Adult:
1 tab (Lisinopril 50mg + HCTZ 12.5mg) daily in the morning.
Precautions
Existing electrolyte disturbances, hepatic cirrhosis, severe heart failure, oedema, elderly, renal impairment. Observe signs of fluid and electrolyte disturbances. Hepatic impairment, diabetes, gout, hyperlipidaemia; hyperuricaemia; ECG: LVH and/or ventricular ectopics (extrasystoles). Volume-depleted patients; patients on diuretics and salt restriction; renal artery stenosis; Monitor serum-potassium concentration.
Potentially Life-threatening
Adverse Drug Reactions
Volume depletion and electrolyte imbalance, dry mouth, thirst, lethargy, drowsiness, muscle pain and cramps, hypersensitivity reactions eg, rashes, photosensitivity, thrombocytopaenia, jaundice, pancreatitis; fatigue, weakness; may precipitate an attack of gout; impotence, hyperglycaemia; anorexia, nausea, vomiting, constipation, diarrhoea, sialadenititssialadenitis, raised Ca concentration. Headache, dizziness, back pain, myalgia, resp tract disorders, first-dose hypotension; rash, angioedema; neutropaenia; GI disturbances; transient elevation of liver enzymes; taste disturbances, cough and hyperkalemia.
Adverse Drug Reactions
Seizures, may unmask diabetes mellitus. Hyponatraemia and idiosyncratic, hypersensitivity reactions.
Interactions
Hydrochlorothiazide: Enhance neuromuscular blocking action of competitive muscle relaxants. Cross-allergy with sulphonamides and sulphonylurea hypoglycaemics with resultant acute interstitial nephritis and vasculitis. Potentiates bone-marrow suppression caused by anticancer drugs. Potentiates aminoglycoside nephrotoxicity. Impaired control of diabetes by oral hypoglycaemic agents. May precipitate digitalis toxicity and lithium toxicity. Increased risk of hypokalaemia with corticosteroids. Prolongs paralysis caused by tubocurarine. Losartan: Risk of lithium toxicity with losartan. Hypotensive effect of losartan potentiated by diuretics and other antihypertensives. Risk of hyperkalaemia increases with concomitant ACE inhibitors, potassium-sparing diuretics and K supplements.
Hydrochlorothiazide: Symptomatic hyponatraemia when combined with carbamazepine. Predisposes to allopurinol sensitivity reactions and impaired renal function. Potentiates hypotensive effect of a-blockers and ACE inhibitors; these also reduce diuretic-induced hypokalaemia. Losartan: NSAIDs decrease efficiency. Cimetidine may increase the AUC of losartan by about 18%. Phenobarbital and other enzyme inducers may decrease levels of losartan and its active metabolite. Ketoconazole inhibits the conversion of losartan to its active metabolite.
