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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.
The potassium losing effect of thiazide diuretics is usually attenuated by the potassium conserving effect of lisinoprilThe use of potassium supplementspotassium-sparing agents or potassium-containing salt substitutes and other medicinal products prednisone 5 mg buy on line. that may increase serum potassium levelsparticularly in patients with impaired renal function or diabetes mellitusmay lead to a significant increase in serum potassiumIf concomitant use of lisinopril/hydrochlorothiazide and any of these agents is requiredthey should be used with caution and with frequent monitoring of serum potassiumsee section 4.4
As with other antihypertensiveslisinopril/hydrochlorothiazide combination products may have a mild to moderate influence on the ability to drive and use machinesEspecially at the start of the treatment or when the dose is modifiedand also when used in combination with alcoholbut these affects depend on the individual’s susceptibility
Severe sweatingdiarrheaor vomiting can increase the risk for lightheadedness or a serious loss of body waterdehydrationReport prolonged diarrhea or vomiting to your doctorTo prevent dehydrationdrink plenty of fluids unless your doctor directs you otherwise.
Thiazide diuretics may increase serum calcium levels due to decreased excretionIf calcium supplements or Vitamin D must be prescribedserum calcium levels should be monitored and the dose adjusted accordingly.
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