Data provided by Applied Health
side effects, nutrient depletions, herbal interactions and health notes:
• Zestoretic (lisinopril/hydrochlorothiazide) may deplete magnesium levels. Lisinopril in this combination is associated with potassium retention, however, the hydrochlorothiazide may cause depletion of potassium. Seek medical advice before supplementing potassium or magnesium.1
• Other nutrients may be lost due to increased urinary excretion. Sodium, zinc, and B1 may be depleted with long term use. Consult with your pharmacist for more information about vitamin and mineral supplementation.2
• Zestoretic may interact with the herbs: Alfalfa, Angelica, Astragalus, Basil, Bean Pod, Buckthorn, Burdock, Butcher’s Broom, Buchu, Celery, Cleavers, Cornflower, Dandelion, Elecampane, Elder, Goat's Rue, Hempnettle, Horsetail, Indian-Hemp, Juniper, Marigold, Meadowsweet, Parsley, Rauwolfia, Sarsaparilla, Sweet clover, Turmeric, and Vervain to increase diuretic effects.3
• Cascara Sagrada, Rhubarb and Senna may increase potassium loss . Do not use these together with zestoretic without first consulting a doctor or pharmacist.4
• Avoid natural Licorice products, Ginsengs, and Ephedra (Ma huang) with zestoretic, they may interfere with antihypertensive therapy.5
• These herbs may have cardiac properties: black hellebore, calamus, cereus, cola, coltsfoot, devil's claw, European mistletoe, fenugreek, fumitory, digitalis leaf, hedge mustard, figwort, lily of the valley roots, motherwort, pleurisy root, squill bulb leaf scales, white horehound, mate, scotch broom flower, shepherd's purse, and wild carrot. These could intensify the effects of Zestoretic. Avoid their use together.6
References1 Whang R, Whang DD, Ryan MP. Refractory potassium repletion-a consequence of magnesium deficiency. Arch Intern Med 1992;152:40-45.
1 Martin B, Milligan K. Diuretic-associated hypomagnesiumia in the elderly. Arch Intern Med 1987;147:1768-71.
1 Quamme GA: Renal magnesium handling - New insights in understanding old problems, Kidney Int, 1997, 52(5):1180-95.
1 Schwinger RH, Erdmann E: Heart failure and electrolyte disturbances, Methods Find Exp Clin Pharmacol, 1992, 14(4):315-25.
1 Linderman RD: Hypokalemia - causes, consequences, and correction, Am J Med Sci, 1976, 272(1):5-17.
1 Lucker PW, Witzmann HK: Influence of magnesium and potassium deficiency on renal elimination and cardiovascular function demonstrated by impedance cardiography, Magnesium, 1984, 3(4-6):265-73.
1 Petri M, Cumber P, Grimes L, Treby D, Bryant R, Rawlins D, Ising H. The metabolic effects of thiazide therapy in the elderly: a population study. Age Ageing. 1986 May;15(3):151-5.
2 Roe, DA: Handbook on Drug and Nutrient Interactions, 5th edition, 1994.
2 Brady JA, Rock CL, Horneffer MR: Thiamin status, diuretic medications, and the management of congestive heart failure, J Am Diet Assoc, 1995, 95(5):541-4.
2 Wester PO: Urinary zinc excretion during treatment with different diuretics, Acta Med Scand, 1980, 208(3):209-12.
2 Reyes AJ, Leary WP, Lockett CJ, et al. Diuretics and zinc. S Afr Med J 1982;62:373-75.
2 Greenberg A. Diuretic complications. Am J Med Sci. 2000 Jan;319(1):10-24. Review.
2 Facts and Comparisons, Clinisphere 2.0, Wolters Kluwer Company, 2000
3 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996.
3 PDR for Herbal Medicines, 2nd edition, Medical Economics Company, 2000
4 De Smet PAGM et al: Adverse effects of herbal drugs 2, 1993.
4 Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
4 PDR for Herbal Medicines, 2nd edition, Medical Economics Company, 2000
5 Wichtl M: Herbal Drugs and Phytopharmaceuticals, 1994.
5 Shintani S, Murase H, Tsukagoshi H, Shiigai T. Glycyrrhizin (licorice)-induced hypokalemic myopathy. Report of two cases and review of the literature. Eur Neurol 1992;32:44-51.
5 Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.
5 Brinker, F Herb Contraindications and Drug Interactions, Eclectic Medical Publications, 1998
6 Newall CA, Anderson LA, Phillipson JD. Herbal Medicines A Guide for Health-care Professionals. London: The Pharmaceutical Press, 1996.
6 PDR for Herbal Medicines, 2nd edition, Medical Economics Company, 2000
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The information in Drug Watch is provided as a courtesy to NewsTarget readers by Applied Health Solutions in cooperation with Healthway Solutions. Although the information is presented with scientific references, we do not wish to imply that this represents a comprehensive list of considerations about any specific drug, herb or nutrient. Nor should this information be considered a substitute for the advice of your doctor, pharmacist, or other healthcare practitioner. Please read the disclaimer about the intentions and limitations of the information provided on these pages. It is important to tell your doctor and pharmacist about all other drugs and nutritional supplements that you are taking if they are recommending a new medication. Copyright © 2007 by Applied Health Solutions, Inc. All rights reserved.