Hyzaar is a combination medication used in the treatment of high blood pressure. One component, losartan, belongs to a new class of blood pressure medications that work by preventing the hormone angiotensin II from constricting the blood vessels, thus allowing blood to flow more freely and keeping the blood pressure down. The other component, hydrochlorothiazide, is a diuretic that increases the output of urine, removing excess fluid from the body and thus lowering blood pressure.

Most important fact about Losartan potassium and Hydrochlorothiazide

 You must take Hyzaar regularly for it to be effective. Since blood pressure declines gradually, it may be several weeks before you get the full benefit of Hyzaar, and you must continue taking it even if you are feeling well. Hyzaar does not cure high blood pressure; it merely keeps it under control.

How should you take Losartan potassium and Hydrochlorothiazide?

Hyzaar may be taken with or without food. Take Hyzaar exactly as directed. Try to take it at the same time each day so that it is easier to remember.

–If you miss a dose…

Take the forgotten dose as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule.

–Storage instructions…

Keep in a tightly closed container at room temperature. Protect from light.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Hyzaar.

• Side effects include:
  Dizziness, upper respiratory infection

Why should Losartan potassium and Hydrochlorothiazide not be prescribed?

If you have ever had an allergic reaction to losartan, hydrochlorothiazide, or sulfa drugs, you should not take Losartan potassium and Hydrochlorothiazide. If you are unable to urinate, do not take Hyzaar.

Possible food and drug interactions when taking Losartan potassium and Hydrochlorothiazide

Hyzaar may increase the effects of alcohol. Avoid alcohol while taking Losartan potassium and Hydrochlorothiazide.

If Hyzaar is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before taking Hyzaar with the following:

Barbiturates such as phenobarbital and Seconal
Cholestyramine (Questran)
Colestipol (Colestid)
Corticosteroids (Prednisone)
Diuretics that leave potassium in the body, such as Aldactone, triamterene, and amiloride
Indomethacin (Indocin)
Insulin
Ketoconazole (Nizoral)
Lithium (Eskalith, Lithobid)
Narcotic painkillers such as Demerol, Tylenol with Codeine, and Percocet
Nonsteroidal anti-inflammatory drugs such as Aleve, Anaprox, and Motrin
Other blood pressure-lowering drugs such as Procardia XL and Tenormin
Oral diabetes drugs such as Diabinese, DiaBeta, and Glucotrol
Potassium supplements such as Slow-K
Salt substitutes containing potassium
Sulfaphenazole
Troleandomycin (Tao)

Special information if you are pregnant or breastfeeding

When used in the second or third trimester of pregnancy, Hyzaar can cause injury or even death to the unborn child. Stop taking Hyzaar as soon as you know you are pregnant. If you are pregnant or plan to become pregnant, tell your doctor immediately. Hyzaar appears in breast milk and can affect the nursing infant. If Losartan potassium and Hydrochlorothiazide is essential to your health, your doctor may advise you to stop breastfeeding while you are taking Hyzaar.

Recommended dosage

ADULTS

Hyzaar comes in two strengths, 50-12.5 (50 milligrams of losartan and 12.5 milligrams of hydrochlorothiazide) and 100-25 (a double dose of each component). The usual starting dose is one 50-12.5 tablet per day.

If your blood pressure does not respond to this dose, after about 3 weeks the doctor may increase the dose to two 50-12.5 tablets once daily, or one 100-25 tablet a day.

CHILDREN

The safety and effectiveness of Hyzaar in children have not been studied.

Overdosage

Any medication taken in excess can have serious consequences. Information concerning Hyzaar overdosage is limited. However, extremely low blood pressure and abnormally rapid or slow heartbeat may be signs of an overdose. Other signs may include dryness and thirst, overall weakness and tiredness, restlessness and confusion, muscle pains, nausea, and vomiting.

 Hyzaar

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Lisinopril is in a group of drugs called ACE inhibitors. ACE stands for angiotensin converting enzyme.

Lisinopril is used to treat high blood pressure (hypertension), congestive heart failure, and to improve survival after a heart attack.

Lisinopril may also be used for purposes other than those listed in this medication guide.

How should I take Prinivil (Lisinopril)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Your doctor may occasionally change your dose to make sure you get the best results from this medication.

Take each dose with a full glass of water.

Lisinopril can be taken with or without food.

Vomiting, diarrhea, or heavy sweating can cause you to become dehydrated. This can lead to very low blood pressure, electrolyte disorders, or kidney failure while you are taking lisinopril. Drink 6 to 8 full glasses of water daily while you are taking this medication.

To be sure this medication is helping your condition, your blood pressure will need to be checked on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking lisinopril. You may need to stop using the medicine for a short time.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

Store lisinopril at room temperature away from moisture and heat.

What are the possible side effects of Prinivil (Lisinopril)?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; severe stomach pain; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have any of these serious side effects:

• feeling light-headed, fainting
• urinating more or less than usual, or not at all
• fever, chills, body aches, flu symptoms
• tired feeling, muscle weakness, and pounding or uneven heartbeats
• chest pain; or
• swelling, rapid weight gain

Less serious side effects may be more likely to occur, such as:

• cough
• dizziness, drowsiness, headache
• nausea, vomiting, diarrhea, upset stomach; or
• mild skin itching or rash

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs affect Prinivil (Lisinopril)?

Before taking lisinopril, tell your doctor if you are taking any of the following drugs:

• lithium (Lithobid, Eskalith)
• a potassium supplement such as K-Dur, Klor-Con
• salt substitutes that contain potassium
• insulin or diabetes medication you take by mouth
• aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Motrin, Advil), diclofenac (Voltaren), diflunisal (Dolobid), etodolac (Lodine), flurbiprofen (Ansaid), indomethacin (Indocin), ketoprofen (Orudis), ketorolac (Toradol), mefenamic acid (Ponstel), meloxicam (Mobic), nabumetone (Relafen), naproxen (Aleve, Naprosyn), piroxicam (Feldene); or
• a diuretic (water pill) such as amiloride (Midamor), bumetanide (Bumex), chlorthalidone (Hygroton, Thalitone), ethacrynic acid (Edecrin), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril), indapamide (Lozol), metolazone (Mykrox, Zarxolyn), spironolactone (Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), torsemide (Demadex)

If you are using any of these drugs, you may not be able to use lisinopril or you may need dosage adjustments or special tests during treatment.

There may be other drugs not listed that can affect lisinopril. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

What should I avoid while taking Prinivil (Lisinopril)?

Lisinopril can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Avoid drinking alcohol. It can further lower your blood pressure and may increase some of the side effects of lisinopril.

Do not use salt substitutes or potassium supplements while taking lisinopril, unless your doctor has told you to.

What happens if I overdose on Prinivil (Lisinopril)?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a lisinopril overdose may include feeling extremely dizzy or light-headed, or fainting.

What happens if I miss a dose of Prinivil (Lisinopril)?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What is the most important information I should know about Prinivil (Lisinopril)?

Do not use this medication without telling your doctor if you are pregnant or planning a pregnancy. Lisinopril could cause birth defects in the baby if you take the medication during pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment.

Lisinopril can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert.

Vomiting, diarrhea, or heavy sweating can cause you to become dehydrated. This can lead to very low blood pressure, electrolyte disorders, or kidney failure while you are taking lisinopril. Drink 6 to 8 full glasses of water daily while you are taking this medication.

What should I discuss with my healthcare provider before taking Prinivil (Lisinopril)?

Do not use this medication if you are allergic to lisinopril or to any other ACE inhibitor, such as benazopril (Lotensin), captopril (Capoten), fosinopril (Monopril), enalapril (Vasotec), moexipril (Univasc), perindopril (Aceon), quinapril (Accupril), ramipril (Altace), or trandolapril (Mavik).

Before using lisinopril, tell your doctor if you are allergic to any drugs, or if you have:

• kidney disease (or if you are on dialysis)
• liver disease
• heart disease or congestive heart failure
• diabetes; or
• a connective tissue disease such as Marfan syndrome, Sjogren’s syndrome, lupus, scleroderma, or rheumatoid arthritis

If you have any of these conditions, you may not be able to use lisinopril, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category D. Do not use this medication without telling your doctor if you are pregnant or planning a pregnancy. Lisinopril could cause birth defects in the baby if you take the medication during pregnancy. Use an effective form of birth control. Stop using this medication and tell your doctor right away if you become pregnant during treatment.

It is not known whether lisinopril passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

What warnings do you have for Prinivil (Lisinopril)?

The following warnings are available for this medication:

• Be careful if taking OTCs.
• Do not take if pregnant.
• Take as directed.

Prinivil

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Zestril is used in the treatment of high blood pressure. It is effective when used alone or when combined with other high blood pressure medications. It may also be used with other medications in the treatment of heart failure, and may be given within 24 hours of a heart attack to improve chances of survival.

Zestril is a type of drug called an ACE inhibitor. It works by reducing production of a substance that increases salt and water retention in your body.

Most important fact about Zestril

If you have high blood pressure, you must take Zestril regularly for it to be effective. Since blood pressure declines gradually, it may be several weeks before you get the full benefit of Zestril; and you must continue taking it even if you are feeling well. Zestril does not cure high blood pressure; it merely keeps it under control.

How should you take Zestril?

Zestril can be taken with or without food. Take it exactly as prescribed. Stopping Zestril suddenly could cause your blood pressure to rise.

–If you miss a dose…

Take the forgotten dose as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at the same time.

–Storage instructions…

Store at room temperature, with the container sealed and dry. Avoid excessive heat or freezing cold.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Zestril.

• More common side effects may include:
  Chest pain, cough, diarrhea, dizziness, headache, low blood pressure

Why should Zestril not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Zestril or other ACE inhibitors such as Capoten, you should not take this medication. You should also avoid this drug if you suffered angioedema (swelling of the face, lips, tongue, throat, arms, or legs) during previous treatment with an ACE inhibitor, or have a tendency to develop the condition for any other reason. Make sure your doctor is aware of any drug reactions you have experienced.

Possible food and drug interactions when taking Zestril

If Zestril is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Zestril with any of the following:

Nonsteroidal anti-inflammatory drugs such as indomethacin (Indocin)
Lithium (Lithonate, Eskalith)
Potassium preparations such as K-Phos and Micro-K
Water pills such as HydroDIURIL and Lasix, and others that leave potassium in the body, such as Aldactone and Midamor

Special information if you are pregnant or breastfeeding

If it is taken during the final 6 months of pregnancy, Zestril can cause birth defects, prematurity, and death in the fetus and newborn. If you are pregnant or plan to become pregnant and are taking Zestril, contact your doctor immediately to discuss the potential hazard to your unborn child. Zestril may appear in breast milk and could affect a nursing infant. If this medication is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with this medication is finished.

Recommended dosage

ADULTS

High Blood Pressure

For people not on water pills (diuretics), the initial starting dose is usually 10 milligrams, taken 1 time a day. Your doctor will increase the dosage until your blood pressure is under control. The long-term dosage usually ranges from 20 to 40 milligrams a day, taken in a single dose.

Diuretic use should, if possible, be stopped before using Zestril. If not, your physician may give an initial dose of 5 milligrams under supervision before any further medication is prescribed.

People with kidney disorders must be carefully monitored, and dosages will be adjusted to the individual’s needs, depending on kidney function.

Heart Failure

For this condition, Zestril is usually prescribed along with diuretics and digitalis. The recommended starting dose is 5 milligrams once a day, with the first dose taken under your doctor’s supervision. The doctor may increase the dose by up to 10 milligrams at intervals of no less than 2 weeks. Typical long-term dosages range from 5 to 40 milligrams taken once a day.

Heart Attack

The usual dose is 5 milligrams within the first 24 hours after a heart attack, then 5 milligrams 24 hours later, 10 milligrams 48 hours later, and, finally, 10 milligrams once a day for 6 weeks. If low blood pressure is a problem, the doctor may recommend a lower dosage.

CHILDREN 6 YEARS OR OLDER

High Blood Pressure

The usual starting dose is 0.07 milligrams per day up to a total of 5 milligrams per day.

Zestril is not recommended in children younger than 6 years old or in children with poor kidney function.

OLDER ADULTS

The physician will adjust the dosage carefully, according to the individual’s needs.

Overdosage

Any medication taken in excess can cause symptoms of overdose. If you suspect an overdose, seek medical attention immediately.

A severe drop in blood pressure is the primary sign of a Zestril overdose.

Zestril

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Isosorbide-5-mononitrate belongs to the family of medications known as anti-anginals. This medication is used to prevent angina attacks associated with coronary artery disease. It is not useful for quick relief of an attack.

It acts by opening up the blood vessels that supply the heart, increasing the blood and oxygen supply to the heart. Isosorbide-5-mononitrate may reduce the number, length, and severity of angina attacks. Tolerance to exercise may be increased and the need for fast-acting nitroglycerin (tablets and spray) may be reduced.

Your doctor may have suggested this medication for conditions other than the ones listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

Is there any reason not to take this drug?

Isosorbide-5-mononitrate should not be taken by anyone who:

• is allergic to isosorbide-5-mononitrate, other nitrates or nitrites, or any of the ingredients of the medication
• is in a state of acute circulatory failure associated with extremely low blood pressure (e.g., states of shock or collapse)
• taking sildenafil
• experiences dizziness, blurred vision, or loss of consciousness when rising from a sitting or lying position
• has increased pressure inside the head
• has myocardial insufficiency due to obstruction
• has severe anemia

What about possible side effects?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent. The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

More common:

• dizziness or lightheadedness, especially when rising from a lying or sitting position
• fast pulse
• flushing of face and neck
• headache
• nausea or vomiting
• restlessness

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Rare:

• blurred vision
• dryness of mouth
• headache (severe or prolonged)
• skin rash

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

What if I am taking other drugs?

There may be an interaction between isosorbide-5-mononitrate and any of the following:

• alcohol
• ergot alkaloids
• heparin
• medications that reduce blood pressure
• sildenafil
• tranquilizers
• tricyclic antidepressants (e.g., amitriptyline, desipramine)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Other information:

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Drowsiness/reduced alertness: Because this medication may cause faintness or dizziness, use caution when driving or operating machinery, especially at the start of treatment.

Low blood pressure: Symptoms of severe lowering of blood pressure, such as weakness or dizziness, particularly when rising suddenly from a sitting or lying position, may occur. People who are prone to low blood pressure (e.g., those taking diuretics) should be cautious when using this medication.

Tolerance: With continued use, isosorbide-5-mononitrate may stop having beneficial effects because the body gets used to it (i.e., develops a tolerance). Call your doctor if at any time you feel that your angina attacks are getting worse or happening more often.

Withdrawal: Stopping this medication suddenly may occasionally aggravate chest pain or other symptoms of angina. To avoid possible withdrawal effects, this medication should be gradually reduced and not stopped suddenly.

Pregnancy: If you are or may be pregnant, talk to your doctor about the benefits and risks of taking this medication.

Breast-feeding: It is not known is isosorbide-5-mononitrate passes into breast milk. Speak with your doctor about the risks and benefits of using this medication while breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children. Its use by this age group is not recommended.

Seniors: Seniors may be more likely to experience dizziness or lightheadedness while taking this medication.

Special Instructions:

The recommended adult dose of isosorbide-5-mononitrate is 1 tablet (60 mg) taken once daily in the morning after getting up. Your doctor may increase the dose to 2 tablets (120 mg) once daily in the morning if necessary. To reduce the risk of headache, your doctor may suggest starting with one-half tablet (30 mg) once daily each morning for the first 2 to 4 days.

The tablets should not be chewed or crushed, and should be swallowed together with half a glass of water. You may sometimes find whole tablets in the stool. These are only the shell of the tablet, and you can be sure that the medication has been released.

The tablets are available in a 30-day package that is designed to make it easy to keep track of your medication. 28 tablets are labeled with a day of the week. To start, take a tablet in the first row that matches the day you begin this pack. Then take a tablet on each of the following days to complete the 28 labelled tablets. The 2 extra non-labelled tablets should be taken after all the other tablets are gone.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that you take this medication exactly as prescribed by your doctor. Isosorbide-5-mononitrate should be taken at about the same time every day. If you miss a dose and remember within 6 hours, take your usual dose as soon as possible. Then go back to your regular schedule. If it has been more than 6 hours when you remember, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.

Imdur

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