Lisinopril/Hydrochlorothiazide

Description

Lisinopril and Hydrochlorothiazide Tablets combine an angiotensin converting enzyme inhibitor, lisinopril, and a diuretic, hydrochlorothiazide. Lisinopril is a synthetic peptide derivative, chemically described as (S)-1-N2-(1-carboxy-3-phenylpropyl)-L-lysyl-L-proline dihydrate, with a molecular formula of C21H31N3O5·2H2O and a molecular weight of 441.53. It appears as a white, crystalline powder, soluble in water, sparingly soluble in methanol, and practically insoluble in ethanol. Hydrochlorothiazide is identified as 6-chloro-3,4-dihydro-2H-1,2,4-benzothiadiazine-7-sulfonamide 1,1-dioxide, with a molecular formula of C7H8ClN3O4S2 and a molecular weight of 297.72. This compound is a white or practically white crystalline powder, slightly soluble in water, and freely soluble in sodium hydroxide solution.

Lisinopril and Hydrochlorothiazide Tablets, USP, are available for oral administration in three combinations: 10 mg lisinopril with 12.5 mg hydrochlorothiazide, 20 mg lisinopril with 12.5 mg hydrochlorothiazide, and 20 mg lisinopril with 25 mg hydrochlorothiazide. Each tablet meets the USP Dissolution Test 2. Inactive ingredients include anhydrous lactose, croscarmellose sodium, and magnesium stearate. The 10-12.5 mg and 20-25 mg formulations also contain red and yellow ferric oxides.

Uses and Indications

Lisinopril and Hydrochlorothiazide Tablets are indicated for the treatment of hypertension to effectively lower blood pressure. The reduction of blood pressure is associated with a decreased risk of both fatal and non-fatal cardiovascular events, particularly strokes and myocardial infarctions.

Management of high blood pressure should be integrated into a comprehensive cardiovascular risk management strategy, which includes lipid control, diabetes management, antithrombotic therapy, smoking cessation, regular exercise, and limited sodium intake. It is important to note that many patients may require a combination of antihypertensive medications to achieve their blood pressure targets.

Clinical evidence from randomized controlled trials has demonstrated that numerous antihypertensive agents can reduce cardiovascular morbidity and mortality, with blood pressure reduction being a significant contributor to these benefits. The most substantial and consistent cardiovascular outcome benefit observed is a reduction in the risk of stroke, alongside reductions in myocardial infarction and overall cardiovascular mortality.

Elevated systolic or diastolic blood pressure is linked to increased cardiovascular risk, and even modest reductions in severe hypertension can yield considerable health benefits. The relative risk reduction associated with blood pressure lowering is consistent across various populations with differing absolute risks, with patients at higher risk—such as those with diabetes or hyperlipidemia—experiencing greater absolute benefits, regardless of their hypertension status.

It is also noted that some antihypertensive medications may exhibit diminished blood pressure-lowering effects when used as monotherapy in black patients, and many of these agents have additional approved indications and therapeutic effects, including those related to angina, heart failure, or diabetic kidney disease.

Dosage and Administration

Lisinopril monotherapy is indicated at once-daily doses ranging from 10 mg to 80 mg. Hydrochlorothiazide monotherapy is effective at daily doses between 12.5 mg and 50 mg.

For patients requiring combination therapy with lisinopril and hydrochlorothiazide, the recommended dosing ranges for lisinopril are 10 mg to 80 mg, while hydrochlorothiazide should be administered at doses of 6.25 mg to 50 mg.

In cases where a patient's blood pressure remains inadequately controlled with either monotherapy, a transition to Lisinopril and Hydrochlorothiazide Tablets may be considered. The initial combination doses can be 10-12.5 mg or 20-12.5 mg, depending on the patient's current monotherapy regimen.

Adjustments to the dosage of either component should be guided by the clinical response, with blood pressure measurements taken at the interdosing interval. It is recommended that the hydrochlorothiazide dose not be increased until a period of 2 to 3 weeks has elapsed to assess the patient's response adequately.

If the diuretic cannot be discontinued, an initial dose of 5 mg of lisinopril should be administered under medical supervision. Blood pressure should be monitored for at least two hours following administration, ensuring stabilization for an additional hour before any further dosing adjustments are made.

Contraindications

Lisinopril and Hydrochlorothiazide Tablets are contraindicated in patients with a known hypersensitivity to this product. The use of this medication is also contraindicated in individuals with a history of angioedema associated with prior treatment using an angiotensin-converting enzyme inhibitor, as well as in those with hereditary or idiopathic angioedema.

Due to the hydrochlorothiazide component, this medication is contraindicated in patients with anuria or hypersensitivity to other sulfonamide-derived drugs. Additionally, Lisinopril and Hydrochlorothiazide Tablets should not be used in combination with a neprilysin inhibitor, such as sacubitril. Administration of this product is contraindicated within 36 hours of switching to or from sacubitril/valsartan.

Furthermore, co-administration of aliskiren with Lisinopril and Hydrochlorothiazide Tablets is contraindicated in patients with diabetes.

Warnings and Precautions

Patients receiving Lisinopril and Hydrochlorothiazide Tablets should be closely monitored for a range of serious adverse reactions, including anaphylactoid and related reactions. These reactions can manifest in various forms, necessitating immediate medical attention.

Angioedema Angioedema affecting the face, extremities, lips, tongue, glottis, and/or larynx has been reported in patients treated with ACE inhibitors. This condition can occur at any point during therapy, and Lisinopril and Hydrochlorothiazide Tablets must be discontinued immediately if such symptoms arise. Additionally, intestinal angioedema has been documented, often presenting with abdominal pain, which resolves upon cessation of the ACE inhibitor.

Anaphylactoid Reactions During Desensitization Patients undergoing desensitization treatment while on ACE inhibitors may experience life-threatening anaphylactoid reactions.

Hypotension and Related Effects Excessive hypotension may occur, particularly in individuals who are salt or volume-depleted. Therefore, therapy should be initiated under strict medical supervision in patients with severe congestive heart failure. In cases of hypotension, patients should be placed in a supine position and may require intravenous infusion of normal saline.

Hematological Concerns Leukopenia, neutropenia, and agranulocytosis have been associated with ACE inhibitors. It is advisable to conduct periodic monitoring of white blood cell counts in patients with collagen vascular disease and renal disease.

Hepatic Failure ACE inhibitors have been linked to a syndrome that can progress to fulminant hepatic necrosis and potentially result in death. If jaundice or significant elevations in hepatic enzymes are observed, the ACE inhibitor should be discontinued, and appropriate medical follow-up is essential.

General Precautions Caution is advised when administering Lisinopril to patients with aortic stenosis or hypertrophic cardiomyopathy due to potential obstruction in the left ventricular outflow tract. Changes in renal function may occur in susceptible individuals; therefore, renal function should be monitored during the initial weeks of therapy.

Hyperkalemia Patients with renal insufficiency or those taking potassium-sparing diuretics are at increased risk for hyperkalemia. Regular monitoring of serum potassium levels is recommended.

Cough A persistent nonproductive cough has been reported in patients taking ACE inhibitors, which may necessitate further evaluation.

Surgery and Anesthesia Lisinopril may inhibit the formation of angiotensin II during major surgical procedures or anesthesia, potentially leading to hypotension.

Laboratory Tests Periodic assessment of serum electrolytes is recommended to detect any possible electrolyte imbalances. Additionally, evaluation of renal function should be included in the routine assessment of hypertensive patients.

Side Effects

Patients may experience a range of adverse reactions while receiving treatment. The most common adverse reactions, occurring in at least 1% of participants, include dizziness (7.5%), headache (5.2%), cough (3.9%), fatigue (3.7%), and orthostatic effects (3.2%). Other common reactions include diarrhea (2.5%), nausea (2.2%), upper respiratory infection (2.2%), muscle cramps (2.0%), asthenia (1.8%), paresthesia (1.5%), hypotension (1.4%), vomiting (1.4%), dyspepsia (1.3%), rash (1.2%), and impotence (1.2%).

In addition to these common reactions, patients may experience other adverse effects categorized by body systems. Notable reactions include chest pain, abdominal pain, syncope, and chest discomfort under the body as a whole. Cardiovascular effects may include palpitations and orthostatic hypotension. Digestive system reactions can manifest as gastrointestinal cramps, dry mouth, constipation, and heartburn. Musculoskeletal complaints may involve back pain, shoulder pain, knee pain, and myalgia.

Nervous and psychiatric effects reported include decreased libido, vertigo, depression, and somnolence. Respiratory issues may present as common cold, nasal congestion, influenza, bronchitis, and dyspnea. Skin reactions can include flushing, pruritus, and skin inflammation. Special senses may be affected, with reports of blurred vision and tinnitus. Urogenital adverse reactions include urinary tract infections.

Serious adverse reactions have also been noted. Angioedema affecting the face, extremities, lips, tongue, glottis, and/or larynx has been reported, with rare cases of intestinal angioedema observed in post-marketing experience. Hypotension has been documented in 1.4% of patients, with orthostatic hypotension occurring in 0.5% and syncope in 0.8%. Persistent nonproductive cough has been associated with all ACE inhibitors, typically resolving after discontinuation of therapy.

Warnings associated with treatment include the potential for fetal toxicity, as drugs acting on the renin-angiotensin system may cause injury or death to a developing fetus. Anaphylactoid reactions have been reported, particularly in patients undergoing desensitization or those with severe renal dysfunction. Rarely, ACE inhibitors have been linked to hepatic failure, beginning with cholestatic jaundice or hepatitis and potentially progressing to fulminant hepatic necrosis.

Postmarketing experience has indicated an increased risk of non-melanoma skin cancer, particularly squamous cell carcinoma, in white patients taking large cumulative doses of hydrochlorothiazide.

Drug Interactions

Patients receiving lisinopril may experience significant drug interactions that necessitate careful monitoring and potential dosage adjustments.

Pharmacodynamic Interactions:

• Diuretics: Patients on diuretic therapy may experience excessive hypotension upon initiation of lisinopril. To mitigate this risk, it is advisable to either discontinue the diuretic or increase salt intake prior to starting lisinopril.

• Non-Steroidal Anti-Inflammatory Agents (NSAIDs): Co-administration of NSAIDs, including selective COX-2 inhibitors, can lead to deterioration of renal function, particularly in elderly, volume-depleted patients, or those with pre-existing renal impairment. Regular monitoring of renal function is recommended. Additionally, the antihypertensive effect of lisinopril may be diminished by NSAIDs.

• Dual Blockade of the Renin-Angiotensin-System (RAS): The combination of RAS inhibitors, including lisinopril and hydrochlorothiazide, increases the risk of hypotension, hyperkalemia, and renal function changes, including acute renal failure. It is advised to avoid this combination and to closely monitor blood pressure, renal function, and electrolytes.

• Potassium-Containing Agents: The concomitant use of potassium-sparing diuretics, potassium supplements, or potassium-containing salt substitutes may lead to significant increases in serum potassium levels. Caution is warranted, and serum potassium should be monitored.

• Lithium: The use of lisinopril with lithium has been associated with increased lithium toxicity. Frequent monitoring of serum lithium levels is recommended.

• mTOR Inhibitors and Neprilysin Inhibitors: Co-administration with these agents may increase the risk of angioedema.

Pharmacokinetic Interactions:

• Hydrochlorothiazide: The absorption of hydrochlorothiazide can be significantly impaired by cholestyramine and colestipol resins, with reductions of up to 85% and 43%, respectively.

• Alcohol, Barbiturates, or Narcotics: These substances may potentiate orthostatic hypotension when used with hydrochlorothiazide.

• Antidiabetic Drugs: Dosage adjustments may be necessary for patients taking oral antidiabetic agents or insulin alongside hydrochlorothiazide.

• Other Antihypertensive Drugs: There may be an additive effect or potentiation when hydrochlorothiazide is used with other antihypertensive medications.

• Corticosteroids and ACTH: These agents can intensify electrolyte depletion, particularly hypokalemia.

• Pressor Amines: The response to pressor amines, such as norepinephrine, may be decreased when used with hydrochlorothiazide.

• Skeletal Muscle Relaxants: There may be an increased responsiveness to non-depolarizing skeletal muscle relaxants, such as tubocurarine.

• Lithium: Hydrochlorothiazide can reduce the renal clearance of lithium, increasing the risk of toxicity.

• Non-Steroidal Anti-Inflammatory Drugs: These may diminish the diuretic, natriuretic, and antihypertensive effects of hydrochlorothiazide, necessitating close monitoring for therapeutic efficacy.

• Gold: Rare nitritoid reactions have been reported with injectable gold when used in conjunction with ACE inhibitors.

In summary, careful consideration of these interactions is essential for optimizing patient safety and therapeutic outcomes when prescribing lisinopril and hydrochlorothiazide. Regular monitoring and appropriate dosage adjustments are recommended based on the specific interactions noted.

Packaging & NDC

The table below lists all NDC Code configurations of Lisinopril and Hydrochlorothiazide, the U.S. brand-name prescription product. Columns show Packaging, Formulation Type, and Active Ingredient Strength.

Pediatric Use

Pediatric patients, particularly neonates with a history of in utero exposure to Lisinopril and Hydrochlorothiazide Tablets, require careful monitoring. In cases of oliguria or hypotension, it is essential to support blood pressure and renal perfusion. Interventions such as exchange transfusions or dialysis may be necessary to address hypotension and/or substitute for impaired renal function. Lisinopril, which is known to cross the placenta, has been removed from neonatal circulation through peritoneal dialysis with some clinical benefit; however, the efficacy of exchange transfusion for this purpose remains untested.

It is important to note that the safety and effectiveness of Lisinopril and Hydrochlorothiazide Tablets in pediatric patients have not been established. Therefore, caution is advised when considering treatment in this population.

Geriatric Use

Elderly patients, defined as those aged 65 and older, were not adequately represented in clinical studies of Lisinopril and Hydrochlorothiazide Tablets to ascertain whether their responses differ from those of younger patients. However, available clinical experience has not indicated any significant differences in responses between elderly and younger patients.

In general, dose selection for geriatric patients should be approached with caution. It is advisable to initiate treatment at the lower end of the dosing range, taking into account the increased likelihood of diminished hepatic, renal, or cardiac function, as well as the presence of concomitant diseases or other drug therapies. Given that this medication is primarily excreted by the kidneys, the potential for toxic reactions may be heightened in patients with impaired renal function.

Therefore, careful consideration must be given to dose selection in elderly patients, particularly since they are more prone to renal function decline. A thorough evaluation of the hypertensive patient should always include an assessment of renal function to ensure safe and effective treatment.

Pregnancy

There is no specific information available regarding the use of Lisinopril during pregnancy, including any safety concerns, dosage modifications, or special precautions. Therefore, healthcare professionals should exercise caution when prescribing Lisinopril to pregnant patients.

In contrast, studies on Hydrochlorothiazide have demonstrated no adverse effects on the fertility of mice and rats of either sex when exposed to doses of up to 100 mg/kg and 4 mg/kg, respectively, prior to conception and throughout gestation. Notably, the doses administered in these studies are significantly higher than the maximum daily human dose, being 25 times and 2 times the maximum daily human dose based on mg/kg and mg/m² in mice, and 1 times and 0.2 times the maximum daily human dose based on mg/kg and mg/m² in rats. Despite these findings, the absence of specific data on Hydrochlorothiazide's effects during pregnancy necessitates careful consideration and consultation with relevant guidelines when prescribing to women of childbearing potential.

Lactation

It is not known whether lisinopril is excreted in human milk. However, studies in lactating rats have shown that the milk contains radioactivity following the administration of 14C lisinopril, with levels in rat milk being similar to plasma levels in the dams. Thiazides, which are components of Lisinopril and Hydrochlorothiazide Tablets, are known to appear in human milk.

Due to the potential for serious adverse reactions in breastfed infants from ACE inhibitors and hydrochlorothiazide, healthcare professionals should consider the risks and benefits when advising lactating mothers. A decision should be made whether to discontinue nursing and/or discontinue Lisinopril and Hydrochlorothiazide Tablets, taking into account the importance of the medication to the mother.

Renal Impairment

Patients with renal impairment should be closely monitored when receiving thiazides, as these agents may precipitate azotemia in individuals with severe renal disease. The cumulative effects of thiazides can develop in patients with reduced kidney function, necessitating caution in their use.

In patients with severe congestive heart failure, whether or not associated with renal insufficiency, there is a risk of excessive hypotension, which may lead to oliguria, progressive azotemia, and, in rare cases, acute renal failure or death.

Periodic monitoring of white blood cell counts is advisable for patients with collagen vascular disease and renal disease. Additionally, patients with a history of angioedema unrelated to ACE inhibitor therapy may face an increased risk of angioedema when treated with an ACE inhibitor.

The coadministration of an ACE inhibitor with an mTOR inhibitor or a neprilysin inhibitor may also elevate the risk of angioedema. While excessive hypotension is rarely observed in uncomplicated hypertensive patients, it remains a potential consequence of lisinopril use in salt- or volume-depleted individuals, such as those receiving vigorous diuretic therapy or patients on dialysis.

Anaphylactoid reactions have been reported in patients undergoing low-density lipoprotein apheresis with dextran sulfate absorption. Caution is also warranted in patients with impaired hepatic function or progressive liver disease, as minor alterations in fluid and electrolyte balance may precipitate hepatic coma.

Hepatic Impairment

Patients with hepatic impairment may experience an increased risk of adverse effects when treated with ACE inhibitors. Rarely, these medications have been associated with a syndrome that begins with cholestatic jaundice or hepatitis and can progress to fulminant hepatic necrosis, and in some cases, death. The underlying mechanism of this syndrome remains unclear.

In patients receiving ACE inhibitors, if jaundice or significant elevations in hepatic enzymes are observed, it is imperative to discontinue the ACE inhibitor immediately and ensure appropriate medical follow-up is provided.

Thiazide diuretics should be administered with caution in patients with impaired hepatic function or those with progressive liver disease. Minor alterations in fluid and electrolyte balance in these patients may precipitate hepatic coma, necessitating careful monitoring and potential dosage adjustments.

Overdosage

In cases of overdosage with Lisinopril and Hydrochlorothiazide Tablets, specific treatment information is limited. Management is primarily symptomatic and supportive. It is recommended that therapy with Lisinopril and Hydrochlorothiazide Tablets be discontinued, and the patient should be closely monitored.

Recommended Actions

Suggested measures for managing overdosage include the induction of emesis and/or gastric lavage. Additionally, it is crucial to correct any dehydration, electrolyte imbalances, and hypotension using established medical procedures.

Potential Symptoms

The most likely manifestation of overdosage is hypotension. In animal studies, a single oral dose of 20 g/kg did not result in lethality in rats, while one out of twenty mice died at the same dosage. Following a single oral dose of 10 g/kg, no lethality was observed in either mice or rats. The common signs and symptoms associated with overdosage are primarily due to electrolyte depletion, including hypokalemia, hypochloremia, and hyponatremia, as well as dehydration resulting from excessive diuresis. If digitalis has been administered concurrently, hypokalemia may exacerbate the risk of cardiac arrhythmias.

Management Procedures

For hypotension, the usual treatment involves the intravenous infusion of normal saline solution. It is also important to note that Lisinopril can be effectively removed from the body through hemodialysis, which may be considered in severe cases of overdosage.

Healthcare professionals should remain vigilant and provide appropriate supportive care to manage the symptoms and complications associated with overdosage of Lisinopril and Hydrochlorothiazide Tablets.

Nonclinical Toxicology

No teratogenic effects were observed in the studies conducted. In terms of non-teratogenic effects, lisinopril did not demonstrate any adverse effects on reproductive performance in male and female rats treated with doses up to 300 mg/kg/day. Similarly, hydrochlorothiazide did not adversely affect the fertility of mice and rats of either sex when administered doses of up to 100 mg/kg and 4 mg/kg, respectively, prior to conception and throughout gestation.

Lisinopril, in combination with hydrochlorothiazide, was evaluated for mutagenicity and found to be non-mutagenic in a microbial mutagen test using Salmonella typhimurium and Escherichia coli, both with and without metabolic activation. Additionally, no DNA single strand breaks were detected in an in vitro alkaline elution assay using rat hepatocytes. Lisinopril did not induce chromosomal aberrations in an in vitro test with Chinese hamster ovary cells or in an in vivo study involving mouse bone marrow.

Carcinogenicity studies revealed no evidence of tumorigenic effects when lisinopril was administered for 105 weeks to male and female rats at doses up to 90 mg/kg/day. Similarly, no carcinogenic effects were noted in male and female mice treated with lisinopril for 92 weeks at doses up to 135 mg/kg/day. Long-term feeding studies in mice and rats also indicated no carcinogenic potential for hydrochlorothiazide in female mice or in male and female rats. However, the National Toxicology Program (NTP) reported equivocal evidence for hepatocarcinogenicity in male mice.

Hydrochlorothiazide was shown to be non-genotoxic in vitro in the Ames mutagenicity assay and in the Chinese Hamster Ovary (CHO) test for chromosomal aberrations. Positive results were only observed in the in vitro CHO Sister Chromatid Exchange assay and in the Mouse Lymphoma Cell assay for mutagenicity.

Postmarketing Experience

Postmarketing experience has identified an association between hydrochlorothiazide and an increased risk of non-melanoma skin cancer. Data from a study conducted within the Sentinel System indicate that this increased risk is primarily observed for squamous cell carcinoma (SCC), particularly among white patients who have received large cumulative doses of the medication. The overall population shows an approximate risk increase of 1 additional case of SCC per 16,000 patients per year. Notably, for white patients who have taken a cumulative dose of ≥50,000 mg, the risk escalates to approximately 1 additional case of SCC for every 6,700 patients per year.

Patient Counseling

Healthcare providers should advise patients about the potential risk of angioedema, including laryngeal edema, which may occur at any time during treatment with angiotensin converting enzyme inhibitors, such as lisinopril and hydrochlorothiazide tablets. Patients should be instructed to report immediately any signs or symptoms of angioedema, including swelling of the face, extremities, eyes, lips, or tongue, as well as difficulty in swallowing or breathing. They should be cautioned to refrain from taking any additional doses of the medication until they have consulted with their prescribing physician.

Patients should also be cautioned about the possibility of symptomatic hypotension, particularly during the initial days of therapy. They should be encouraged to report any feelings of lightheadedness. In the event of actual syncope, patients should discontinue the medication and seek advice from their healthcare provider.

It is important to inform all patients that excessive perspiration and dehydration can lead to a significant drop in blood pressure due to reduced fluid volume. Other factors that may cause volume depletion, such as vomiting or diarrhea, can also result in decreased blood pressure. Patients should be advised to consult with their physician if they experience these conditions.

Patients should be informed about the risk of hyperkalemia and advised against using salt substitutes that contain potassium without prior consultation with their physician.

Healthcare providers should instruct patients to promptly report any signs of infection, such as a sore throat or fever, as these may indicate leukopenia or neutropenia.

Female patients of childbearing age should be made aware of the potential consequences of exposure to lisinopril and hydrochlorothiazide tablets during pregnancy. It is essential to discuss treatment options with women who are planning to become pregnant, and patients should be encouraged to report any pregnancies to their healthcare provider as soon as possible.

For patients taking hydrochlorothiazide, it is crucial to emphasize the importance of protecting their skin from sun exposure and undergoing regular skin cancer screenings, as there is an associated risk of non-melanoma skin cancer.

Storage and Handling

The product is supplied in a tight, light-resistant container that complies with USP standards and features a child-resistant closure. It is essential to store the product at a temperature range of 20°C to 25°C (68°F to 77°F), in accordance with USP Controlled Room Temperature guidelines. Additionally, the product must be protected from excessive light and humidity to maintain its integrity and efficacy.

Additional Clinical Information

Periodic determination of serum electrolytes is recommended to detect potential electrolyte imbalances in patients. Clinicians should evaluate renal function in hypertensive patients, as minor reversible increases in blood urea nitrogen and serum creatinine have been observed in patients treated with Lisinopril and Hydrochlorothiazide Tablets.

Patients should be counseled to report any signs of angioedema, such as swelling of the face, extremities, or difficulty in breathing, and to refrain from taking additional medication until consulting their physician. They should also be advised to report lightheadedness, particularly during the initial days of therapy, and to discontinue the drug if syncope occurs. Caution is warranted regarding excessive perspiration and dehydration, which may lead to significant drops in blood pressure. Patients are advised against using potassium-containing salt substitutes without physician consultation and should promptly report any signs of infection, which may indicate leukopenia or neutropenia. Female patients of childbearing age should be informed about the risks associated with Lisinopril and Hydrochlorothiazide Tablets during pregnancy and discuss treatment options if planning to conceive. Additionally, those taking hydrochlorothiazide should protect their skin from sun exposure and undergo regular skin cancer screenings, as there is an increased risk of non-melanoma skin cancer, particularly squamous cell carcinoma, associated with hydrochlorothiazide use.

FDA Insert (PDF)

This document is the official FDA-approved prescribing information for Lisinopril and Hydrochlorothiazide as submitted by GSMS, Incorporated. It includes detailed information about indications, dosage, contraindications, warnings, and clinical pharmacology.

View full prescribing information (PDF)