Zestoretic-20 Astrazeneca medicine for primary hypertension (2 blisters x 14 tablets)

Dosage form Box of 2 blisters x 14 tablets
Specifications Lisinopril, hydrochlorothiazide

Ingredient

Composition informationContent
Lisinopril20mg
Hydrochlorothiazide12.5mg

Uses

indications

Zestoretic medicine is indicated in the following cases:

Treatment of hypertension patients from mild to moderate is being treated stably with the same single drug at each dose of 20 mg/ 12.5mg.

Pharmacokology

Mechanism of action

Lisinopril is an enamel inhibitor peptidyl dipeptidase. Lisinopril inhibits Angiotensin (ACE), Angiotensin's catalyst into Angiotensin II vasoconstriction. Angiotensin II also stimulates the secretion of aldosteron from the adrenal shell.

ACE inhibition reduces angiotensin II concentration in plasma, leading to reduced vasoconstrictor activity and reducing aldosteron secretion. The decrease in aldosteron secretion can lead to an increase in serum potassium levels.

Pharmacy effects

Meanwhile, Lisinopril's mechanism of hypotension is thought mainly due to the inhibition of the renin-angiotensin-aldosteron system, Lisinopril still works to treat hypertension even in hypertension patients with low levels of lenin.

ACE is exactly like Kininase II, the enzyme with Bradykinin variables. Bradykinin's increased concentration, a vasodilator peptide, plays a role in the therapeutic effect of Lisinopril or not is still a problem that needs to be clarified.

hydrochlorothiazid is a diuretics and treatment of hypertension. It affects the mechanism of the reabsorption of electrolytes in the distance and increases the excretion of sodium and chloride in the same amount. Increasing excretion of sodium dollar may come with potassium and bicarbonate loss.

Thiazid usually does not affect normal blood pressure.

Dynamic pharmacokinetics

absorption

After taking a dose of Lisinopril, the peak concentration of lisinopril serum reaches 7 hours. Based on the amount of medication through urine, absorbing Lisinopril is approximately 25% of the dose, with variation between patients (6-60%). Food does not affect the absorption of Lisinopril through the gastrointestinal tract.

distribution

Lisinopril is not linked to proteins in the serum in addition to enzymes angiotensin in the blood. Mouse studies show that Lisinopril is poor through bloody barriers.

metabolism and elimination

Lisinopril is not metabolized and eliminated in the form of unchanged urine. With a repeated dose, Lisinopril has a cumulative selling time of 12 hours. Half -life elimination in plasma varies from 5.6 to 14.8 hours.

Hydrochlorothiazid is not metabolized, but quickly eliminated through the kidneys; At least 61% of oral dosage is eliminated within the first 24 hours.

hydrochlorothiazid through the placenta but not through the bloody barrier. The multi -dose of Lisinopril and Hydrochlorothiazid does not affect or affect the bioavailability of both drugs. Biological combination tablets with simultaneous use of two separate drugs.

Patients with liver failure: liver function damage in cirrhosis patients reduces the absorption of lisinopril (about 30%).

Patients with renal failure: Kidney function damage reduces lisinopril excretion, this decrease is only clinical significance when glomerular filtration is less than 30 ml/min.

Patients with heart failure: Compared to healthy people, patients with heart failure have larger contacts of lisinopril (AUC), but absorption decreases about 16% based on the amount of drug in urine.

Before taking Zestoretic-20 Astrazeneca medicine for primary hypertension (2 blisters x 14 tablets)

How to use

Take oral use.

Dosage

The usual dose is one tablet, used 1 time/ day. As well as other drugs used 1 time/ day. Zestoretic should be taken at the same time of the day.

If the desired treatment is not achieved in 2-4 weeks at this treatment dose, the dose can be increased to two, 1 time/ day.

Hypertension with kidney failure: Thiazids are not suitable diuretics for patients with renal impairment and ineffective at the level of creatinine clearance ≤ 30 ml/min (average to severe renal failure).

Do not use Zestoretic treatment to start in patients with renal failure. Used in patients with creatinine clearance from 30 ml/minute to 80 ml/min, Zestoretic can be used but only used but only after adjusting the dose for each of their own ingredients. The starting dose of lisinopril when used alone in mild renal impairment patients is 5 - 10 mg.

Previous treatment with diuretics: Hypotension with symptoms may occur after the starting dose of Zestoretic. This is likely to occur in patients with reduced circulatory volume and/or electrolytes. Treatment should be discontinued with diuretics 2-3 days before using Zestoretic. If not, only begins to treat individually with lisinopril at a dose of 5 mg.

Use drugs in children: The safety and effectiveness of drugs in children has not been established.

Using drugs in the elderly: It is not necessary to adjust the dose for the elderly. In clinical studies, validity and tolerance when using Lisinopril and Hydrochlorothiazid used in combination are similar in both patients aged 65 and over and in young patients.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.What to do when overdose?

symptoms

Data overdose in people is limited. The symptoms of overdose inhibiting enzymes include hypotension, circulatory shock, electrolyte disorders, kidney failure, rapid breathing, fast heart rate, chest drum, dizziness and cough.

Symptoms related to the overdose of Thiazide are increased urology, cognitive decline, convulsions, paralysis, arrhythmia and kidney failure.

Management

Slow intravenous infusion of physiological saline solution. If severe hypotension occurs, the patient should be placed in the back. It is possible to remove lisinopril from the circulatory method by hemolysis method. Place the pacemaker, regularly monitor signs of survival, electrolyte concentration and creatinin in serum.

Slow heart rate or prolonged vagus nerve reaction should be treated with Atropine symptoms.

What to do when you forget a dose? However, if close to the next dose, skip the forgotten dose and take the next dose at the time as planned. Note that it should not be used double the prescribed dose.

Side Effects

When using Zestoretic medicine, you may experience unwanted effects (ADR).

generally lisinopri/hydrochlorothiazid 20/12.5mg is well tolerated. Unwanted effects are usually less, fleeting and most cases do not need to stop treatment. The unwanted effects are all in the unwanted effects of Lisinopril or Hydrochlorothiazid.

Common, ADR> 1/100

  • Mental disorders and nervous system disorders: dizziness, headache, fainting;

    • Cardiovascular disorders: posture;

  • Respiratory disorders, chest and mediastinum: cough;
    • gastrointestinal disorders: diarrhea, vomiting;
  • Kidney and urinary disorders: renal dysfunction.

    • Uncommon, 1/1000

  • Mental disorders and nervous system disorders: abnormalities, dizziness, taste disorders, sleep disorders, mood change, symptoms of depression;

    • cardiovascular disorders: myocardial infarction or stroke, may be secondary due to excessive hypotension in high -risk patients;

  • Respiratory disorders, chest and mediastitis: rhinitis;

    • Digestive disorders: Nausea, abdominal pain and indigestion;

    Liver disorders: Hyper enzyme and bilirubin;

    Skin and tissue disorders: rash, itching;

  • Reproductive and mammary disorders: helplessly;
  • General disorders and local traits: weakness, fatigue;
  • Testing results: Hypertoinemia, increased serum creatinine, hyperkalemia.

    • Rare, 1/10,000

  • Blood disorders and lymphatic systems: Hemoglobin decrease, hematocrit decrease;

    • Endocrine disorders: The excretion syndrome is not appropriate;

  • Disorders of metabolism and nutrition: Hypoglycemia;
  • Mental disorders and nervous system disorders: mental disorders, smell disorders;

    • Digestive disorders: dry mouth;

    Skin and subcutaneous disorders: Too hut/vasodeic edema (facial vein, thread, lips, tongue, subjects and/or larynx);

  • Renal and urinary disorders: increased blood urea, acute renal failure;
  • Reproductive and mammary disorders: female mammary glands;
  • Testing results: Hypotenemia;

    • Very rare, ADR

  • Clinical: Hypoglycemia, hyperuricemia, hyperkalemia or decrease in potassium. Hypermath of blood urea and serum and anemia creatinine;

    • Hepatitis disorders: hepatitis;

    Blood disorders and lymphatic systems: bone marrow failure, thrombocytopenia, granulocytosis, hemolytic anemia, lymph nodes, autoimmune diseases;

    Respiratory disorders, chest and mediastinum: bronchospasm, sinusitis, bronchitis/Nonyle hypernagic pneumonia;

    Gastrointestinal disorders: pancreatitis, angioedema; Skin and subcutaneous tissue disorders: Skin atrophy, poisoned epidermal necrosis, Stevens-Johnson syndrome, diverse roses;

    Kidney and urinary disorders: Distant, anuria.

    Unknown:

  • Immune system disorders: Anaphylaxis, anaphylactic reaction;

    • Mental disorders and nervous system disorders: illusion;

    Cardiovascular disorders: flushing;

    When encountering side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

    Warnings

    Before using the drug you need to read the instructions carefully and refer to the information below.

    contraindicated

    Zestoretic medicine is contraindicated in the following cases:

  • Hypersensitivity to the active ingredients or any excipients in the drug product;

    • Hypersensitivity to any other transferred inhibitors (ACEI);

    Hypersensitivity to any derivatives of sulfonamid;

    History of angioedema with previous conversion inhibitors;

  • Genetic or idiopathic eagles;
  • 3 months or the last 3 months of pregnancy;
  • severe kidney failure (creatinin ≤ 30 ml/minute);
  • Animal;
    • Severe liver failure;
  • Conventional use of zestoretic with a product containing Aliskiren in patients with diabetes or patients with renal impairment (GFR

    Caution when using

    Hypotension with symptoms:

  • Hypotension with rare symptoms in patients with hypertension without complications, but the likelihood of occurrence is higher in patients with decreased volume such as diuretics, salt -limiting diet, hemolysis, diarrhea or vomiting or hypertension dependent on severe lenin. When hypotension is needed for the patient to lie on the back, intravenously physiological saline solution. After restoring blood pressure and volume can continue to use the drug in lower doses or with appropriate doses for each component.
  • In patients with heart failure with normal or low blood pressure, the reduction of systemic blood pressure may occur when using lisinopril. If the hypotension becomes symptomatic, may need to reduce the dose or stop taking the drug.

    • Aortic valve stenosis and mitral valve/ hypertrophic myocardial disease:

    Be cautious when using lisinopril in patients with mitral stenosis and clogged flow of left ventricle such as aortic stenosis or hypertrophic cardiomyopathy.

    Dual inhibitor Renin-Anotensin-Aldosteron:

    Increases the risk of hypotension, hyperkalemia and reduced kidney function (including acute renal failure). Should not use the enzyme inhibitors and the Angiotensin II or Aliskiren receptor blockers.

    Kidney function damage:

  • Thiazids are not a suitable diuretics for patients with renal impairment, these drugs do not work when creatinine clearance is 30 ml/min or lower (severe renal failure to severe levels). The separate part of the drug shows the need to use a combination. This is especially likely to occur in patients with renal impairment.

    kidney transplantation:

    Do not use this drug.

    Anaphylactic reaction in patients with hemolysis:

    Not only prescribed this medicine.

    Anaphylactic reactions related to decanted lipoprotein separation method: The risk of anaphylactic reaction is life -threatening. Should temporarily stop using enzyme inhibitors before making separation.

    Hepatic failure:

    Be careful to use thiazids in patients who have a double liver function or have progressive liver disease because small changes in electrolyte balance can also cause liver coma.

    surgery and anesthesia:

  • For patients in the surgery or use of anti -hypotension, Lisinopril can prevent the formation of secondary Angiotensin II due to release of re -release.

    Effects on endocrine and metabolism:

    Medications reduces glucose tolerance. The dose of diabetes can be adjusted, including insulin.

    Electrolyte imbalance:

    Should regularly check the concentration of serum electrolytes in appropriate time.

    Hemorrhage:

    Patients with a risk of hyperkalemia include people with kidney failure, diabetes, or users who simultaneously save potassium -saving diuretic, potassium or replacement salt with potassium, or patients who are taking other drugs associated with serum hyperpass.

    Patients with diabetes:

    Hemodiac control should be closely monitored in the first month of treatment with transferred inhibitors.

    Hypersensitivity/ eagles:

  • Facial vein, limb, tongue, tongue, and/or larynx nerves in patients treated with enzyme inhibitors including Lisinopril.

    Hypersensitivity:

    There may be a long -term anaphylactic reaction.

    Neutral leukemia/ grain leukemia:

    Platelets and anemia have been recorded when taking the drug. Symptoms can recover when stopping the drug.

    Race:

    Evaluation drugs in black people with higher rate in people with other skin color.

    ho:

    Typically, dry, persistent and self -stop cough when stopping the drug. Coughing due to transferring enzyme inhibitors must be considered when diagnosing the cause of cough.

    Lithi:

    Do not encourage coordination with enzyme inhibitors.

    Anti -doping test:

    Hydrochlorothiazide drugs can give positive results with anti -doping tests.

    The ability to drive and operate machinery

    The drug can cause light to medium impact to the ability to drive and operate machinery. Especially when starting or changing dose, and when used with alcohol, but these effects depend on the sensitivity of each patient. When driving and operating machinery, attention should be noted that the drug can cause dizziness or fatigue.

    Pregnancy

    Enzyme inhibitors are at high risk of disease and death for fetus and infants if during pregnancy, it is not recommended to use yeast inhibitors in the first 3 months.

    Contraindicated for inhibition of yeast inhibitors transferred to women who are 3 months pregnant between and the last 3 months of pregnancy. Therefore, do not use lisinopril for pregnant women, if you are taking the drug and detect pregnancy, you must stop the drug immediately.

    The period of breastfeeding

    has not determined whether lisinopril has excreted in breast milk or not, but whether the thiazids are in breast milk.

    Due to the serious harm of hydrochlorothiazid and infants, it is necessary to choose between breastfeeding or stopping lisinopril/hydrochlorothiazide 20/12.5 mg based on the importance of the mother.

    Interactive drug

    Hypertension drugs:

  • Causes more blood pressure. Simultaneous use of trinitrate glycerin and other nitrate or vasodilators can cause more hypotension.

    lithium:

  • Do not use lithium with pepper or enzyme inhibitors that transferred angiotensin because these drugs reduce lithium kidney clearance thus increases the risk of toxicity.

    Potassium supplements, potassium diuretics or potassium salt replacements and other drugs:

    may increase serum potassium concentration.

    Twisted drugs:

    Due to the risk of hypokalemia, be careful when using Hydrochlorothiazide with peak -causing drugs (anti -arrhythmia, psychotic drugs ...)

    3 -round antidepressant/ anti -psychotic/ anesthetic drugs:

    Used with transferred enzyme inhibitors can continue hypotension.

    Non-Stoid anti-inflammatory drugs, including aspirin:

    can reduce the anti -hypertension effect of hydrochlorothiazid and lisinopril when used in combination.

    Parasma stimulants:

    may reduce the effect of lowering the blood pressure of the drug. Thiazid may reduce the artery response to noradrenalin.

    Gold:

    Nitritoid reaction (symptoms of vasodilation, which can be very serious including flushing, nausea, dizziness and hypotension) after using gold in the form of injection occurs in patients treated with enzyme inhibitors.

    Diabetes treatment:

    Reduce glucose tolerance. Dosage of other diabetes treatments including insulin in diabetes patients may increase, decrease, or constant.

    amphotericin B, carbenoxolon, corticosteroid, corticotropine or laxative stimulating:

    Increases the effect of reducing potassium.

    Calcium salts:

    Thiazide diuretics may increase serum calcium concentration due to secretion.

    heart glycosides:

    Hypotension can cause sensitivity or increase the response to the heart to the toxic effects of digitalis.

    cholestyramin and colestipol:

    Reduce the absorption of hydrochlorothiazid.

    Non -reducing muscle relaxants:

    Thiazide may increase the response to non -reducing muscle relaxants.

    trimethoprim:

    Increases the risk of hyperkalemia.

    sotalol:

    Thiazide hypotension can increase the risk of sotalol heart arrhythmia.

    • Allopurinol:

    Increases the risk of kidney damage and may increase the risk of hyperuricemia and complications of gout.

    ciclosporin:

    Increases the risk of hyperkalemia and complications of gout.

    lovastatin:

    Increases the risk of hyperkalemia.

    cell pliers, immunosuppressive drugs, processes:

    Thiazide reduces excretion and increases bone marrow inhibition effect.

    co-trimoxazol:

  • can increase the risk of hyperkalemia.

    • Storage

    Store at a temperature not exceeding 30 ° C, avoid light.

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