Side effects of lisinopril hydrochlorothiazide
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Side Effects of Lisinopril-Hydrochlorothiazide Combination Therapy
Common Side Effects: Dizziness, Headache, and Cough
The combination of lisinopril and hydrochlorothiazide is generally well-tolerated, but some common side effects have been reported. Dizziness is the most frequently observed side effect, occurring in approximately 7.5% of patients. Other common side effects include headache (5.2%), cough (3.9%), fatigue (3.7%), orthostatic effects (3.2%), diarrhea (2.5%), nausea (2.2%), and upper respiratory tract infections (2.2%). Cough, in particular, is noted to be slightly higher in patients taking lisinopril alone or in combination with hydrochlorothiazide .
Metabolic Side Effects: Serum Potassium and Glucose Levels
The combination therapy can also affect metabolic parameters. Notably, hydrochlorothiazide can lead to a decrease in serum potassium levels, which is a significant concern when using higher doses (25 mg). Additionally, an increase in serum glucose levels has been observed with higher doses of hydrochlorothiazide and its combination with lisinopril . These metabolic side effects are important considerations, especially for patients with pre-existing conditions like diabetes or electrolyte imbalances.
Laboratory Adverse Experiences: Uric Acid and Creatinine
Patients on lisinopril-hydrochlorothiazide therapy may experience increases in serum glucose, triglycerides, uric acid, serum creatinine, blood urea nitrogen, and blood urea levels. Conversely, there is a decrease in serum potassium levels. These changes necessitate regular monitoring of blood chemistry to manage potential adverse effects effectively.
Long-Term Safety: Elderly and Renally Impaired Patients
Long-term studies indicate that the side effects in elderly patients and those with renal impairment are similar to those observed in the general population. This suggests that the combination therapy is relatively safe for extended use in these subgroups, although careful monitoring is still recommended.
Hemodynamic and Electrocardiographic Effects
In terms of hemodynamic and electrocardiographic responses, lisinopril and hydrochlorothiazide have been shown to have different impacts. Hydrochlorothiazide tends to increase whole blood viscosity, while lisinopril tends to decrease it, although these changes are not statistically significant. Additionally, hydrochlorothiazide can induce hypokalemia, which may have arrhythmogenic potential, especially in the context of increased plasma epinephrine.
Comparative Efficacy and Side Effects
When comparing lisinopril alone to its combination with hydrochlorothiazide, the combination therapy appears to be more effective in lowering blood pressure. However, the incidence of side effects is similar between the two treatment regimens, with no major side effects reported. The combination therapy is particularly effective in patients with mild to moderate hypertension, showing significant reductions in both systolic and diastolic blood pressure.
Conclusion
The combination of lisinopril and hydrochlorothiazide is effective in managing hypertension but comes with a range of side effects, including dizziness, headache, cough, and metabolic changes such as altered serum potassium and glucose levels. Regular monitoring and individualized patient management are essential to mitigate these side effects and ensure the safe use of this combination therapy.
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