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Order lisinopril hydrochlorothiazide at doses of 2.4 to 4.4mg/day (500 1500mg/day) or 600mg/24hr (500mg/24hr). This was initially given to patients who had failed respond to lisinopril in the previous course of treatment. Since that time, lisinopril hydrochlorothiazide has been withdrawn due to an increased risk of major cardiac events. At present it is prescribed for the treatment of moderate/severe migraine headaches. The side-effects of lisinopril hydrochlorothiazide (LHT) have been summarised at: 1: The most striking effect, in terms of its clinical significance, is the increase in frequency of postural tachycardia, which is the most significant predictor of future cardiac events. This effect is dose dependent. 2: When given with an antiarrhythmic drug, the patient often develops ventricular arrhythmias. 3: During the first week after taking lisinopril, the plasma concentrations of all prothrombin inactive substances begin to rise and patients develop signs symptoms of a thrombus (thrombosis) the aorta. 4: Lisinopril hydrochlorothiazide has been associated with a threefold increased risk of first myocardial infarction (MI). This risk does not decrease during long-term treatment with the drug. There have been reports of increased myocardial infarction in patients taking lisinopril. 5: Long-term use of lisinopril hydrochlorothiazide has been associated with an increased Hydrochlorothiazide 12.5mg $60.42 - $0.34 Per pill tendency to develop congestive heart failure, angina pectoris, and cardiovascular death. 6: In the elderly, use of LHT may lead to an increased risk of myocardial infarction in elderly patients. 7: It is possible that patients with hypercoagulation, a high level of plasma proteins, and/or other predisposing genetic factors may be prone to developing serious cardiac events during long-term treatment with LHT. The risk of acute myocardial infarction and its complications increases with each dose of lisinopril hydrochlorothiazide. The incidence serious cardiac complications was threefold greater after a single oral dose of lisinopril hydrochlorothiazide in the study by Zang et al. than after a similar dose taken 30 min before a test of cardiopulmonary function. The most common adverse effects were headache (about one in every three patients), nausea, vomiting, and dizziness. There were more nausea-dependent nausea-promoting effects at doses of 1.6mg daily. The patient must continue to take lisinopril hydrochlorothiazide for at least six months after discontinuation of its use. The most commonly observed adverse effects included headache, nausea, nausea-like effects, drowsiness and insomnia. Lisinopril hydrochlorothiazide (LHT) has been found to be associated with a 3.8-fold increased risk of first myocardial infarction compared to placebo; a 2.3-fold increased risk of stroke; and a 4.2-fold increased risk of coronary heart disease. Clinical trials of LHT in the elderly LICENSURE Patients who are not already taking a prothrombin (antiarrhythmic) drug, or those who are at risk of a myocardial infarction, should not receive oral lisinopril hydrochlorothiazide (LHT) AUTHORITY TO PROSCRIBE The Australian Therapeutic Goods Administration has approved LHT as a medicine and it is dispensed by all pharmacies in Australia. PACKAGE FORMULA Lisinopril hydrochlorothiazide Tablets, single Dose for the treatment of migraine headaches (500 mg every 24 hours) Parenteral (injectable) preparation (500 mg/15ml/5mg), intramuscular (IM) or epidural (EP) IM IM administration should be used when LHT is contraindicated according to the manufacturer's directions. EP EP administration should be used when LHT is contraindicated according to the manufacturer's directions. Dosing All doses below are for the treatment of migraine headaches and must be followed exactly as prescribed. If the patient is using a lower dose, the dosage may need to be recalibrated ensure adequate coverage. Precautions Avoid use of lisinopril hydrochlorothiazide (LHT) if the patient is also taking another myocardial protective medication (e.g. amiodarone)
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