Composition:
ZESTOZID 10 / 12.5 : Each tablet contains 10 mg lisinopril , 12.5 mg hydrochlorothiazide.
ZESTOZID 20 / 12.5 : Each tablet contains 20 mg lisinopril , 12.5 mg hydrochlorothiazide.
ZESTOZID 20 / 25 : Each tablet contains 20 mg lisinopril , 25 mg hydrochlorothiazide.

Mechanism of Action:
Hydrochlorothiazide:
As a result of its diuretic effects, hydrochlorothiazide increases plasma renin activity, increases aldosterone secretion, and decreases serum potassium. Administration of lisinopril blocks the renin‐ angiotensin aldosterone axis and tends to reverse the potassium loss associated with the diuretic. Concomitant administration of lisinopril and hydrochlorothiazide has little or no effect on the bioavailability of either drug.
The combination tablet is bioequivalent to concomitant administration of the separate entities.
Lisinopril:
Lisinopril inhibits angiotensin‐converting enzyme in human and animals. ACE is a peptidyl dipeptidase that catalyzes the conversion of angiotensin I to the vasoconstrictor substance, angiotensin II. Angiotensin II also stimulates aldosterone secretion by the adrenal cortex. Inhibition of ACE results in decreased plasma angiotensin II which leads to decreased vasopressor activity and to decrease aldosterone secretion.
The latter decrease may result in a small increase of serum potassium. Removal of angiotensin II negative feedback on renin secretion leads to increased plasma renin activity.

Indications:
Indicated for the treatment of hypertension, to lower blood pressure. Lowering blood pressure lowers the risk of fatal and non‐fatal cardiovascular events, primarily strokes and myocardial infarctions. These benefits have been seen in controlled trials of antihypertensive drugs from a wide variety of pharmacologic classes including lisinopril and hydrochlorothiazide. Control of high blood pressure should be part of comprehensive cardiovascular risk management, including, as appropriate, lipid control, diabetes management, antithrombotic therapy, smoking cessation, exercise, and limited sodium intake. Many patients will require more than 1 drug to achieve blood pressure goals. For specific advice on goals and management. In using This drug, consideration should be given to the fact that an angiotensin‐converting enzyme inhibitor, captopril, has caused agranulocytosis, particularly in patients with renal impairment or collagen vascular disease, and that available data are insufficient to show that lisinopril does not have a similar risk.

Dosage and Administration

Lisinopril monotherapy is an effective treatment of hypertension in once‐daily doses of 10 ‐ 80 mg, while hydrochlorothiazide monotherapy is effective in doses of 12.5 ‐ 50 mg per day. In clinical trials of lisinopril/hydrochlorothiazide combination therapy using lisinopril doses of 10 ‐ 80 mg and hydrochlorothiazide doses of 6.25 ‐ 50 mg, the antihypertensive response rates generally increased with increasing dose of either component.

A patient whose blood pressure is not adequately controlled with either lisinopril or hydrochlorothiazide monotherapy may be switched to lisinopril/HCTZ 10 / 12.5 or lisinopril/HCTZ 20 / 12.5, depending on current monotherapy dose. Further increases of either or both components should depend on clinical response with blood pressure. The hydrochlorothiazide dose should generally not be increased until 2 ‐ 3 weeks have elapsed. After addition of the diuretic it may be possible to reduce the dose of lisinopril. Patients whose blood pressures are adequately controlled with 25 mg of daily hydrochlorothiazide, but who experience significant potassium loss with this regimen may achieve similar or greater blood‐pressure control without electrolyte disturbance if they are switched to lisinopril/HCTZ 10 / 12.5.

The diuretic should, if possible, be discontinued for two to three days before beginning therapy with lisinopril to reduce the likelihood of hypotension. If the patient’s blood pressure is not controlled with lisinopril alone, diuretic therapy may be resumed. If the diuretic cannot be discontinued, an initial dose of 5 mg of lisinopril should be used under medical supervision for at least two hours and until blood pressure has stabilized for at least an additional hour. Concomitant administration of this drug    HCT with potassium supplements, potassium salt substitutes or potassium‐sparingdiuretics may lead to increases of serum potassium.

Storage conditions:

Store at controlled room temperature, 20 – 25 ^o C, protect from excessive light and humidity.

Keep out of reach of children.

Presentation:

ZESTOZID 10 / 12.5 : Pack of 30 tablets.

ZESTOZID 20 / 12.5 : Pack of 30 tablets.

ZESTOZID 20 / 25 : Pack of 30 tablets.