Depressive symptoms
    Dry mouth
    Fluctuating serum potassium levels
    Gastro-intestinal symptoms
    Glaucoma (closed angle)
    Hepatic failure
    Hypersensitivity reactions
    Hypochloraemic alkalosis
    Inappropriate secretion of antidiuretic hormone
    Increase in antinuclear antibodies (ANA)
    Increase in blood urea nitrogen
    Increase in plasma cholesterol
    Increase in plasma triglyceride concentration
    Interstitial nephritis
    Intrahepatic cholestasis
    Lupus erythematosus-like syndrome
    Mood changes
    Muscle disorders
    Myocardial infarction
    Necrotising angiitis
    Olfactory senses altered
    Orthostatic hypotension
    Pulmonary oedema
    Raynaud's phenomenon
    Renal impairment
    Respiratory distress
    Serum bilirubin increased
    Serum creatinine increased
    Skin reactions
    Sleep disturbances
    Stevens-Johnson syndrome
    Taste disturbances
    Toxic epidermal necrolysis

    Effects on Laboratory Tests

    The hydrochlorothiazide component could produce a positive analytic result in an anti-doping test.


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: July 2020.

    Reference Sources

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 10th edition (2015) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Summary of Product Characteristics: Lisoretic 10mg/12.5mg Tablets. Bristol Laboratories Ltd. Revised September 2020.

    Summary of Product Characteristics: Lisoretic 20mg/12.5mg Tablets. Bristol Laboratories Ltd. Revised September 2020.

    Summary of Product Characteristics: Zestoretic 10. AstraZeneca UK Ltd. Revised February 2020.

    Summary of Product Characteristics: Zestoretic 20. AstraZeneca UK Ltd. Revised February 2020.

    Nice Evidence Services.
    Available at:
    Last accessed: 25 June 2020.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Hydrochlorothiazide. Last Revised: 31 October 2018.
    Last accessed: 06 July 2020.

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Lisinopril. Last Revised: 28 February 2019.
    Last accessed: 06 July 2020.

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.