Lisinopril hydrochlorothiazide adverse effects
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Common Adverse Effects of Lisinopril Hydrochlorothiazide Combination
The combination of lisinopril and hydrochlorothiazide is generally well tolerated, but several adverse effects have been consistently reported. The most common side effects include dizziness, headache, cough, fatigue, orthostatic effects (such as feeling lightheaded when standing up), diarrhea, nausea, and upper respiratory tract infections. The frequency of these effects varies, with dizziness (up to 7.5%), headache (up to 5.2%), and cough (up to 5.9%) being among the most frequently observed. Fatigue, orthostatic effects, diarrhea, and nausea are less common, each affecting around 2–4% of patients. Most of these side effects are mild and rarely lead to discontinuation of the medication Murray1991Gerc2007Brockman2010+4 MORE.
Cough as a Notable Adverse Effect
Cough is a well-known side effect of lisinopril, an ACE inhibitor, and is also observed in patients taking the lisinopril-hydrochlorothiazide combination. The incidence of cough ranges from about 3% to nearly 7% in different studies. This cough is typically dry and persistent, and it is more common with lisinopril than with hydrochlorothiazide alone. In some cases, cough is the main reason for stopping the medication Murray1991Gerc2007Brockman2010+5 MORE.
Laboratory and Metabolic Changes
The combination therapy can cause changes in laboratory values. Increases in serum glucose, triglycerides, uric acid, serum creatinine, and blood urea nitrogen have been reported. There is also a decrease in serum potassium, which is a known effect of hydrochlorothiazide. However, lisinopril can help reduce the risk of low potassium (hypokalemia) when used together with hydrochlorothiazide. Both the combination and hydrochlorothiazide alone can increase uric acid levels, which may be a concern for patients with gout Murray1991Gerc2007Lang1991+1 MORE.
Rare and Unusual Adverse Effects
Rarely, lisinopril has been associated with nightmares, which may return if the drug is restarted after being stopped. This effect is not common but should be considered if patients report sleep disturbances after starting therapy .
Adverse Effects in Special Populations
The side effect profile in elderly patients and those with kidney problems is similar to that seen in the general population. Long-term use (up to 50 weeks or more) does not appear to increase the risk of adverse effects .
Comparison with Monotherapy
When compared to taking lisinopril or hydrochlorothiazide alone, the combination does not significantly increase the risk of adverse effects. The tolerability of the combination is similar to that of the individual drugs, and severe adverse events are uncommon Gerc2007Brockman2010Benz1997+2 MORE.
Conclusion
Lisinopril-hydrochlorothiazide is an effective and generally well-tolerated treatment for hypertension. The most common adverse effects are mild and include cough, dizziness, headache, and fatigue. Laboratory changes such as increased uric acid and decreased potassium can occur, but lisinopril may help reduce some of the metabolic side effects of hydrochlorothiazide. Rarely, unusual effects like nightmares may occur. Overall, the combination is considered safe for most patients, including the elderly and those with kidney impairment.
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Most relevant research papers on this topic
Review of international safety data for lisinopril-hydrochlorothiazide combination treatment.
A fixed dose combination of lisinopril-hydrochlorothiazide is a well-tolerated therapeutic option for patients with mild-to-moderate hypertension, with common adverse experiences including dizziness, headache, and fatigue.
Lisinopril‐Induced Nightmares
Lisinopril may cause nightmares, but the exact mechanism responsible for this adverse effect remains unclear.
Efficacy and safety of a fixed-dose combination of lisinopril and hydrochlorothiazide : results of a drug monitoring study in 5,480 patients
A fixed-dose combination of lisinopril 20 mg and hydrochlorothiazide 12.5 mg once daily effectively and well-tolerated in managing hypertension in 5,480 patients.
Clinical experience with lisinopril. Observations on safety and tolerability.
Lisinopril is well-tolerated for long-term treatment of hypertension and congestive heart failure, with a similar side-effect profile to other ACE inhibitors, but taste disturbance is rarely observed.
Efficacy and safety of the fixed combination of lisinopril plus hydrochlorothiazide in treatment of patients with mild to moderate essential hypertension: a multicenter, observational study
The fixed combination of lisinopril plus hydrochlorothiazide is effective and safe in treating grade 1-2 essential hypertension.
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