Zestril

Zestril is the brand name for lisinopril, an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension, heart failure, and to improve survival following myocardial infarction.

ACE inhibitors are a cornerstone of cardiovascular medicine, and lisinopril is one of the most widely prescribed drugs in this class worldwide.

Lisinopril works by blocking the angiotensin-converting enzyme, which normally converts angiotensin I to angiotensin II, a potent vasoconstrictor.

By inhibiting this conversion, lisinopril reduces vasoconstriction, lowers aldosterone secretion, and decreases blood pressure.

It also has protective effects on the heart, kidneys, and blood vessels, making it valuable in patients with heart failure, diabetic nephropathy, and chronic kidney disease.

Zestril is taken once daily, and its long duration of action provides consistent blood pressure control over a full 24-hour period.

It can be used alone or in combination with other antihypertensive agents such as calcium channel blockers, thiazide diuretics, or beta-blockers.

Take one Zestril tablet once daily at the same time each day, with or without food. Swallow the tablet whole with water.

Do not stop taking Zestril without consulting your doctor, as sudden discontinuation may cause blood pressure to rise. Treatment for hypertension and heart failure is usually long-term.

Your doctor will start you on a low dose and may increase it gradually over several weeks, checking your blood pressure, kidney function, and potassium levels during titration.

Hypertension: starting dose 10 mg once daily, adjusted to a usual maintenance dose of 20 mg once daily. In some patients, up to 80 mg daily may be required. Heart failure: starting dose 2.

5 mg once daily, titrated to a target of 20 to 35 mg once daily as tolerated. Post-myocardial infarction: starting dose 5 mg within 24 hours of the event, increasing over six weeks.

Dose reduction is necessary in renal impairment; your prescriber will adjust based on creatinine clearance.

Common side effects (up to 1 in 10 users) include a dry, persistent cough, dizziness, headache, and hypotension (particularly with the first dose or after dose increases).

The cough is a class effect of ACE inhibitors, occurring in up to 10% of patients, and usually resolves on stopping the medication.

Uncommon effects include taste disturbance, rash, and renal impairment.

Rare but serious effects include angioedema (swelling of the face, lips, tongue, or throat), which requires immediate emergency treatment, and hyperkalaemia (raised potassium), particularly in patients with renal impairment.

Monitor renal function and serum potassium, particularly after starting treatment, after dose changes, and in patients with renal impairment or diabetes.

Be alert for signs of angioedema, which can be life-threatening. Avoid potassium supplements and potassium-sparing diuretics unless prescribed.

ACE inhibitors may cause a significant first-dose drop in blood pressure, especially in patients who are dehydrated or on diuretics; consider giving the first dose at bedtime.

Avoid concomitant use with sacubitril/valsartan due to the risk of angioedema.

Zestril is contraindicated in patients with a history of angioedema related to previous ACE inhibitor therapy, hereditary or idiopathic angioedema, bilateral renal artery stenosis, pregnancy (particularly second and third trimesters), concurrent use with aliskiren in patients with diabetes or renal impairment, and hypersensitivity to lisinopril or any other ACE inhibitor.