Zestoretic

What Zestoretic is and what it is used for

Zestoretic is used to treat high blood pressure (hypertension). It contains two medicines called lisinopril and hydrochlorothiazide.
• Lisinopril belongs to a group of medicines called ACE inhibitors. It works by making your blood vessels widen.
• Hydrochlorothiazide belongs to a group of medicines called diuretics (water tablets). It helps your body to get rid of water and salts like sodium in your urine. These medicines work together to lower your blood pressure.

How to take Zestoretic

Always take Zestoretic exactly as your doctor has told you. You should check with your doctor or pharmacist if you are not sure. Once you have started taking Zestoretic your doctor may take blood tests. Your doctor may then adjust your dose so you take the right amount of medicine for you. Taking your medicine
• Swallow the tablet with a drink of water.
• Try to take your tablets at the same time each day. It does not matter if you take Zestoretic before or after food.
• Keep taking Zestoretic for as long as your doctor tells you to, it is a long term treatment. It is important to keep taking Zestoretic every day. Taking your first dose
• Take special care when you have your first dose of Zestoretic or if your dose is increased. It may cause a greater fall in blood pressure than later doses.
• This may make you feel dizzy or light-headed. If this happens, it may help to lie down. If you are concerned, please talk to your doctor as soon as possible. Adults
• The recommended dose is one tablet once a day. Your doctor will prescribe the tablet that is the right strength for you.
• If necessary, your doctor may increase your dose to two tablets once a day. Use in children
• Zestoretic is not recommended for use in children. If you take more Zestoretic than you should If you take more Zestoretic than prescribed by your doctor, talk to a doctor or go to a hospital immediately. Take the medicine pack with you so that the tablets can be identified. If you forget to take Zestoretic
• If you forget to take a dose, take it as soon as you remember. However, if it is nearly time for the next dose, skip the missed dose.
• Do not take a double dose to make up for a forgotten dose. If you stop taking Zestoretic Do not stop taking your tablets, even if you are feeling well, unless your doctor tells you to. If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. Zestoretic contains two medicines: lisinopril and hydrochlorothiazide.

The following side effects have been seen with these individual medicines. This means they could also happen with Zestoretic. Your doctor may take blood samples from time to time to check whether Zestoretic has had any effect on your blood. Possible side effects with lisinopril Severe allergic reactions (rare, may affect up to 1 in 1,000 people) If you have a severe allergic reaction, stop taking Zestoretic and see a doctor immediately. The signs may include sudden onset of:
• Swelling of your face, lips, tongue or throat. This may make it difficult to swallow.
• Severe or sudden swelling of your hands, feet or ankles.
• Difficulty breathing.
• Severe itching of the skin (with raised lumps). Severe liver problems (very rare, may affect up to 1 in 10,000 people) The signs may include:
• Yellowing of your skin or eyes, dark coloured urine or a loss of appetite. If this happens to you, see a doctor immediately. Other possible side effects:

Common (may affect up to 1 in 10 people)
• Headache.
• Feeling dizzy or light-headed, especially if you stand up quickly.
• Fainting.
• Diarrhoea.
• Being sick (vomiting).
• Cough.
• Kidney problems (shown in a blood test).

Uncommon (may affect up to 1 in 100 people)
• Mood changes including feeling depressed.
• Tingling feeling such as ‘pins and needles’.
• Spinning feeling (vertigo).
• Changes in the way things taste.
• Difficulty in sleeping.
• A very big drop in blood pressure may happen in people with the following conditions: coronary heart disease; narrowing of the aorta (a heart artery), kidney artery or heart valves; an increase in the thickness of the heart muscle. If this happens to you, you may feel dizzy or light-headed, especially if you stand up quickly.
• Heart attack or stroke.
• Unusual heart beat.
• Change of colour in your fingers or toes.
• Runny nose.
• Feeling sick (nausea).
• Stomach pain and indigestion.
• Changes in blood tests that check how the liver is working.
• Rash.
• Itching.
• Being unable to get an erection (impotence).
• Feeling weak.
• Feeling tired.
• Increased levels of certain substances in your blood (urea, creatinine or potassium).

Rare (may affect up to 1 in 1,000 people)
• Changes to some of the cells or other parts of your blood. The signs may include feeling tired and pale skin.
• Feeling confused.
• Changes in the way things smell.
• Dry mouth.
• Skin rash with dark red, raised, itchy bumps (hives).
• Hair loss (alopecia).
• Psoriasis (a skin problem).
• Infection of the blood.
• Kidney failure.
• Enlarged breasts in men.
• Syndrome of inappropriate antidiuretic hormone secretion (SIADH).
• Low levels of sodium in the blood, which may cause weakness, tiredness, headache, feeling sick, being sick (vomiting) and cramps.

Very rare (may affect up to 1 in 10,000 people)
• Problems with your bone marrow or a reduced number of blood cells and/or platelets in your blood. You may notice tiredness, an infection (which may be serious), fever, feeling breathless or that you bruise or bleed more easily.
• Swollen glands (lymph nodes).
• Increased immune response (autoimmune disease).
• Low levels of sugar in your blood (hypoglycaemia). The signs may include feeling hungry or weak, sweating and a fast heart beat.
• Suddenly feeling wheezy or short of breath (bronchospasm).
• Lung inflammation (which may make you feel breathless).
• Sinusitis (a feeling of pain and fullness behind your cheeks and eyes).
• Eosinophilic pneumonia. The signs include a combination of the following:
• sinusitis
• feeling like you have flu
• feeling more and more breathless
• pain in the area of your stomach or gut
• skin rash
• a feeling of ‘pins and needles’ or numbness of your arms or legs.
• Inflammation of the pancreas. This causes moderate to severe pain in the stomach.
• Swelling of the lining of the gut. This may cause sudden stomach pain, diarrhoea or make you be sick (vomit).
• Sweating.
• Severe skin disorder or rash. The symptoms include redness, blistering and peeling of the skin which may develop quickly and may include blistering in the mouth and nose.
• Passing less water (urine) than normal or passing no water.

Not known (frequency cannot be estimated from the available data)
• Seeing, feeling or hearing things that are not there (hallucinations).
• Flushing of your skin. Possible side effects with hydrochlorothiazide (frequency not known)
• Inflammation of a salivary gland.
• A reduced number of blood cells and/or platelets in your blood. You may notice tiredness, an infection (which may be serious), fever, feeling breathless or that you bruise or bleed more easily.
• Loss of appetite.
• An increase in the amount of sugar (glucose) in your blood (hyperglycaemia).
• Sugar in your urine.
• An increase in the amount of uric acid in your blood.
• Altered levels of substances in your blood (for example low sodium and potassium). You may notice muscle weakness, thirst, ‘pins and needles’, cramps or feeling sick.
• Raised or high levels of fats in your blood (including cholesterol).
• Feeling restless.
• Depression.
• Difficulty sleeping.
• Tingling feelings such as ‘pins and needles’.
• Feeling light headed.
• Changes to your vision that can make things look yellow.
• Problems with your sight for a short time.
• Severe eye pain with redness and sudden blurred vision. If you have a suddenly painful red eye tell your doctor immediately; you may need treatment to avoid permanent loss of vision.
• A spinning feeling (vertigo).
• Feeling faint (especially when standing up).
• Damage to blood vessels causing red or purple spots in the skin.
• Difficulty breathing. You may feel breathless if your lungs get inflamed or have fluid on them.
• Stomach irritation.
• Diarrhoea.
• Constipation.
• Inflammation of the pancreas. This causes moderate to severe pain in the stomach.
• Yellowing of your skin or the whites of your eyes (jaundice).
• Skin problems including rash caused by sensitivity to sunlight, rash, severe rash that develops quickly with blistering or peeling of the skin and possibly blistering in the mouth, activating or worsening of existing lupus conditions or appearance of unusual skin reactions.
• Allergic reactions.
• Muscle cramps and muscle weakness.
• Kidney problems which may be severe (shown in blood tests).
• Fever.
• Weakness. Do not be concerned by this list of possible side effects. You may not get any of them.

Reporting of side effects If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

How to Store Zestoretic

Keep this medicine out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated on the blister strip and the carton. The expiry date refers to the last day of that month.
• Store your tablets below 30°C. Always keep the blister strip in the carton to protect your tablets from light.
• Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.