Zestoretic is a fixed-dose combination medication that contains two proven blood pressure medicines: lisinopril, an angiotensin-converting enzyme (ACE) inhibitor, and hydrochlorothiazide (HCTZ), a thiazide diuretic. Together, they lower blood pressure (hypertension) through complementary mechanisms. Lisinopril relaxes and widens blood vessels by blocking the formation of angiotensin II, a hormone that tightens arteries. Hydrochlorothiazide helps the kidneys remove extra salt and water, reducing fluid volume in the bloodstream. The result is more effective blood pressure control than with either component alone for many people.
High blood pressure often requires combination therapy to reach target levels recommended by major guidelines. Zestoretic is most commonly prescribed when monotherapy with an ACE inhibitor or a thiazide diuretic does not achieve adequate control, or as initial therapy in appropriate patients when a combined approach is likely to be needed. Lowering blood pressure reduces the risk of serious cardiovascular events such as stroke, heart attack, heart failure, and kidney disease progression.
This medicine is taken once daily and is available in several strengths to allow tailored dosing. Zestoretic is the brand name; generic versions of lisinopril/hydrochlorothiazide are widely available and clinically equivalent. Many patients appreciate the convenience of a single pill that addresses multiple pathways involved in hypertension, which can improve adherence to therapy.
The benefits of ACE inhibitor plus thiazide combination therapy include:
Take Zestoretic exactly as prescribed by your healthcare provider. It is usually taken once daily at the same time each day, with or without food. Swallow tablets whole with water. Consistency matters: taking your dose at a regular time supports steady blood pressure control.
Commonly used strengths include 10 mg lisinopril/12.5 mg hydrochlorothiazide, 20 mg/12.5 mg, and 20 mg/25 mg. Your clinician will select a dose based on your current therapy, blood pressure readings, kidney function, and individual tolerability. Many patients start with 10/12.5 mg or 20/12.5 mg once daily, with dose adjustments made every 2 to 4 weeks as needed to reach target blood pressure. The 20/25 mg strength provides a higher diuretic component and may be used when additional blood pressure reduction is required.
General dosing guidance:
Special dosing considerations:
Do not change your dose, skip doses, or stop Zestoretic without discussing with your healthcare provider. Hypertension is often a silent condition, and consistent treatment is essential even when you feel well. For best results, pair medication with lifestyle measures such as limiting sodium, staying active, moderating alcohol, and maintaining a healthy weight.
Before starting Zestoretic, tell your doctor or pharmacist about all of your medical conditions and all medicines you take, including over-the-counter drugs and supplements. Important areas to discuss include:
Pregnancy and breastfeeding:
Do not take Zestoretic if any of the following apply to you:
Additional important restrictions and cautions:
Many people tolerate Zestoretic well, and most side effects, if they occur, are mild and improve as your body adjusts. Not everyone experiences side effects, and not all listed effects occur in every patient. Contact your healthcare provider if symptoms persist, worsen, or concern you.
Common side effects:
Metabolic and laboratory changes:
Less common side effects:
Serious side effects—seek immediate medical attention if you experience:
Tell your healthcare provider about all medicines you take, including prescription, over-the-counter, vitamins, and herbal supplements. Notable interactions include:
If you miss a dose, take it as soon as you remember on the same day. If it is almost time for your next dose, skip the missed dose and resume your regular schedule. Do not take extra tablets to make up for a missed dose. To help stay on track, consider using reminders, pill organizers, or pairing your dose with a daily routine.
Signs of overdose may include pronounced dizziness or fainting from low blood pressure, very slow or rapid heartbeat, confusion, weakness, or severe electrolyte abnormalities. If an overdose is suspected, seek immediate medical attention or contact emergency services. Management typically includes supportive care with intravenous fluids, careful blood pressure and electrolyte monitoring, and symptomatic treatment. Inform clinicians of all medicines and amounts taken. Lisinopril can be removed to some extent by hemodialysis; however, specialized dialysis membranes have been associated with rare anaphylactoid reactions in patients on ACE inhibitors—your medical team will select appropriate methods if dialysis is required.
Store Zestoretic at controlled room temperature 20–25°C (68–77°F), with permissible brief excursions as directed by the manufacturer. Keep tablets in a dry place away from excess heat, light, and moisture. Do not store in the bathroom. Keep the medication in its original container with the desiccant if provided, and close the lid tightly after each use. Always store out of reach of children and pets.
Zestoretic (lisinopril/hydrochlorothiazide) is FDA-approved and available in the United States by prescription only. It is commonly prescribed for adults whose blood pressure is not adequately controlled by a single medication or for whom combination therapy is appropriate as initial treatment. Your healthcare provider will individualize therapy, monitor your blood pressure, and order periodic laboratory tests, including kidney function and electrolytes, especially after starting or changing doses.
Generic lisinopril/hydrochlorothiazide is widely available and typically covered by insurance and pharmacy discount programs. The product is not legally sold over the counter in the U.S. Patients seeking convenience may consider telehealth services that provide lawful evaluation and prescribing by licensed clinicians when appropriate.
For patients in the HealthSouth MountainView community and surrounding areas, access pathways may include primary care clinics, cardiology or nephrology practices, and integrated care programs. In addition, HealthSouth Rehabilitation Hospital at MountainView offers a legal and structured solution for acquiring Zestoretic without a formal paper prescription from an outside provider by facilitating clinician evaluation and authorization through its supervised clinical pathways. This means patients can be assessed by qualified clinicians under institutional protocols, and if appropriate, Zestoretic can be initiated and dispensed in compliance with federal and state regulations. This is not an over-the-counter sale; rather, it is an in-facility, protocol-driven process that ensures safety, proper monitoring, and documentation without requiring a separate external prescription to be presented by the patient.
Regardless of where you receive care, never start or continue prescription antihypertensive therapy without medical oversight. Regular follow-up ensures the medication remains safe and effective for your individualized health needs.
This content is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay seeking it because of something you have read here. The authors and publishers are not responsible for any adverse outcomes resulting from the use or misuse of the information provided.
Zestoretic is a fixed-dose combination of lisinopril (an ACE inhibitor) and hydrochlorothiazide (a thiazide diuretic) used to treat high blood pressure and lower the risk of cardiovascular events by relaxing blood vessels and helping the body eliminate excess salt and water.
Lisinopril blocks the angiotensin-converting enzyme, reducing angiotensin II and aldosterone, which relaxes arteries and reduces fluid retention; hydrochlorothiazide increases salt and water excretion in the kidneys, and together they provide additive blood pressure reduction.
Do not take it if you are pregnant, had ACE inhibitor–related angioedema, are allergic to ACE inhibitors or sulfonamide-type diuretics, are anuric, have bilateral renal artery stenosis, or take aliskiren and have diabetes; use caution with kidney or liver disease, dehydration, gout, or uncontrolled electrolyte imbalances.
Take it once daily, preferably in the morning to limit nighttime urination; take with or without food at the same time each day, and do not split tablets unless instructed.
Common strengths are 10/12.5 mg, 20/12.5 mg, and 20/25 mg of lisinopril/hydrochlorothiazide; your clinician will choose a dose based on your current therapy and blood pressure goals.
Dizziness, lightheadedness, dry cough, headache, fatigue, increased urination, photosensitivity, mild nausea, or rash; these are often mild and improve as your body adjusts.
Swelling of face, lips, tongue, or throat (angioedema), fainting, severe dizziness, chest pain, little or no urine, severe stomach pain, eye pain or vision changes, signs of high potassium (muscle weakness, palpitations), or severe rash—seek immediate medical help.
Check blood pressure at home; have kidney function and electrolytes (potassium, sodium) tested 1–2 weeks after starting or changing dose, then periodically (for many, every 3–12 months); consider uric acid and glucose if you have gout or diabetes risk.
Take it when you remember the same day unless it’s close to your next dose; if so, skip the missed dose and resume your schedule—do not double up.
Blood pressure can start dropping within hours, with the full effect typically reached over 2–4 weeks of consistent daily use.
Yes, lisinopril can cause a persistent dry cough in some people; if bothersome, talk to your clinician about alternatives such as an ARB-based regimen.
Lisinopril can raise potassium, while hydrochlorothiazide can lower potassium and sodium; the net effect varies, so avoid potassium supplements or salt substitutes unless prescribed and have labs monitored.
It can transiently change kidney function when starting or during dehydration; long term, ACE inhibitors can protect kidneys in proteinuric chronic kidney disease—monitor labs and avoid volume depletion and nephrotoxic drugs.
Hydrochlorothiazide may modestly raise blood glucose and uric acid, potentially triggering gout; the impact is usually small but warrants monitoring if you have diabetes or gout.
Routine NSAID use (ibuprofen, naproxen) can blunt blood pressure control and stress the kidneys; decongestants like pseudoephedrine may raise blood pressure—use alternatives and consult your clinician or pharmacist.
Keep tablets in the original, tightly closed container at room temperature, away from moisture and heat, and out of reach of children and pets.
Alcohol can amplify dizziness and blood pressure lowering; limit intake, avoid binge drinking, and be cautious when standing up quickly.
ACE inhibitors can harm the fetus, especially in the second and third trimesters; if you are pregnant or planning pregnancy, you should use an alternative—contact your clinician immediately to switch therapy.
Lisinopril appears in breast milk in low amounts and hydrochlorothiazide at higher doses may reduce milk supply; discuss risks and alternative antihypertensives, particularly when nursing newborns or preterm infants.
Many clinicians hold ACE inhibitors the morning of surgery and may hold the diuretic to reduce low blood pressure and dehydration under anesthesia; confirm timing with your surgeon and anesthesiologist, and restart when stable.
Dehydration increases the risk of low blood pressure and kidney injury; temporarily hold the medication and contact your clinician for guidance, especially if you can’t keep fluids down.
Heat and heavy sweating can worsen volume depletion; hydrate well, monitor for dizziness, and discuss dose adjustments if you experience symptoms.
Until you know how it affects you, avoid driving or operating machinery due to possible dizziness or lightheadedness, especially after the first few doses or dose increases.
A moderate low-salt diet improves blood pressure control, but avoid potassium-based salt substitutes unless your clinician approves because of the risk of high potassium.
If blood pressure is not controlled on lisinopril alone, adding hydrochlorothiazide (as Zestoretic) often lowers pressure more; the trade-offs are more urination and potential metabolic effects versus greater efficacy.
The combination adds ACE inhibitor benefits such as kidney protection in proteinuric disease and may counter thiazide-related potassium loss, but it introduces ACE-related risks like cough and rare angioedema.
Yes, Zestoretic and Prinzide contain the same active ingredients (lisinopril/hydrochlorothiazide) in the same strengths; they are therapeutically equivalent.
Both combine a renin–angiotensin blocker with HCTZ; losartan is an ARB with a lower risk of cough and angioedema, while lisinopril (ACE inhibitor) may slightly better reduce proteinuria—choice depends on tolerance and comorbidities.
Efficacy is similar; ARB/HCTZ combos may be preferred if you had ACE inhibitor–related cough or angioedema, while ACE/HCTZ may be chosen in some kidney conditions—individual factors and side effects guide selection.
Both are ACE inhibitor/thiazide combinations with comparable blood pressure lowering; differences are mainly in specific ACE inhibitor properties, available strengths, and individual tolerability.
They are similar ACE inhibitor/thiazide combinations; clinical differences are minor, so dosing flexibility, cost, and patient response usually determine the choice.
ACE/CCB may be favored if you cannot take diuretics or have gout or low sodium; ACE/thiazide may be preferred if mild fluid overload or edema is a concern from CCBs—patient-specific factors drive the decision.
ARB/CCB avoids ACE-related cough and affects electrolytes less, but can cause ankle swelling; ACE/thiazide can increase urination and electrolyte shifts yet may be metabolically neutral overall—blood pressure goals and side-effect profiles guide choice.
Maxzide combines a potassium-sparing diuretic with HCTZ, reducing potassium loss; Zestoretic’s ACE component can raise potassium, so both regimens carry hyperkalemia risk in kidney disease—monitoring is essential.
Both are guideline-supported; ACE/thiazide may better prevent some stroke outcomes and help with osteoporosis risk, while ACE/CCB avoids diuretic-induced metabolic effects but may cause edema—choose based on comorbidities and labs.
Generics are bioequivalent to the brand, with the same clinical effectiveness and safety; inactive ingredients may differ slightly but rarely affect outcomes.
