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Everything you need to know about Zestril In Pakistan?

Dr. Hira Tanveer

6 min read

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What is Zestril?

Zestril is a type of Lisinopril, which are drugs that belong to the class of ACE inhibitors. Essentially, they work by causing the blood vessels to dilate, so that blood flows through them with ease. It is mostly used for treating hypertension, especially the cases where the blood pressure needs to be controlled urgently. 

Zestril also works by promoting the excretion of sodium salts from the body. As sodium causes water retention in the body, it increases blood volume, exacerbating hypertension. Thus, Zestril’s approach to moderating blood pressure is two-pronged.

Zestril Formula:

Zestril is a Lisinopril. These belong to a category of ACE inhibitors. 

What are the available forms of Zestril in Pakistan?

Zestril is only available in the form of tablets in Pakistan

Zestril dosage and strength: 

Zestril tablets are available in different dosage strengths. These include:

  • Tablet 2.5mg
  • Tablet 5mg
  • Tablet 10mg
  • Tablet 20mg
  • Tablet 30mg
  • Tablet 40mg

The suggested dosage initially for hypertension in adults is 10mg, once a day. For maintaining the condition, it is recommended that patients take Zestril 20 mg, once daily. The maximum daily dosage is 80mg per day. 

How to take Zestril?

Zestril tables should not be crushed or chewed but swallowed whole with a glass of water. It is pertinent that doctor’s instructions be followed for the dosage, timing and frequency of the medication. Altering the medicine dosage on your own can have grave implications for your health. 

Moreover, many people stop taking Zestril when their blood pressure normalizes. This is counter intuitive and can negatively affect their health. Thus, even if you feel that your blood pressure is fine, do not stop taking the medicine unless advised by your doctor. Otherwise, stick to the regimen regulated by your healthcare provider. 

What are the uses of Zestril?

Zestril is taken to treat the following conditions:

  • Hypertensive Retinopathy
  • Renovascular Hypertension
  • Hypertensive Encephalopathy
  • Hypertensive Heart Disease
  • Heart failure
  • Heart attacks 
  • Strokes 
  • Kidney problems 
  • Kidney problems due to diabetes
  • Hypertension
  • Myocardial Infarction
  • Pre-eclampsia/Eclampsia
  • Cardiovascular Disease
  • Hypertensive Congestive Heart Failure
  • Recent myocardial infarction 
  • Congestive Heart Failure
  • Diabetic Nephropathy
  • Hypertensive Heart (w/ CHF) and Renal Disease
  • Hypertensive Renal Disease

What are the side effects of Zestril?

Using an ACE inhibitor can have some side-effects. These include:

  • Fatigue
  • Asthenia
  • Orthostatic effects.
  • Pancreatitis
  • Constipation
  • Flatulence  
  • Dry mouth
  • Diarrhea
  • Hemolytic anemia
  • Leukopenia/neutropenia 
  • Thrombocytopenia
  • Diabetes mellitus
  • Inappropriate antidiuretic hormone secretion
  • Gout.
  • Urticaria
  • Alopecia
  • Photosensitivity
  • Erythema
  • Flushing
  • Diaphoresis
  • Cutaneous pseudolymphoma
  • Toxic epidermal necrolysis
  • Stevens-Johnson syndrome
  • Pruritus 
  • Visual loss
  • Diplopia
  • Blurred vision
  • Tinnitus
  • Photophobia
  • Taste disturbances
  • Olfactory disturbance
  • Impotence.
  • Elevated erythrocyte sedimentation rate
  • Arthralgia
  • Arthritis 
  • Myalgia
  • Fever
  • Vasculitis
  • Eosinophilia
  • Leukocytosis
  • Paresthesia
  • Vertigo
  • Rash
  • Photosensitivity
  • Hyperkalemia- is a life-threatening condition in which potassium levels rise in your body. In order to prevent this condition, it is imperative that people also maintain their potassium levels when they are taking Zestril. 

What are the risks and warnings for Zestril?

Hypersensitivity:

People who have sensitivity to ACE inhibitors, should not use Zestril, or any other medicines with the same chemical composition. Consumption can lead to anaphylactic shock, which is a life-threatening condition. Therefore, be sure to disclose all and any of your allergies to your doctor at the time of the visit, so that they do not prescribe medicines that can lead to hypersensitivity.

Pregnancy:

Use of Zestril during pregnancy should be done only at the discretion of the doctor, and that too, only after a thorough risk assessment has been done. When taken during pregnancy, especially during the second & third trimesters, it can be injurious to the health of the baby. 

Breastfeeding:

Women who are nursing should also only use Zestril, or any other Lisinopril when advised by their doctor. It can get absorbed into the milk, and can gravely affect the baby’s health.

Sacubitril:

People who are taking sacubitril should not take Lisinopril with it. Even after ceasing the use of sacubitril, they must wait for 36 hours before they can use Lisinopril.

Diabetes:

Diabetics using insulin or taking oral hypoglycemics should take Zestril with caution. They should especially be careful during the first month of treatment. Furthermore, Diabetics who take medicines with Aliskiren as an ingredient should not take Zestril.

Conditions that lower blood pressure:

Individuals with health conditions like diarrhea, volume depletion, heatstroke or infections that lower blood pressure should use Zestril with caution. Similarly, those taking medicines with diuretics in them should also be careful when using Zestril. Such people are at risk of severely low blood pressure, which can be a life-threatening situation.

Heart conditions:

People with heart conditions like ischemic heart disease or cerebrovascular disease should be cautious with their use of Zestril. There is a danger of blood pressure falling below normal levels in this condition, which can be further exacerbated with Zestril and other ACE inhibitors since they too are aimed at lowering blood pressure.

Heart failure:

In those individuals who have normal blood pressure, taking Zestril can lead to dropping in blood pressure, which can also then lead to an adverse impact on their renal system. Thus, Zestril should be administered at the discretion of the doctor in patients with heart failure and normal blood pressure. 

Aortic or mitral valve stenosis:

Those people with conditions that obstruct the flow of blood from the left ventricle like aortic or mitral valve stenosis or hypertrophic cardiomyopathy should take Zestril with caution. 

Renal function impairment :

People suffering from renal impairment must be cautious when taking an ACE inhibitor. In such cases, doctors frequently test serum creatinine and potassium levels, so that they can watch out for the health of the patients. Similarly, people with diabetic nephropathy, and who are taking angiotensin II receptor blockers also should not take ACE inhibitors like Lisinopril.

Liver diseases:

Liver does the metabolism and excretion of drugs in the body. When it does not work properly due to any disease or disorder, drugs get accumulated in the body, leading to severe health issues. 

Albeit rare, Lisinopril also affects liver function, causing cholestatic jaundice that leads to fulminant jaundice. In such cases, doctors tend to stop the patients from taking Zestril, immediately. 

Blood count:

Zestril can cause blood diseases like neutropenia, thrombocytopenia, and anemia. Thus, anyone with blood issues that alter blood count should take Zestril with caution. When on Zestril therapy, your healthcare provider will carefully monitor your blood count, especially when you also suffer from altered renal functions. 

Moreover, similar caution should be observed by people taking drugs like procainamide, allopurinol, or a combination of these, or have diseases like collagen vascular disease, when taking Lisinopril. 

Cough:

ACE inhibitors can lead to the build-up of bradykinin in the pulmonary tree, which then causes cough. The resultant cough is non-productive and persistent, which gets better with the discontinuation of Zestril. 

You should inform your healthcare provider if you get a cough with the use of Zestril so that they can give an alternative medicine.

Anesthesia:

People who get anesthesia may also be administered agents that lower blood pressure. Thus, in such cases, ACE inhibitors should only be given in cases where blood pressure needs to be controlled and there is no risk of hypotension. Otherwise, there is a risk of the blood pressure falling to severely low levels, causing a life-threatening state known as shock. 

Hyperkalemia:

Hyperkalemia occurs when there is excess potassium in your blood. ACE inhibitors lead to hyperkalemia, as they work by stopping the release of aldosterone. Hyperkalemia tends to become a life-threatening condition. 

People who take potassium supplements, or suffer from renal impairment, or eat a potassium-rich diet like dates and bananas, have a higher risk of hyperkalemia. In order to prevent this situation, people should keep track of their serum potassium levels and avoid a potassium-rich diet when also taking Zestril alongside. 

Lithium:

Patients on lithium therapy should not take Zestril, if, for some reason, they have to take the two together, it should then be done with extreme caution. 

Gold:

Those taking gold injections like sodium aurothiomalate complain of nitritoid reaction when they take Zestril. Symptoms of this include facial flushing, nausea, vomiting, hypotension.

Heparin and cyclosporin:

When Heparin and cyclosporine are taken with Zestril, there is a risk of developing hyperkalemia. Thus, it is pertinent that people in such a situation monitor their potassium levels alongside Zestril therapy. 

Anticoagulants or bleeding disorders:

Individuals with bleeding disorders, or those taking anticoagulants for blood thinning, should take Zestril after consulting with their healthcare provider.

Interactions between Zestril and other medications:

Lisinopril or any other ACE inhibitors may interact with other drugs. However, drug interaction does not mean that you stop taking your medicines on your own, instead, tell your healthcare provider about it. 

Following are some drugs that can interact with Zestril:

  • Thiazide diuretics like furosemide, bumetanide and others
  • Potassium-sparing diuretics like spironolactone, triamterene, and eplerenone 
  • Antidiabetic medicines like metformin, pioglitazone, and others
  • Insulins 
  • NSAIDs like ibuprofen, naproxen, indomethacin and others
  • Vasodilators like nitroglycerin
  • Lithium 
  • Gold 

To prevent drug interactions, you should provide your healthcare professional, a complete medical history, including any allergies and conditions ailing you as well as any medicine that you are currently taking. Doctors can then prescribe medicine and dosage accordingly. 

What is the price of Zestril in Pakistan?

The prices of Zestril tablets in Pakistan are Rs.17/-. 

Storage Conditions:

  • Medicines should be kept out of sight and reach of children. 
  • Zestril should be stored at room temperature. 
  • It should not be used after the expiration date has passed.

How to get Zestril in Pakistan?

Zestril is not an over-the-counter medicine. Therefore, you need to present your latest prescription authorized by a doctor to your pharmacist in order to buy Zestril. 

What medicines are available as alternatives to Zestril in Pakistan?

Lisinopril is also available under different brand names, including:

  • Zestril 
  • Ziscar
  • Lispril

Conclusion:

Zestril is a type of ACE inhibitor, which is used to dilate blood vessels. It helps with treatment of hypertension, kidney problems, heart failure etc. However, Zestril also has many contraindications and must only be used at the discretion of the doctor. 

In order to consult a doctor before using Zestril, make sure to use Oladoc or call (042) 38900939 and get the best expert counseling while availing up to a 50 percent discount on your appointments. 

Disclaimer: The contents of this article are intended to raise awareness about common health issues and should not be viewed as sound medical advice for your specific condition. You should always consult with a licensed medical practitioner prior to following any suggestions outlined in this article or adopting any treatment protocol based on the contents of this article.

Dr. Hira Tanveer - Author Dr. Hira Tanveer is among the Best General Physicians in Lahore. Dr. Hira Tanveer is an MBBS doctor and currently serving at CMH Lahore. Writing is her favorite hobby as she loves to share professional advice on trendy healthcare issues, general well-being, healthy diet, and lifestyle.
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