Drug Class: ACE inhibitors with thiazides
Usual Adult Dose for Hypertension
Initial dose: Hydrochlorothiazide 12.5 mg-Lisinopril 10 to 20 mg orally once a day, depending on the current monotherapy dose
Maximum dose: Hydrochlorothiazide 50 mg-Lisinopril 80 mg per day
Comments:
- May increase dose every 2 to 3 weeks.
- If blood pressure is controlled with monotherapy hydrochlorothiazide 25 mg per day, but significant potassium loss occurs, then similar or greater blood pressure control without electrolyte disturbance may be achieved with hydrochlorothiazide 12.5 mg-lisinopril 10 mg orally once a day.
Renal Dose Adjustments
Mild to moderate renal dysfunction (CrCl greater than 30 mL/min): No adjustment recommended.
Severe renal dysfunction (CrCl less than 30 mL/min): Not recommended; loop diuretics preferred over thiazides
Liver Dose Adjustments
Caution recommended
Precautions
US BOXED WARNING:
- FETAL TOXICITY: If pregnancy is detected, discontinue this drug as soon as possible. Drugs that act directly on the renin-angiotensin system (RAS) can cause injury and death to the developing fetus.
Safety and efficacy have not been established in patients younger than 18 years.
Consult WARNINGS section for additional precautions.
Dialysis
Data not available
Other Comments
Monitoring:
- Monitor serum electrolytes periodically.
- Monitor renal function during the first few weeks of therapy.
- Consider monitoring white blood cell counts periodically in patients with collagen vascular disease, especially if the disease is associated with impaired renal function.
Patient advice:
- Advise patients to immediately report any signs or symptoms of angioedema (breathing difficulty or swelling of face, eyes, lips, or tongue) and to stop taking this drug until consulting a physician.
- Encourage patients to report any lightheadedness that may occur during treatment initiation and to stop taking this drug until consulting a physician.
- Caution patients to consult their physician if excessive perspiration, dehydration, vomiting, or diarrhea occurs as it may lead to excessive blood pressure reduction due to reduced fluid volume.
- Advise patients against using potassium-sparing diuretics, potassium supplements or potassium-containing salt substitutes without consulting their physician.
- Tell patients to promptly report any sign of infection (e.g., sore throat, fever), which may be a sign of neutropenia.
- Females of childbearing age should be informed of the consequences of exposure to this drug during pregnancy; ask these patients to report pregnancies as soon as possible.
