hydrochlorothiazide + lisinopril: clinical use

Prescribing considerations

• Use only after stabilisation on the individual components in matching proportions; this is not initial therapy.
• Assess volume or sodium depletion, renal and hepatic function, diabetes, gout, valve or outflow obstruction and renovascular disease.
• Review medicines affecting the renin–angiotensin system, potassium, renal function or angioedema risk.
• Advise sun and UV protection, skin self-checking and prompt review of suspicious lesions.
• Safety and efficacy have not been established in children.

Contraindications and cautions

• Previous ACE-inhibitor-associated angioedema, hereditary or idiopathic angioedema
• Hypersensitivity to either component, another ACE inhibitor, sulphonamide-derived medicines or excipients
• Concurrent sacubitril/valsartan
• Second or third trimester of pregnancy
• Severe renal impairment, anuria or severe hepatic impairment
• Aliskiren in patients with diabetes or specified renal impairment

Monitoring

• Blood pressure and symptoms of hypotension
• Renal function and serum electrolytes, particularly potassium and sodium
• Glucose where clinically relevant
• Uric acid or gout symptoms where relevant
• Calcium where relevant
• New or changing skin lesions during long-term hydrochlorothiazide exposure

Clinical pharmacology

Lisinopril is an active, non-prodrug ACE inhibitor that reduces angiotensin II and aldosterone. Hydrochlorothiazide promotes renal sodium and water loss. Co-administration has little or no effect on either component’s bioavailability, and the tablet is bioequivalent to the corresponding separate components.

Formulation and product differences

• Selected tablets differ in colour and imprint; both are round and uncoated.
• Their score lines are not intended for breaking the tablets.
• Selected products contain mannitol; the peach tablet also contains iron oxide colouring.