Do not take Zestril:

• if you are allergic to lisinopril or any of the other ingredients of this medicine (listed in section 6).
• if you have ever had an allergic reaction to another ACE inhibitor medicine. The allergic reaction may have caused swelling of the hands, feet, ankles, face, lips, tongue or throat. It may also have made it difficult to swallow or breathe (angioedema).
• If you have taken or are currently taking sacubitril/valsartan, a medicine used to treat a type of long-term (chronic) heart failure in adults, as the risk of angioedema (rapid swelling under the skin in an area such as the throat) is increased.
• if a member of your family has had severe allergic reactions (angioedema) to an ACE inhibitor or you have had severe allergic reactions (angioedema) without a known cause.
• if you are more than 3 months pregnant. (It is also better to avoid Zestril in early pregnancy – see Pregnancy section).
• if you have diabetes or impaired kidney function and you are treated with a blood pressure lowering medicine containing aliskiren.

If you are not sure if any of these apply to you, talk to your doctor or pharmacist before taking Zestril.

If you develop a dry cough which is persistent for a long time after starting treatment with Zestril, talk to your doctor.

Warnings and precautions

Talk to your doctor or pharmacist before taking Zestril:

• if you have a narrowing (stenosis) of the aorta (an artery in your heart) or a narrowing of the heart valves (mitral valves).
• if you have a narrowing (stenosis) of the kidney artery.
• if you have an increase in the thickness of the heart muscle (known as hypertrophic cardiomyopathy).
• if you have problems with your blood vessels (collagen vascular disease).
• if you have low blood pressure. You may notice this as feeling dizzy or light-headed, especially when standing up.
• if you have kidney problems or you are having kidney dialysis.
• if you have liver problems.
• if you have diabetes.
• if you are taking any of the following medicines, the risk of angioedema (rapid swelling under the skin in area such as the throat) is increased:
  • temsirolimus, sirolimus, everolimus and other medicines belonging to the class of mTOR inhibitors (used to avoid rejection of transplanted organs and for cancer).
  • Racecadotril, a medicine used to treat diarrhoea;
  • Vildagliptin, a medicine used to treat diabetes.
• if you are taking any of the following medicines used to treat high blood pressure:
  • an angiotensin II receptor blocker (ARBs) (also known as sartans – for example valsartan, telmisartan, irbesartan), in particular if you have diabetes-related kidney problems.
  • aliskiren.

  Your doctor may check your kidney function, blood pressure, and the amount of electrolytes (e.g. potassium) in your blood at regular intervals.
  See also information under the heading “Do not take Zestril”.

• if you have recently had diarrhoea or vomiting (being sick).
• if your doctor has told you to control the amount of salt in your diet.
• if you have high levels of cholesterol and you are having a treatment called ‘LDL apheresis’.
• you must tell your doctor if you think you are (or might become) pregnant. Zestril is not recommended in early pregnancy, and must not be taken if you are more than 3 months pregnant, as it may cause serious harm to your baby if used at that stage (see pregnancy section).
• if you are of black origin as Zestril may be less effective. You may also more readily get the side effect ‘angioedema’ (a severe allergic reaction).

If you are not sure if any of these apply to you, talk to your doctor or pharmacist before taking Zestril.

Treatment for allergies such as insect stings

Tell your doctor if you are having or are going to have treatment to lower the effects of an allergy such as insect stings (desensitisation treatment). If you take Zestril while you are having this treatment, it may cause a severe allergic reaction.

Operations

If you are going to have an operation (including dental surgery) tell your doctor or dentist that you are taking Zestril. This is because you can get low blood pressure (hypotension) if you are given certain local or general anaesthetics while you are taking Zestril.

Children and adolescents

Zestril has been studied in children. For more information, talk to your doctor. Zestril is not recommended in children under 6 years of age or in any child with severe kidney problems.

Other medicines and Zestril

Tell your doctor or pharmacist if you are taking, have recently taken, or might take any other medicines. This is because Zestril can affect the way some medicines work and some medicines can have an effect on Zestril. Your doctor may need to change your dose and/or to take other precautions.

In particular, tell your doctor or pharmacist if you are taking any of the following medicines:

• Other medicines to help lower your blood pressure.
• An angiotensin II receptor blocker (ARB) or aliskiren, (see also information under the headings “Do not take Zestril” and “Warnings and precautions”).
• Water tablets (diuretic medicines).
• Beta-blocker medicines, such as atenolol and propranolol.
• Nitrate medicines (for heart problems).
• Non-steroidal anti-inflammatory drugs (NSAIDs) used to treat pain and arthritis.
• Aspirin (Acetylsalicylic acid), if you are taking more than 3 grams each day.
• Medicines for depression and for mental problems, including lithium.
• Potassium supplements (including salt substitutes), potassium-sparing diuretics and other medicines that can increase the amount of potassium in your blood (e.g. trimethoprim and co-trimoxazole for infections caused by bacteria; ciclosporin, an immunosuppressant medicine used to prevent organ transplant rejection; and heparin, a medicine used to thin blood to prevent clots).
• Insulin or medicines that you take by mouth for diabetes.
• Medicines used to treat asthma.
• Medicines to treat nose or sinus congestion or other cold remedies (including those you can buy in the pharmacy).
• Medicines to suppress the body’s immune response (immunosuppressants).
• Allopurinol (for gout).
• Procainamide (for heart beat problems).
• Medicines that contain gold, such as sodium aurothiomalate, which may be given to you as an injection.

The following medicines may increase the risk of angioedema (signs of angioedema include swelling of the face, lips, tongue and/or throat with difficulty in swallowing or breathing):

• Medicines to break up blood clots (tissue plasminogen activator), usually given in hospital.
• Medicines which are most often used to avoid rejection of transplanted organs (temsirolimus, sirolimus, everolimus and other medicines belonging to the class of mTOR inhibitors). See section 2 “Warnings and precautions”.
• Racecadotril used to treat diarrhoea.
• Vildagliptin, a medicine used to treat diabetes.

Pregnancy and breast-feeding

Pregnancy:

You must tell your doctor if you think you are (or might become) pregnant. Your doctor will normally advise you to stop taking Zestril before you become pregnant or as soon as you know you are pregnant and will advise you to take another medicine instead of Zestril. Zestril is not recommended in early pregnancy, and must not be taken when more than 3 months pregnant, as it may cause serious harm to your baby if used after the third month of pregnancy.

Breast-feeding:

Tell your doctor if you are breast-feeding or about to start breast-feeding. Zestril is not recommended for mothers who are breast-feeding, and your doctor may choose another treatment for you if you wish to breast-feed, especially if your baby is newborn, or was born prematurely.

Driving and using machines

• Some people feel dizzy or tired when taking this medicine. If this happens to you, do not drive or use any tools or machines.
• You must wait to see how your medicine affects you before trying these activities.