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Lisinopril and Hydrochlorothiazide

Lisinopril and hydrochlorothiazide is a combination ACE inhibitor and diuretic (water pill) used to treat high blood pressure.

Brand names PrinzideZestoretic
Drug class Thiazide Diuretic
Rx Form 1
Dr. Brian Staiger, PharmD, BCPS
Reviewed by Last reviewed Jul 10, 2026 Content updated Oct 2, 2026
🧬 Where this information comes from Click to expand

The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 82 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →

✓No current FDA shortage listed · checked Oct 5, 2026 🚨Recall on record
Lisinopril and Hydrochlorothiazide at a glance The quick version — the full detail is in the Patient Information Guide below.
Dr. Brian Staiger, PharmD, BCPS
The Pharmacist’s Take By · Clinical pharmacist · Written

Lisinopril and hydrochlorothiazide pairs an ACE inhibitor that relaxes blood vessels with a water pill that flushes salt and fluid. It is a familiar combination for high blood pressure when one medicine alone falls short, available generically and on the U.S. market since about 2002. Most people tolerate it well, though some notice dizziness on standing, especially early on, or a dry, nagging cough from the lisinopril. The boxed warning covers pregnancy, since it can injure or kill a developing baby, so stop it as soon as you know you are pregnant. Swelling of the face, lips, tongue or throat (angioedema) is rare, but it can come even after long use and needs emergency help.

Clinical pearls

  • Skip potassium supplements and potassium-based salt substitutes unless cleared, because lisinopril can raise potassium to dangerous levels.
  • For aches, avoid regular ibuprofen or naproxen, which weaken the blood pressure effect and can strain the kidneys.
  • If you take lithium, this combination can push lithium to dangerous levels, so your lithium blood levels need closer checks.
  • Long-term hydrochlorothiazide has been linked to squamous cell skin cancer, so use sunscreen and get new skin spots checked.
How we write & review this content — our editorial policy →
⚠️ FDA Boxed Warning — the FDA’s strongest safety alert ▾

Do not take this medication if you are pregnant, and stop taking it as soon as you find out you are pregnant. Lisinopril and hydrochlorothiazide work on a system in the body called the renin-angiotensin system. When used during the second or third trimester of pregnancy, drugs that affect this system can cause serious injury or death to the developing baby — including kidney failure, low blood pressure, abnormal skull development, and other severe complications. If no safer alternative exists and this drug must be used during pregnancy, close monitoring with ultrasound is essential.

Read the full warning on DailyMed →
How you get itPrescription only
Comes asTablet
Earliest FDA record2002
Companies listing it with the FDA22
FDA label last updatedMar 31, 2025
FDA’s strongest warning (boxed)Yes, read the warning

Patient information guide A plain-language walkthrough of Lisinopril and Hydrochlorothiazide, written from its FDA label.

What Lisinopril and Hydrochlorothiazide is used for

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Lisinopril and hydrochlorothiazide tablets are approved to treat high blood pressure (hypertension).

  • Zestoretic (oral tablet) is indicated for the treatment of hypertension to lower blood pressure
  • Lisinopril and hydrochlorothiazide tablets (oral, generic) are also indicated for the treatment of hypertension to lower blood pressure
  • Lowering blood pressure reduces the risk of fatal and non-fatal cardiovascular events, primarily strokes and heart attacks
  • Neither product is intended as a first treatment choice — this fixed-dose combination is used after a single medication alone has not been sufficient

How Lisinopril and Hydrochlorothiazide works

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Lisinopril blocks an enzyme called ACE (angiotensin-converting enzyme), which normally produces a substance called angiotensin II that tightens blood vessels. With less angiotensin II, blood vessels relax, reducing blood pressure. Hydrochlorothiazide is a thiazide diuretic — it helps the kidneys flush out extra salt and water, which also lowers blood pressure. Because hydrochlorothiazide can cause potassium loss, and lisinopril tends to retain potassium, the two drugs partially balance each other on electrolytes.

In clinical studies, their combined blood pressure-lowering effect was roughly additive. Black patients generally have a smaller response to lisinopril alone, though the 10/12.5 mg combination was found to work equally well across racial groups in trials.

Lisinopril and Hydrochlorothiazide dosage

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Both Zestoretic and lisinopril and hydrochlorothiazide tablets are taken once daily by mouth. Food does not affect absorption, so the tablet can be taken with or without a meal. Your prescriber will adjust the combination based on how your blood pressure responds — dose changes are typically made carefully over several weeks.

  • Do not use potassium supplements, salt substitutes containing potassium, or potassium-sparing diuretics unless your doctor specifically tells you to
  • If you are switching from a diuretic, your doctor may make adjustments to reduce the risk of low blood pressure after the first dose
  • In patients with reduced kidney function, your doctor will assess whether this combination is appropriate

Dosing details from the FDA-approved label

From the Lisinopril and Hydrochlorothiazide prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.

  • Hypertension - lisinopril monotherapy
    • Once-daily doses of 10 mg to 80 mg
  • Hypertension - hydrochlorothiazide monotherapy
    • 12.5 mg per day to 50 mg per day
  • Patient not adequately controlled on lisinopril or hydrochlorothiazide monotherapy (dose titration guided by clinical effect)
    • May be switched to lisinopril/HCTZ 10/12.5 or lisinopril/HCTZ 20/12.5, depending on current monotherapy dose
    • Further increases of either or both components should depend on clinical response
    • The hydrochlorothiazide dose should generally not be increased until 2 to 3 weeks have elapsed; after addition of the diuretic it may be possible to reduce the dose of lisinopril
  • Patients controlled on 25 mg of daily hydrochlorothiazide but with significant potassium loss
    • May be switched to lisinopril/HCTZ 10/12.5
  • Patients currently treated with a diuretic that cannot be discontinued
    • Initial dose of 5 mg of lisinopril under medical supervision for at least two hours and until blood pressure has stabilized for at least an additional hour
    • If possible, discontinue the diuretic for two to three days before beginning lisinopril; if blood pressure is not controlled with lisinopril alone, diuretic therapy may be resumed
  • Replacement therapy
    • The combination may be substituted for the titrated individual components
  • Renal impairment - creatinine clearance >30 mL/min/1.7m2 (serum creatinine roughly ≤3 mg/dL or 265 μmol/L)
    • Regimens of therapy with lisinopril/HCTZ need not take account of renal function
  • More severe renal impairment
    • Lisinopril/HCTZ is not recommended
    • Loop diuretics are preferred to thiazides
Read the label’s full dosing text

DOSAGE AND ADMINISTRATION Lisinopril monotherapy is an effective treatment of hypertension in once-daily doses of 10 mg to 80 mg, while hydrochlorothiazide monotherapy is effective in doses of 12.5 mg per day to 50 mg per day. In clinical trials of lisinopril/hydrochlorothiazide combination therapy using lisinopril doses of 10 mg to 80 mg and hydrochlorothiazide doses of 6.25 mg to 50 mg, the antihypertensive response rates generally increased with increasing dose of either component. The side effects (see WARNINGS ) of lisinopril are generally rare and apparently independent of dose; those of hydrochlorothiazide are a mixture of dose-dependent phenomena (primarily hypokalemia) and dose-independent phenomena (e.g., pancreatitis), the former much more common than the latter. Therapy with any combination of lisinopril and hydrochlorothiazide may be associated with either or both dose-independent or dose-dependent side effects, but addition of lisinopril in clinical trials blunted the hypokalemia normally seen with diuretics. To minimize dose-independent side effects, it is usually appropriate to begin combination therapy only after a patient has failed to achieve the desired effect with monotherapy. Dose Titration Guided by Clinical Effect A patient whose blood pressure is not adequately controlled with either lisinopril or hydrochlorothiazide monotherapy may be switched to Lisinopril and Hydrochlorothiazide Tablets 10-12.5 mg or Lisinopril and Hydrochlorothiazide Tablets 20-12.5 mg, depending on current monotherapy dose. Further increases of either or both components should depend on clinical response with blood pressure measured at the interdosing interval to ensure that there is an adequate antihypertensive effect at that time. The hydrochlorothiazide dose should generally not be increased until 2 to 3 weeks have elapsed. After addition of the diuretic it may be possible to reduce the dose of lisinopril. Patients whose blood pressures are adequately controlled with 25 mg of daily hydrochlorothiazide, but who experience significant potassium loss with this regimen, may achieve similar or greater blood pressure control without electrolyte disturbance if they are switched to Lisinopril and Hydrochlorothiazide Tablets 10-12.5 mg.

Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →

Lisinopril and Hydrochlorothiazide side effects

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Most side effects with lisinopril and hydrochlorothiazide are mild and tend to improve over time. The most commonly reported include:

Common side effects

  • Dizziness
  • Headache
  • Dry cough
  • Fatigue or weakness
  • Nausea or vomiting
  • Muscle cramps
  • Diarrhea
  • Orthostatic effects (lightheadedness when standing up)
  • Rash

When to get medical help

  • Get emergency help right away if you have swelling of the face, lips, tongue, throat, or hands — this could be angioedema (severe swelling) and can be life-threatening
  • Call your doctor if you faint or feel severely dizzy, especially after starting treatment or after a dose change
  • Call your doctor if you develop yellowing of the skin or eyes (jaundice) — a rare sign of liver injury
  • Tell your doctor right away if you have sudden eye pain or vision changes — a rare reaction from hydrochlorothiazide that can cause acute glaucoma
  • Stop taking this medication and contact your doctor immediately if you become pregnant
  • Call your doctor if you notice signs of high potassium (muscle weakness, irregular heartbeat) or low potassium (muscle cramps, weakness)

Serious reactions — including severe swelling of the face, lips, tongue, or throat (angioedema), sudden vision changes, fainting, or signs of liver problems (jaundice) — require immediate medical attention. Hydrochlorothiazide has also been associated with an increased risk of squamous cell skin cancer with long-term use, particularly in white patients taking high cumulative doses.

Lisinopril and Hydrochlorothiazide warnings and precautions

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Fetal toxicity is the most critical warning. This medication must be stopped as soon as pregnancy is detected. Use during the second and third trimesters can severely damage the baby's kidneys and cause low blood pressure, skull defects, and death. Women of childbearing age should use reliable contraception and notify their doctor immediately if they become pregnant.

  • Angioedema: Rare but potentially fatal swelling of the face, tongue, throat, or intestines can occur at any time — even after years of use. Black patients face a higher risk. Seek emergency help immediately if this occurs.
  • Acute angle-closure glaucoma: Hydrochlorothiazide can rarely trigger sudden eye pain and vision loss — stop the medication and seek urgent eye care.
  • Low blood pressure (hypotension): Most likely after the first dose or in patients who are dehydrated or on other diuretics. Rise slowly from sitting or lying positions.
  • Kidney function: Can worsen in patients with severe kidney disease, renal artery narrowing, or when combined with NSAIDs.
  • Skin cancer risk: Hydrochlorothiazide has been linked to an increased risk of squamous cell skin cancer with large cumulative doses, primarily in white patients. Use sun protection and have regular skin checks.
  • Liver injury: Rarely, ACE inhibitors have caused serious liver damage. Stop the medication and seek care if jaundice develops.

Lisinopril and Hydrochlorothiazide interactions

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This combination can interact with several common medications and substances — always share your full medication list with your doctor and pharmacist.

  • NSAIDs (ibuprofen, naproxen, COX-2 inhibitors): Can reduce blood pressure-lowering effects and worsen kidney function, especially in older or dehydrated patients
  • Potassium supplements or potassium-sparing diuretics (spironolactone, amiloride, triamterene): Can raise potassium to dangerous levels — avoid unless specifically prescribed
  • Lithium: Diuretics reduce lithium clearance; ACE inhibitors add to that risk — lithium toxicity is possible and monitoring is essential
  • Aliskiren: Must not be combined in patients with diabetes; also avoid in kidney impairment
  • Sacubitril/valsartan (Entresto): Do not take within 36 hours of switching to or from this drug — high angioedema risk
  • mTOR inhibitors (sirolimus, everolimus, temsirolimus): Increase the risk of angioedema when combined with ACE inhibitors
  • Alcohol, barbiturates, or opioids: Can increase lightheadedness and low blood pressure when standing
  • Cholestyramine or colestipol: These cholesterol-lowering resins can significantly reduce hydrochlorothiazide absorption — take the tablet at a separate time

Interactions listed in the FDA-approved label

From the Lisinopril and Hydrochlorothiazide prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.

  • Diuretics (lisinopril): Patients on diuretics, especially those recently started, may occasionally experience an excessive reduction of blood pressure after initiation of lisinopril. Discontinue the diuretic or increase salt intake before starting lisinopril; if the diuretic must continue, start lisinopril at 5 mg daily with close medical supervision for at least two hours and until blood pressure has stabilized for at least an additional hour.
  • NSAIDs including selective COX-2 inhibitors: In patients who are elderly, volume-depleted, or with compromised renal function, co-administration may result in deterioration of renal function, including possible acute renal failure, and may attenuate the antihypertensive effect; NSAIDs can also reduce the diuretic, natriuretic, and antihypertensive effects of thiazide diuretics. Monitor renal function periodically; observe the patient closely to determine if the desired antihypertensive effect is obtained.
  • Dual blockade of the RAS (angiotensin receptor blockers, ACE inhibitors, aliskiren): Associated with increased risk of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy. Avoid combined use of RAS inhibitors and closely monitor blood pressure, renal function, and electrolytes; do not co-administer aliskiren in patients with diabetes; avoid aliskiren in patients with renal impairment (GFR < 60 mL/min).
  • Nitrates, digoxin, propranolol: Lisinopril has been used concomitantly with nitrates and/or digoxin without evidence of clinically significant adverse interactions; no meaningful clinically important pharmacokinetic interactions occurred with propranolol, digoxin, or hydrochlorothiazide.
  • Potassium-sparing diuretics (spironolactone, eplerenone, triamterene, amiloride), potassium supplements, potassium-containing salt substitutes: May lead to significant increases in serum potassium; lisinopril attenuates potassium loss caused by thiazide-type diuretics. If concomitant use is indicated because of demonstrated hypokalemia, use with caution and frequent monitoring of serum potassium.
  • Lithium: Lithium toxicity has been reported with ACE inhibitors; diuretic agents reduce the renal clearance of lithium and add a high risk of lithium toxicity. Monitor serum lithium levels frequently; lithium should not generally be given with diuretics.
  • mTOR inhibitors (temsirolimus, sirolimus, everolimus) and neprilysin inhibitors: Patients may be at increased risk for angioedema.
  • Alcohol, barbiturates, or narcotics: Potentiation of orthostatic hypotension may occur.
  • Antidiabetic drugs (oral agents and insulin): Dosage adjustment of the antidiabetic drug may be required.
  • Cholestyramine and colestipol resins: Absorption of hydrochlorothiazide is impaired; single doses reduce its absorption from the gastrointestinal tract by up to 85 percent and 43 percent, respectively.
Read the label’s full interactions text

Drug Interactions Lisinopril Hypotension - Patients on Diuretic Therapy: Patients on diuretics, and especially those in whom diuretic therapy was recently instituted, may occasionally experience an excessive reduction of blood pressure after initiation of therapy with lisinopril. The possibility of hypotensive effects with lisinopril can be minimized by either discontinuing the diuretic or increasing the salt intake prior to initiation of treatment with lisinopril. If it is necessary to continue the diuretic, initiate therapy with lisinopril at a dose of 5 mg daily, and provide close medical supervision after the initial dose for at least two hours and until blood pressure has stabilized for at least an additional hour (see WARNINGS , and DOSAGE AND ADMINISTRATION ). When a diuretic is added to the therapy of a patient receiving lisinopril, an additional antihypertensive effect is usually observed (see DOSAGE AND ADMINISTRATION ). Non-Steroidal Anti-Inflammatory Agents including Selective Cyclooxygenase-2 Inhibitors (COX-2 Inhibitors) : In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, co-administration of NSAIDs, including selective COX-2 inhibitors, with ACE inhibitors, including lisinopril, may result in deterioration of renal function, including possible acute renal failure. These effects are usually reversible. Monitor renal function periodically in patients receiving lisinopril and NSAID therapy. The antihypertensive effect of ACE inhibitors, including lisinopril, may be attenuated by NSAIDs. Dual Blockade of the Renin-Angiotensin-System (RAS) Dual blockade of the RAS with angiotensin receptor blockers, ACE inhibitors, or aliskiren is associated with increased risk of hypotension, hyperkalemia, and changes in renal function (including acute renal failure) compared to monotherapy.

Excerpted — the section continues on the label. Read the full Drug Interactions section on DailyMed →

Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.

🌿236 supplements and herbs with documented Lisinopril and Hydrochlorothiazide interactions, ranked by severity Check Lisinopril and Hydrochlorothiazide against a supplement or herb →

Before taking Lisinopril and Hydrochlorothiazide

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  • Tell your doctor if you have ever had angioedema — from any cause, not just from an ACE inhibitor — as your risk is higher with this medication
  • Tell your doctor if you are allergic to sulfonamide-based medications — hydrochlorothiazide is derived from that class
  • Do not take this medication if you are pregnant; stop it immediately if you become pregnant
  • Breastfeeding: hydrochlorothiazide passes into breast milk; discuss risks with your doctor
  • Kidney disease: this combination is not recommended when kidney function is severely reduced (creatinine clearance below 30 mL/min)
  • Liver disease: use with caution — fluid and electrolyte changes can trigger serious problems in patients with liver impairment
  • Older adults tend to have higher drug levels in the body; closer monitoring may be needed
  • Black patients have a higher risk of angioedema with ACE inhibitors and may respond differently — your doctor will take this into account
  • Children: the label does not establish safety and effectiveness in pediatric patients

Lisinopril and Hydrochlorothiazide overdose

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The most likely effects of taking too much of this combination are a severe drop in blood pressure (from lisinopril) and electrolyte imbalances such as low potassium, low sodium, and dehydration (from hydrochlorothiazide). If an overdose is suspected, stop the medication, seek medical attention immediately, and treatment will focus on supportive care — including fluids and monitoring. Lisinopril can be removed by hemodialysis if needed.

What Lisinopril and Hydrochlorothiazide does in the body

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In patients with high blood pressure, lisinopril lowers blood pressure in both lying-down and standing positions without causing a compensatory increase in heart rate. Blood pressure begins to fall within about one hour of an oral dose, with the peak effect typically reached around six hours. The effect of a single daily dose generally lasts at least 24 hours, though the effect is strongest in the first several hours after dosing. Some patients may need two to four weeks of treatment to reach their optimal blood pressure reduction.

How your body processes Lisinopril and Hydrochlorothiazide

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After taking lisinopril by mouth, peak blood levels are reached in about 7 hours. Lisinopril is not broken down by the body — it leaves unchanged through the kidneys. Its effective half-life (how long it takes the body to clear half the drug with regular dosing) is about 12 hours. Kidney impairment slows elimination and raises drug levels, which matters most when kidney function drops below a certain threshold. Older adults tend to have roughly double the drug exposure compared to younger patients. Food does not affect how well lisinopril is absorbed.

How to store Lisinopril and Hydrochlorothiazide

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Store at 20° to 25°C (68° to 77°F) . Protect from excessive light and humidity.

Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →

236

Supplements & herbs that interact with Lisinopril and Hydrochlorothiazide

236 supplements and herbal products have documented interactions with Lisinopril and Hydrochlorothiazide in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.

Severity mix
  • Major · 10
  • Moderate · 199
  • Minor · 27
ACTIVATED CHARCOAL Major AMERICAN HELLEBORE Major AMERICAN MISTLETOE Major ASARABACCA Major DOLOMITE Major LITHIUM Major OLEANDER Major SIBERIAN COCKLEBUR Major +228 more
Every supplement checked against Lisinopril and Hydrochlorothiazide — ranked by severity The full interaction hub: 10 major · 199 moderate · 27 minor · every one linked to its full report. Check Lisinopril and Hydrochlorothiazide against your exact supplements

Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.

8

Nutrient depletion considerations

Lisinopril and Hydrochlorothiazide has been associated with lower levels of 8 nutrients in the clinical literature. This does not mean a deficiency will occur — it means these may be worth discussing with your pharmacist or healthcare provider, especially with long-term use.

Evidence & significance mix
  • Higher significance · 2
  • Moderate · 3
  • Unrated · 3
POTASSIUM Major Depletion VITAMIN C Insignificant Depletion MAGNESIUM Moderate Depletion THIAMINE Moderate Depletion ZINC Moderate Depletion COENZYME Q10 Insufficient Evidence FOLIC ACID Insufficient Evidence SODIUM Insufficient Evidence
See the full Lisinopril and Hydrochlorothiazide nutrient depletion report

Educational information from a licensed clinical database (Natural Medicines) — not medical advice. Do not start or stop medications or supplements without professional guidance.

Lisinopril and Hydrochlorothiazide: pharmacist answers to common questions

Quick, plain-English answers to the questions patients ask most about Lisinopril and Hydrochlorothiazide — the kind of thing our pharmacy team would talk through with you at the counter.

What exactly is this medication doing for me — why do I need two drugs in one pill?

▾
Great question. Lisinopril relaxes your blood vessels by blocking a chemical that causes them to tighten. Hydrochlorothiazide helps your kidneys remove extra salt and fluid. Together, they lower your blood pressure more effectively than either one alone. Doctors typically prescribe this combination after one medication hasn't been enough to reach your blood pressure goal.

I've noticed a dry, nagging cough since I started this. Is that from the medication?

▾
Yes, that cough is a known side effect of the lisinopril part of this combination. It's not dangerous, but it can be really annoying. Don't just stop the medication on your own — talk to your doctor. They may consider switching you to a different type of blood pressure medication if the cough is bothering you.

What should I watch out for that would mean I need to call 911 or go to the ER?

▾
The most important one is sudden swelling of your face, lips, tongue, or throat — that's called angioedema and it can block your airway. Get emergency help immediately if that happens. Also seek urgent care if you have sudden eye pain or vision changes, or if you feel like you're going to faint and can't recover quickly. These are rare but serious and need attention right away.

Can I take ibuprofen or other over-the-counter pain relievers with this medication?

▾
It's best to check with your doctor or pharmacist before using NSAIDs like ibuprofen or naproxen (Advil, Motrin, Aleve). These pain relievers can reduce how well your blood pressure medication works and can also put extra strain on your kidneys — especially if you're older or tend to get dehydrated. Acetaminophen (Tylenol) is generally a safer option for pain, but always ask to be sure.

Is it safe to take this medication if I'm pregnant or trying to get pregnant?

▾
This is really important: you should NOT take this medication during pregnancy. It can cause serious harm or even death to a developing baby, particularly in the second and third trimesters. If you're planning to become pregnant, talk to your doctor now so they can switch you to a safer blood pressure medication. And if you find out you're pregnant while taking this, stop it and call your doctor right away.

Do I need to watch what I eat or drink while taking this?

▾
A few things to keep in mind: avoid using salt substitutes that contain potassium — they can push your potassium too high when combined with this medication. Alcohol can make low blood pressure effects worse, especially that lightheaded feeling when you stand up. Food doesn't affect how well the medication works, so you can take it with or without a meal — whatever works best for your routine.

Is Lisinopril and Hydrochlorothiazide available over the counter?

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No. Lisinopril and Hydrochlorothiazide is a prescription medicine: every Lisinopril and Hydrochlorothiazide product listed with the FDA is prescription only, so it is not sold over the counter. Your prescriber decides whether it is appropriate for you, and your pharmacist dispenses it.

When was Lisinopril and Hydrochlorothiazide first available?

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The earliest FDA record we hold for Lisinopril and Hydrochlorothiazide is from 2002: its first approval in Drugs@FDA or its earliest product listing in the NDC Directory, whichever is older. Many older medicines were in use before their first formal FDA approval, so this is the earliest date on record, not necessarily when Lisinopril and Hydrochlorothiazide was first used.

Who makes Lisinopril and Hydrochlorothiazide?

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22 companies currently list Lisinopril and Hydrochlorothiazide products in the FDA's NDC Directory, including A-S Medication Solutions, Bryant Ranch Prepack, NuCare Pharmaceuticals,Inc.. That count includes repackagers and distributors as well as manufacturers (companies that sell only the raw ingredient are not counted), so fewer companies actually make it; the label on your bottle names the one that supplied yours.

Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →

More about Lisinopril and Hydrochlorothiazide on HelloPharmacist

📊Lisinopril and Hydrochlorothiazide supplement interactions236 checked — ranked by severity 🌿Drug & Supplement CheckerLisinopril and Hydrochlorothiazide vs. vitamins & herbs 💬Ask a PharmacistFree answer, usually < 24h 🔎NDC & pricing lookupFind Lisinopril and Hydrochlorothiazide NDCs & costs 🅰️Browse Drugs A–ZLook up any medication
Detailed data & references for Lisinopril and Hydrochlorothiazide Forms & strengths, pricing, billing codes, manufacturers, safety reports and sourcing — the data behind the page. Most people can stop here. Each section below opens on a tap.

Lisinopril and Hydrochlorothiazide forms and strengths (how it comes)

Lisinopril and Hydrochlorothiazide is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.

Tablet

By mouth
Brands Zestoretic
How this form is used
What it may be used for
  • Zestoretic (lisinopril/hydrochlorothiazide) oral tablet is used to treat high blood pressure (hypertension)
  • Lisinopril and hydrochlorothiazide oral tablet is used to treat high blood pressure (hypertension)
  • Both products are used when a single blood pressure medication has not been adequate — not as initial therapy
  • Lowering blood pressure with these tablets reduces the risk of stroke and heart attack
Important instructions
  • Zestoretic and lisinopril and hydrochlorothiazide tablets are taken by mouth once daily
  • These tablets may be taken with or without food
  • Do not use potassium supplements or salt substitutes containing potassium unless directed by your doctor
  • Follow your prescriber's dosing instructions closely; do not stop or change your dose without guidance
Available strengths 6 strengths
10 mg / 12.5 mg 12.5 mg / 10 mg 12.5 mg / 20 mg 20 mg / 12.5 mg 20 mg / 25 mg 25 mg / 20 mg
211 FDA-listed product records ⓘ

Lisinopril and Hydrochlorothiazide on the U.S. market: products, makers and brands

How Lisinopril and Hydrochlorothiazide appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.

22 companies list 94 Lisinopril and Hydrochlorothiazide product records with the FDA, mostly as tablet; the earliest marketing or approval year on record is 2002. Brand names on the directory include Prinzide, Zestoretic; the rest are generics.

1
Dose forms ⓘ
22
Labelers (makers, repackagers, distributors)
2
Brand names
94
FDA-listed product records ⓘ
2002
Earliest FDA record ⓘ
A-S Medication Solutions12%
Bryant Ranch Prepack10%
NuCare Pharmaceuticals,Inc.10%
Proficient Rx LP7%
Aphena Pharma Solutions - Tennessee, LLC6%
Preferred Pharmaceuticals Inc.6%
Other makers49%

Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.

How widely Lisinopril and Hydrochlorothiazide is used (Medicaid data)

A general measure of how commonly Lisinopril and Hydrochlorothiazide is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.

Think of this as a proxy for how widely Lisinopril and Hydrochlorothiazide is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.

999,534
Medicaid prescriptions filled (Q1–Q4 2025)
$9.2M gross Medicaid reimbursement (before mandatory rebates — net cost is lower)

How commonly is Lisinopril and Hydrochlorothiazide prescribed? Of the 1,601 medications we measure, Lisinopril and Hydrochlorothiazide ranks #178 by Medicaid prescriptions — more than 89% of them.

Where Lisinopril and Hydrochlorothiazide ranks among the drugs we measure · Q1–Q4 2025 · neighbors ±5
Total prescriptions — #178 of 1,601
#173 Paliperidone 1,015,111 Rx #174 Levocetirizine 1,014,061 Rx #175 Ethinyl Estradiol / Fe... 1,010,948 Rx #176 Clotrimazole Topical 1,007,055 Rx #177 Insulin Aspart (rDNA O... 1,003,363 Rx #178 Lisinopril and Hydroch... 999,534 Rx #179 Naloxone 980,072 Rx #180 Oxybutynin 974,653 Rx #181 Naloxone Nasal Spray 970,105 Rx #182 Budesonide 967,284 Rx #183 Ciprofloxacin 959,810 Rx

Utilization by Lisinopril and Hydrochlorothiazide product

Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.

The 12.5 mg / 20 mg oral tablet is the most-dispensed Lisinopril and Hydrochlorothiazide product — about 38% of these Medicaid prescriptions.

hydrochlorothiazide 12.5 MG / lisinopril 20 MG Oral Tablet Most dispensed

377,091 Medicaid prescriptions (Q1–Q4 2025) 38% of Lisinopril and Hydrochlorothiazide prescriptions shown $3.7M gross reimbursement (before rebates) ≈ $9.75 per prescription (gross)

Summed across the 10 of 165 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197886

hydrochlorothiazide 25 MG / lisinopril 20 MG Oral Tablet

360,912 Medicaid prescriptions (Q1–Q4 2025) 36% of Lisinopril and Hydrochlorothiazide prescriptions shown $3.3M gross reimbursement (before rebates) ≈ $9.19 per prescription (gross)

Summed across the 11 of 129 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197887

hydrochlorothiazide 12.5 MG / lisinopril 10 MG Oral Tablet

261,531 Medicaid prescriptions (Q1–Q4 2025) 26% of Lisinopril and Hydrochlorothiazide prescriptions shown $2.2M gross reimbursement (before rebates) ≈ $8.52 per prescription (gross)

Summed across the 8 of 140 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197885

Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.

Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Lisinopril and Hydrochlorothiazide, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 29 of 434 listed Lisinopril and Hydrochlorothiazide NDCs with Medicaid activity.

Compare Lisinopril and Hydrochlorothiazide products

A representative set of FDA-listed product records for Lisinopril and Hydrochlorothiazide — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)

Showing 94 of 94 products — FDA National Drug Code Directory. See every product, package size and price: browse all 94 Lisinopril and Hydrochlorothiazide NDCs →

Lisinopril and Hydrochlorothiazide side effects reported to the FDA (FAERS)

After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Lisinopril and Hydrochlorothiazide — a signal of what to watch for, not proof the drug caused it.

The effects most often named in FDA reports that mention Lisinopril and Hydrochlorothiazide are nausea, fatigue, diarrhoea; about 61% of the reports were classed as serious. These are voluntary reports, so they show what people report, not how often it happens.

10,177
Reports mentioning it
61%
Reported as serious
12
Distinct effects shown
Most reported effects
Nausea
685
Fatigue
672
Diarrhoea
609
Pain
498
Dizziness
491
Dyspnoea
437
Headache
433
Asthenia
369
Vomiting
356
Cough
348
Age groups
Elderly · 585Adult · 576Adolescent · 2Infant · 1

Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Lisinopril and Hydrochlorothiazide in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.

Lisinopril and Hydrochlorothiazide recall history

A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.

The FDA’s enforcement reports list 2 Lisinopril and Hydrochlorothiazide recalls since July 2021. One of them is still ongoing and is listed first. A recall names specific lots from one company, so check the lot number on your own bottle rather than assuming every product is affected; your pharmacist can check whether your supply came from an affected lot.

Ongoing Class II Jun 20, 2025 · Lupin Pharmaceuticals Inc.
Product Mix Up: This product is being recalled because of a complaint received that a sealed bottle of lisinopril and hydrochlorothiazide tablets 20mg/12.5 mg had a foreign tablet identified as atazanavir and ritonavir tablet 300mg/100mg.
  • Lisinopril and Hydrochlorothiazide Tablets USP 20mg/12.5mg, 100-count bottles, Rx only, Mfg for: Lupin Pharmaceuticals, Inc. Baltimore, MD 21202, Manufactured by: Lupin Limited Nagpur-441 108, INDIA,… Lots: Lot #: QA01081, Exp. Date April 2027 FDA record D-0532-2025 →
Class II Jan 26, 2022 · Terminated · CARDINAL HEALTHCARE
CGMP Deviations: Products were exposed to temperatures outside of the products labeled storage conditions.
  • Lisinopril and Hydrochlorothiazide Tablets USP, 10mg/12.5mg, Rx only, 100 Tablets per bottles, Manufactured for: Lupin Pharmaceuticals, Inc., Baltimore, Maryland 21202; Manufactured by: Lupin Limited… Lots: Batch Q101699, Q101981 FDA record D-0188-2024 →

Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.

💵 What Lisinopril and Hydrochlorothiazide costs pharmacies (NADAC benchmark)

The national average invoice price pharmacies pay for the drug itself, from CMS's NADAC survey (data as of Sep 30, 2026). This is a supply-cost benchmark — not a retail price and not what you'd pay at the counter.

FormStrengthPharmacy acquisition benchmark
Tablet · Oral 12.5; 10 mg/1; mg $0.029 per tablet NDC details & price history
Tablet · Oral 12.5; 20 mg/1; mg $0.036 per tablet NDC details & price history
Tablet · Oral 25; 20 mg/1; mg $0.041 per tablet NDC details & price history
Tablet · Oral LISINOPRIL 20 mg/1; HYDROCHLOROTHIAZIDE 12.5 mg $0.036 per tablet NDC details & price history
Tablet · Oral LISINOPRIL 10 mg/1; HYDROCHLOROTHIAZIDE 12.5 mg $0.029 per tablet NDC details & price history
Tablet · Oral LISINOPRIL 20 mg/1; HYDROCHLOROTHIAZIDE 25 mg $0.041 per tablet NDC details & price history
Tablet LISINOPRIL 20 mg/1; HYDROCHLOROTHIAZIDE 12.5 mg $0.036 per tablet NDC details & price history
Tablet LISINOPRIL 20 mg/1; HYDROCHLOROTHIAZIDE 25 mg $0.041 per tablet NDC details & price history
Tablet LISINOPRIL 10 mg/1; HYDROCHLOROTHIAZIDE 12.5 mg $0.029 per tablet NDC details & price history
Why show this? Your out-of-pocket cost depends on insurance, pharmacy markup, and discounts — but the acquisition benchmark tells you whether the medication itself is inexpensive or costly, which strengths cost more per dose, and whether a cash-price quote is in a reasonable range. Each row links to the NDC-level record with its full price history.

Source: CMS National Average Drug Acquisition Cost (NADAC), a survey of retail pharmacy invoice prices. Benchmarks shown are the range across package sizes of a representative product for each form and strength — other manufacturers' products may differ.

Lisinopril and Hydrochlorothiazide brand names

Lisinopril and Hydrochlorothiazide is sold under 2 brand names in the FDA directory — Prinzide, Zestoretic. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.

Prinzide Zestoretic

Who makes Lisinopril and Hydrochlorothiazide: manufacturers and labelers

22 companies list Lisinopril and Hydrochlorothiazide products with the FDA. By number of product records, the largest are A-S Medication Solutions, Bryant Ranch Prepack, NuCare Pharmaceuticals,Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.

A-S Medication Solutions 11 Bryant Ranch Prepack 9 NuCare Pharmaceuticals,Inc. 9 Proficient Rx LP 7 Aphena Pharma Solutions - Tennessee, LLC 6 Preferred Pharmaceuticals Inc. 6 Remedyrepack Inc. 5 Northwind Health Company, LLC 4 Actavis Pharma, Inc. 3 Almatica Pharma Inc. 3 Aurobindo Pharma Limited 3 Cipla USA Inc. 3 Exelan Pharmaceuticals, Inc. 3 GSMS, Incorporated 3 Legacy Pharmaceutical Packaging, LLC 3 Lupin Pharmaceuticals, Inc. 3 PD-Rx Pharmaceuticals, Inc. 3 St. Mary's Medical Park Pharmacy 3 Solco Healthcare LLC 3 QPharma Inc 2 Advanced Rx Pharmacy of Tennessee, LLC 1 Coupler LLC 1

Lisinopril and Hydrochlorothiazide drug class (RxNorm)

Lisinopril and Hydrochlorothiazide belongs to the Angiotensin Converting Enzyme Inhibitor class.

Pharmacologic class Angiotensin Converting Enzyme Inhibitor
Drug family (ATC) ACE inhibitors, plain
How it works Angiotensin-converting Enzyme Inhibitors

Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.

Sources for this Lisinopril and Hydrochlorothiazide page

Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.

📄
FDA-filed drug labels (SPL) Uses, dosing, warnings & side effects from SPL records retrieved through openFDA; the linked representative set can be verified on DailyMed. ✓ Linked label effective Mar 31, 2025
🏭
Forms, brands & labelersAggregated from ingredient-matched FDA National Drug Code Directory product records for Lisinopril and Hydrochlorothiazide.
📈
Real-world reportsThe FDA Adverse Event Reporting System (FAERS), served through openFDA.
🚨
Recalls & shortagesopenFDA drug-enforcement reports and the FDA drug-shortage database.
🧾 Clinical label set — FDA-filed SPL labels retained for Lisinopril and Hydrochlorothiazide after exact ingredient or ingredient-combination matching and applicable route/form matching
Clinical labels in scope
82
Finished products in the current FDA directory
94
Companies listing them (makers, repackagers, distributors)
22
FDA labeler codes behind them ⓘ
25
Linked representative label ⓘ
Almatica Pharma Inc.
Linked label effective
Mar 31, 2025
Composite sections available
18
Linked SPL Set ID
0d3a966f-f937-05a8-a90f-5aa52ebbd613
Linked SPL Document ID
b8a81227-c1af-6093-4d92-647ad3fee155
Open the linked representative label on DailyMed ↗

How this page is built

HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. Almatica Pharma Inc. is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →