Zestoretic 10 & 20

Zestoretic 10 mg/12.5 mg and

20 mg/12.5 mg Tablets

lisinopril, hydrochlorothiazide

Read all of this leaflet carefully before you start taking this medicine.

• Keep this leaflet. You may need to read it again.


• If you have any further questions, ask your doctor or pharmacist.


• This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.


• If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

In this leaflet:

1. What Zestoretic is and what it is used for

2. Before you take Zestoretic

3. How to take Zestoretic

4. Possible side effects

5. How to store Zestoretic

6. Further information

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.

Before you take Zestoretic

Do not take Zestoretic if:

• You are allergic (hypersensitive) to lisinopril or hydrochlorothiazide or any of the other ingredients of Zestoretic (listed in Section 6: Further information).


• You are allergic to ACE inhibitor or sulphonamide medicines. If you are not sure if this applies to you, please ask your doctor.


• You have ever had sudden swelling of the hands, feet, ankles, face, lips, tongue or throat, especially if this followed treatment with an ACE inhibitor. It may also have been difficult to swallow or breathe.


• You have hereditary angioedema (a condition that makes you more prone to the swelling described above). If you are not sure if this applies to you, please ask your doctor.


• You have severe kidney problems.


• You have stopped passing water (urine).


• You have severe liver problems.


• You are more than 3 months pregnant. (It is also better to avoid Zestoretic in early pregnancy - see the sections on 'Pregnancy and breast-feeding').

Do not take Zestoretic if any of the above applies to you. If you are not sure, talk to your doctor or pharmacist before taking Zestoretic.

Take special care with Zestoretic

Check with your doctor or pharmacist before taking Zestoretic if:

• You have a narrowing (stenosis) of the aorta (an artery in your heart) or the kidney artery.


• You have an increase in the thickness of the heart muscle (known as hypertrophic cardiomyopathy).


• You have problems with your blood vessels (collagen vascular disease).


• You have low blood pressure. You may notice this as feeling dizzy or light-headed, especially when standing up.


• You have kidney problems or you are having kidney dialysis or you have had a kidney transplant.


• You have liver problems.


• You have diabetes.


• You have recently had diarrhoea or vomiting (being sick).


• Your doctor has told you to control the amount of salt in your diet.


• You have high levels of cholesterol and you are having a treatment called 'LDL apheresis'.


• You have ever had a condition called systemic lupus erythematosus (SLE).


• You are of black origin as Zestoretic may be less effective. You may also more readily get the side effect 'angioedema' (a severe allergic reaction with swelling of the hands, feet, ankles, face, lips, tongue or throat).

You must tell your doctor if you think you are (or might become) pregnant. Zestoretic is not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage (see the sections on 'Pregnancy and breast-feeding').

If you are not sure if any of the above applies to you, talk to your doctor or pharmacist before taking Zestoretic.

Treatment for allergies such as insect stings

Tell your doctor if you are having or are going to have treatment to lower the effects of an allergy such as insect stings (desensitisation treatment). If you take Zestoretic while you are having this treatment, it may cause a severe allergic reaction.

Operations

If you are going to have an operation (including dental surgery) tell the doctor or dentist that you are taking Zestoretic. This is because you can get low blood pressure (hypotension) if you are given certain local or general anaesthetics while you are taking Zestoretic.

Taking other medicines

Tell your doctor if you are taking, or have recently taken, any other medicines. This includes medicines that you buy without a prescription and herbal medicines. This is because Zestoretic can affect the way some medicines work and some
medicines can have an effect on Zestoretic.

In particular, tell your doctor or pharmacist if you are taking any of the following medicines:

• Other medicines to help lower your blood pressure.


• Water tablets (diuretic medicines).


• Non-steroidal anti-inflammatory drugs (NSAIDs) such as indomethacin, used to treat pain and arthritis.


• Medicines for depression (tricyclic and tetracyclic antidepressants).


• Medicines for mental problems, including lithium.


• Aspirin (acetylsalicylic acid), if you are taking more than 3 grams each day.


• Medicines that can increase the amount of potassium in the blood such as potassium tablets, potassium sparing diuretics or salt substitutes that have potassium in them.


• Calcium salts.


• Insulin or medicines that you take by mouth for diabetes.


• Medicines to treat asthma.


• Medicines to treat nose or sinus congestion or other cold remedies (including those you can buy in the pharmacy).


• Medicines to suppress the body's immune response (immunosuppressants, such as ciclosporin).


• Allopurinol (for gout).


• Medicines for uneven heart beat problems (such as procainamide).


• Cardiac glycosides (to treat heart failure).


• Medicines that contain gold, such as sodium aurothiomalate, which may be given to you as an injection.


• Amphotericin B injection (to treat fungal infections).


• Carbenoxolone (to treat ulcers or inflammation in the gullet or in and around the mouth).


• Corticosteroids (steroid medicines).


• Corticotropin (a hormone).


• Medicines to treat constipation (stimulant laxatives).


• Colestyramine and colestipol (to lower cholesterol, prevent diarrhoea or reduce itching).


• Muscle relaxants such as tubocurarine.


• Trimethoprim (an antibiotic).


• Sotalol (a beta-blocker).


• Lovastatin (to lower cholesterol).


• Dextran sulphate (used in the treatment called 'LDL apheresis' to lower cholesterol).


• Chemotherapy for cancer (cytostatics).


• Other medicines known to have an effect on the heart called Torsades de pointes.

Pregnancy

• You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Zestoretic before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Zestoretic. Zestoretic is not recommended in early pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.

Breast-feeding

• Tell your doctor if you are breast-feeding or about to start breast-feeding. Zestoretic is not recommended for mothers who are breast-feeding, and your doctor may choose another treatment for you if you wish to breast-feed, especially if your baby is newborn, or was born prematurely.

Driving and using machines

• This medicine may have an effect on your ability to drive or use machines, especially at the start of treatment or when the dose is adjusted, or in combination with alcohol. If this happens to you, do not drive or use any tools or machines.


• You must wait to see how your medicine affects you before trying these activities.

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 usual 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.

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, Zestoretic 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, affect less than 1 in 1000 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, affect less than 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 (affect less than 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 (affect less than 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.


• 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 (affect less than 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.


• 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.


• Low levels of sodium in the blood, which may cause weakness, being sick (vomiting) and cramps.

Very rare (affect less than 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.

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.


• 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.


• Blurred vision for a short time or changes to your vision that can make things look yellow.


• 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, worsening of existing lupus erythematosus-like reactions 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. If any of the side effects get serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

How to store Zestoretic

• Keep out of the reach and sight of children.


• Do not take your tablets after the expiry date that 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.


• Medicines should not be disposed of via waste water or household waste. Ask your pharmacist how to dispose of medicines no longer required. This will help to protect the environment.

Further information

What Zestoretic contains

The active substances are lisinopril (as dihydrate) and hydrochlorothiazide. Two strengths of tablets are available:

• Zestoretic 10 mg/12.5 mg Tablets contain 10 mg of lisinopril and 12.5 mg of hydrochlorothiazide.


• Zestoretic 20 mg/12.5 mg Tablets contain 20 mg of lisinopril and 12.5 mg of hydrochlorothiazide.

The other ingredients are calcium hydrogen phosphate dihydrate, magnesium stearate, maize starch, mannitol and pregelatinised starch. Zestoretic 10 mg/12.5 mg Tablets also contain iron oxide (E172).

What Zestoretic looks like and contents of the pack

Zestoretic 10 mg/12.5 mg Tablets are peach coloured and round. They have 'Zt' and '10' on one side.

Zestoretic 20 mg/12.5 mg Tablets are white and round. They have 'Zestoretic' written on.

They are supplied in cartons containing blister strips of 28 tablets.

Marketing Authorisation Holder and Manufacturer

The Marketing Authorisations for Zestoretic are held by

AstraZeneca UK Ltd

600 Capability Green

Luton

LU1 3LU

UK

Zestoretic is manufactured by

AstraZeneca UK Ltd

Silk Road Business Park

Macclesfield

Cheshire

SK10 2NA

UK

To listen to or request a copy of this leaflet in Braille, large print or audio please call, free of charge:

0800 198 5000 (UK only)

Please be ready to give the following information:

Product name Reference number

Zestoretic 10 mg/12.5 mg Tablets 17901/0058

Zestoretic 20 mg/12.5 mg Tablets 17901/0059

This is a service provided by the Royal National Institute of Blind People.

Leaflet prepared: June 2010

© AstraZeneca 2010

Zestoretic is a trade mark of the AstraZeneca group of companies.

CV 09 0083a

P023948