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Neutropenia/agranulocytosisthrombocytopenia and anaemia have been reported for patients receiving ACE inhibitorsIn patients with normal renal function and no other complicating factors neutropenia occurs rarelyNeutropenia and agranulocytosis are reversible after discontinuation of the ACE inhibitorLisinopril should be used with extreme caution in patients with collagen vascular diseaseimmunosuppressant therapytreatment with allopurinol or procainamideor a combination of these complicating factorsespecially if there is pre-existing impaired renal functionSome of these patients developed serious infectionswhich in a few instances did not respond to intensive antibiotic therapyIf lisinopril is used in such patientsperiodic monitoring of white blood cell counts is advised and patients should be instructed to report any sign of infection.
In some patients with bilateral renal artery stenosis or stenosis of the artery to a solitary kidneywho have been treated with ACE inhibitorsincreases in blood urea and serum creatinineusually reversible upon discontinuation of therapyhave been seenThis is especially likely in patients with renal insufficiencyIf renovascular hypertension is also present there is an increased risk of severe hypotension and renal insufficiencyIn these patientstreatment should be started under close medical supervision with low doses and careful dose titrationSince treatment with diuretics may be a contributory factor to the aboverenal function should be monitored during the first few weeks of lisinopril/hydrochlorothiazide therapy.
Do not use potassium supplements or salt substitutes while you are taking Zestoreticunless your doctor has told you to.
Amphotericin BparenteralcarbenoxolonecorticosteroidscorticotropinACTHor stimulant laxatives.
Hydrochlorothiazide is excreted in human milk in small amountsThiazides in high doses causing intense diuresis can inhibit the milk productionThe use of lisinopril/hydrochlorothiazide during breast feeding is not recommendedIf lisinopril/hydrochlorothiazide is used during breast feedingdoses should be kept as low as possible.
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