Lisinopril + Hydrochlorothiazide Pharmacology

Lisinopril + Hydrochlorothiazide

About Lisinopril + Hydrochlorothiazide
Mechanism of Action of Lisinopril + Hydrochlorothiazide
Pharmacokinets of Lisinopril + Hydrochlorothiazide
Onset of Action for Lisinopril + Hydrochlorothiazide
Duration of Action for Lisinopril + Hydrochlorothiazide
Half Life of Lisinopril + Hydrochlorothiazide
Side Effects of Lisinopril + Hydrochlorothiazide
Contra-indications of Lisinopril + Hydrochlorothiazide
Special Precautions while taking Lisinopril + Hydrochlorothiazide
Pregnancy Related Information
Old Age Related Information
Breast Feeding Related Information
Children Related Information
Indications for Lisinopril + Hydrochlorothiazide
Interactions for Lisinopril + Hydrochlorothiazide
Typical Dosage for Lisinopril + Hydrochlorothiazide
Schedule of Lisinopril + Hydrochlorothiazide
Storage Requirements for Lisinopril + Hydrochlorothiazide
Effects of Missed Dosage of Lisinopril + Hydrochlorothiazide
Effects of Overdose of Lisinopril + Hydrochlorothiazide


About Lisinopril
Dicarboxylate-containing Angiotensin-Converting Enzyme (ACE) Inhibitor, Antihypertensive.
Mechanism of Action of Lisinopril
It is an angiotensin converting enzyme inhibitor prevents the conversion of angiotensin-1 to angiotensin-2 and abolishes the pressor actions of angiotensin. It decreases aldosterone secretion, sodium and water retention, and total peripheral resistance, leads to fall in BP. The arterioles dilate and the compliance of larger arteries is increased. Both systolic and diastolic BP is lowered. It has no effect on cardiac output and cardiovascular reflexes. There is little dilatation of capacitance vessels; so postural hypotension is not a problem. The drug does not compromise renal, cerebral, and coronary blood flow. BP lowering depending up on sodium status and renin angiotensin activity. So greater fall in BP occurs in Reno vascular accelerated and malignant hypertension. The drug also increases plasma kinin levels and potentiate the hypotensive action of exogenously administered bradykinin. It is used for treatment of systolic heart failure, because it improves symptoms, decrease mortality and reduce ventricular hypertrophy. It reduces both preload and after load and thus increasing cardiac out put in patients with heart failure.
Pharmacokinets of Lisinopril
Absorption: Slowly absorbed orally about 25%.
Distribution: Widely distributed, but poor brain penetration.
Metabolism: Not metabolized in the body.
Excretion: Excreted unchanged in urine.
Onset of Action for Lisinopril
1 hour
Duration of Action for Lisinopril
24 hours
Half Life of Lisinopril
12 hours
Side Effects of Lisinopril
1. Cough
2. Angioedema
3. Hypotension
4. Chest pain
5. Hyperkalemia
6. Rashes
7. Urticaria
8. Swelling of lips mouth nose and larynx
9. Fetopathic in later half of pregnancy
10. Headache
11. Diarrhoea
12. Fatigue
13. Dizziness
14. Nausea
15. Acute renal failure is precipitated in renal artery stenosis

Contra-indications of Lisinopril
1. Hypersensitivity to the drug
2. Renal artery stenosis
3. Aortic stenosis
4. Coarctation of aorta

Special Precautions while taking Lisinopril
1.Renal impairment:
2.Cardiogenic shock
3.Severe heart failure
6.Stops diuretics 2 to 3 days before therapy

Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Use with caution
Children Related Information
Indications for Lisinopril
1. Hypertension
2. Congestive heart failure
Interactions for Lisinopril
Antacids : Decrease efficacy of Lisinopril.
Indomethacin : Reduces hypotensive effect.
Digoxin : Increases plasma digoxin levels.
Potassium preparations & Postassium sparing diuretics : Hyperkalaemia and increased risk of renal failure.
Lithium : Toxicity due to increased serum concentration of Lithium.
Immunosuppressive Drugs : Increased risk of bone marrow depression.
Antidepressants , Diuretics, Beta-Blockers, Phenothiazines : Enhance hypotensive effect.
Morphine : Enhanced analgesic effect and respiratory depression.

Typical Dosage for Lisinopril
Starts with 2.5mg once daily. Increases the dose to 5 to 20mg once daily; depending on patient`s response if required.
Maximum dose: 40mg/day
Schedule of Lisinopril
Storage Requirements for Lisinopril
Store at a temperature range of 15 to 30 degree C. in a well closed container and protect from moisture.
Effects of Missed Dosage of Lisinopril
Effects of Overdose of Lisinopril
Treatment is supportive and symptomatic. To remove drug from the body perform induced emesis and gastric lavage. Administer activated charcoal to reduce absorption. In severe cases haemodialysis is considered if required. Treatment includes I.V. infusion of normal saline solution.


About Hydrochlorothiazide
Thiazide derivatibve, Diuretic.
Mechanism of Action of Hydrochlorothiazide
It is thiazide diuretic which exerts its action by acting at site-3(central dilating segment of early distal tubule). It binds to Na+Cl- symporter and inhibits Na+Cl- symport at the luminal membrane. It has additional carbonic anhydrase inhibitory actions in proximal tubules. It increases natriuresis, kaliuresis and diuresis. It decreases Ca2+ excretion and increases Mg2+excretion. It also has minor carbonic anhydrase inhibitory action. It also causes direct arteriolar vasodilatation and decreases total peripheral resistance. The antihypertensive actions of the drug may be attributable to depletion of sodium and subsequent reduction in plasma volume and a decrease in peripheral resistance. Decrease in peripheral resistance is due to either the loss of sodium from the arteriolar wall or a direct action on the vascular bed. It is an effective drug in edema associated with congestive heart failure.
Vertigo: Diuretics are used in vertigo in assumption that vertigo is due to endolymphatic hydrops. They reduce labyrinthine fluid pressure

Pharmacokinets of Hydrochlorothiazide
Absorption: It is absorbed after oral administration.
Metabolism: It is not metabolized in the body.
Excretion: Excreted unchanged in urine.

Onset of Action for Hydrochlorothiazide
1 to 3 hours
Duration of Action for Hydrochlorothiazide
12 to 16 hours
Half Life of Hydrochlorothiazide
5 to 15 hours
Side Effects of Hydrochlorothiazide
1. Dizziness
2. Blurred vision
3. Confusion
4. Tingling fingers
5. Dry mouth
6. Nausea
7. Diarrhoea
8. Constipation
9. Vomiting
10. Weakness
11. Hypokalaemia
12. Hyponatraemia
13. Hyperuricaemia
14. Elevated levels of glucose, calcium and lipids
15. Gastro intestinal disturbances
16. Polyuria
17. Electrolyte imbalance
18. Jaundice
19. Rashes
20. Photosensitivity
21. Fever
22. Itching
23. Myalgia
24. Muscle cramps
25. Arthralgia
26. Blood dyscrasias
27. Ototoxicity

Contra-indications of Hydrochlorothiazide
1. Hyper uricaemia
2. Hyper calcaemia
3. Renal impairment
4. Hepatic impairment
5. Anuria
6. Hypersensitivity to the drug
7. Hyper sensitivity to sulfonamides
8. Fluid and electrolyte imbalance

Special Precautions while taking Hydrochlorothiazide
1. Gout
2. Diabetes mellitus
3. Renal impairment
4. Hepatic impairment
5. Monitor and correct Fluid and electrolyte imbalance
6. Hyper parathyroidism
7. Cirrhosis

Pregnancy Related Information
Old Age Related Information
Use with caution
Breast Feeding Related Information
Children Related Information
May be used
Indications for Hydrochlorothiazide
1. Hypertension
2. Oedema associated with heart failure
3. Oedema due to renal and hepatic diseases
4. Diabetes insipidus
5. Idiopathic hypercalciurea.
6. Vertigo
Interactions for Hydrochlorothiazide
Cholestyramine & Colestipol: decrease absorption of hydrochlorothiazide.
Diazoxide: Additive action - may cause hyperglycemia, hyperuricaemia and hypotension.
Digitalis: Diuretics induced hypokalaemia may precipitate digitalis toxicity.
Lithium: Hydrochlorothiazide potentiates therapeutic and toxic effects by increasing its renal excretion.
Frusemide: Synergy leading to profound diuresis and greater than predicted electrolyte loss.
Non-depolarizing muscle relaxants: Diuretics induced hypokalaemia enhances efficacy.
Sulfonylureas: Efficacy decreased due to hydrochlorothiazide induced glucose intolerance.
Chlorpropamide: Hypokalaemia.
Propantheline: Bioavailability of hydrochlorothiazide increased.
Metoclopramide: Bioavailability of hydrochlorothiazide decreased.
NSAIDs: Natriuretic effect of hydrochlorothiazide decreased.
Typical Dosage for Hydrochlorothiazide
Hypertension: 25mg once daily or in divided doses. Increased to 50mg if required; depending up on the patient`s response.
Children: 1mg/kg single daily dose.
Starts with 25 to 50mg. Increased the dose until desired response is obtained.
Maximum dose: 200mg/day
Maintenance dosage: 25 to 100mg daily or on alternate days.
Children: 1mg/kg single daily dose or 1 to 3mg/kg/day in two divided doses

Schedule of Hydrochlorothiazide
Storage Requirements for Hydrochlorothiazide
Store at room temperature in a well closed container and protected from light.
Effects of Missed Dosage of Hydrochlorothiazide
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose.Continue the regular schedule.Do not double the dose.
Effects of Overdose of Hydrochlorothiazide
Treatment is supportive and symptomatic. Remove drug from the body by induced emesis and gastric lavage. Monitor and assist respiratory, cardiovascular, and renal function as indicated. Monitor and support fluid and electrolyte balance.

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