To help you remember to take your medicine, try to get into the habit of taking it at the same time each day.

For patients taking captopril and hydrochlorothiazide or moexipril and hydrochlorothiazide:

• This medicine is best taken on an empty stomach 1 hour before meals, unless you are otherwise directed by your doctor.

For patients taking this medicine for high blood pressure :

• In addition to the use of the medicine your doctor has prescribed, treatment for your high blood pressure may include weight control and care in the types of foods you eat, especially foods high in sodium. Your doctor will tell you which of these are most important for you. You should check with your doctor before changing your diet.
• Many patients who have high blood pressure will not notice any signs of the problem. In fact, many may feel normal. It is very important that you take your medicine exactly as directed and that you keep your appointments with your doctor even if you feel well.
• Remember that this medicine will not cure your high blood pressure but it does help control it. Therefore, you must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life . If high blood pressure is not treated, it can cause serious problems such as heart failure, blood vessel disease, stroke, or kidney disease.

This medicine may cause you to have an unusual feeling of tiredness when you begin to take it. You may also notice an increase in the amount of urine or in your frequency of urination. After you have taken the medicine for a while, these effects should lessen. In general, to keep the increase in urine from affecting your sleep:

• If you are to take a single dose a day, take it in the morning after breakfast.
• If you are to take more than one dose a day, take the last dose no later than 6 p.m., unless otherwise directed by your doctor.

However, it is best to plan your dose or doses according to a schedule that will least affect your personal activities and sleep. Ask your health care professional to help you plan the best time to take this medicine.

Dosing

The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine.

For benazepril and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 tablet once a day.
    • Children Use and dose must be determined by your doctor.

For captopril and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 tablet two or three times a day.
    • Children Dose is based on body weight and must be determined by your doctor.

For enalapril and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 tablet once or twice a day.
    • Children Dose is based on body weight and must be determined by your doctor.

For lisinopril and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 or 2 tablets once a day.
    • Children Dose must be determined by your doctor.

For moexipril and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 or 2 tablets once a day.
    • Children Use and dose must be determined by your doctor.

For quinapril and hydrochlorothiazide combination
• For oral dosage form (tablets):
  • For high blood pressure:
    • Adults 1 tablet once or twice a day.
    • Children Use and dose must be determined by your doctor.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For the angiotensin-converting enzyme (ACE) inhibitors and hydrochlorothiazide, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to benazepril, enalapril, captopril, lisinopril, moexipril, quinapril, sulfonamides (sulfa drugs), bumetanide, furosemide, acetazolamide, dichlorphenamide, or methazolamide or to hydrochlorothiazide or any of the other thiazide diuretics (water pills). Also tell your health care professional if you are allergic to any other substances, such as foods, sulfites or other preservatives, or dyes.

Pregnancy Studies with this combination medicine have not been done in pregnant women. However, use of any of the ACE inhibitors during pregnancy, especially in the second and third trimesters (after the first three months), can cause low blood pressure, kidney failure, too much potassium, or even death in newborns. Therefore, it is important that you check with your doctor immediately if you think that you may be pregnant . Be sure that you have discussed this with your doctor before taking this medicine. In addition, if your medicine contains:

• Benazepril Studies in rats, mice and rabbits at doses up to 300 times the recommended human dose showed no evidence of birth defects.
• Captopril Studies in rabbits and rats at doses up to 400 times the recommended human dose have shown that captopril causes an increase in death of the fetus and newborn. Also, captopril has caused deformed skulls in the offspring of rabbits given doses 2 to 70 times the recommended human dose.
• Enalapril Studies in rats at doses many times the recommended human dose have shown that use of enalapril causes the fetus to be smaller than normal. Studies in rabbits have shown that enalapril causes an increase in fetal death. Enalapril has not been shown to cause birth defects in rats or rabbits.
• Lisinopril Studies in mice and rats at doses many times the recommended human dose have shown that use of lisinopril causes a decrease in successful pregnancies, a decrease in the weight of infants, and an increase in infant deaths. It has also caused a decrease in successful pregnancies and abnormal bone growth in rabbits. Lisinopril has not been shown to cause birth defects in mice, rats, or rabbits.
• Moexipril Studies in rats and rabbits did not show moexipril to cause birth defects.
• Quinapril Studies in rats showed quinapril caused reduced body weights but did not show it to cause birth defects in either rats or rabbits.
• Hydrochlorothiazide Hydrochlorothiazide has not been shown to cause birth defects or other problems in animal studies. However, when hydrochlorothiazide is used during pregnancy, it may cause side effects including jaundice, blood problems, and low potassium in the newborn baby.

Breast-feeding

• Benazepril Passes into breast milk. However, this medicine has not been reported to cause problems in nursing babies.
• Captopril Passes into breast milk. However, this medicine has not been reported to cause problems in nursing babies.
• Enalapril Passes into breast milk. However, this medicine has not been reported to cause problems in nursing babies.
• Lisinopril It is not known whether lisinopril passes into breast milk. However, this medicine has not been reported to cause problems in nursing babies.
• Moexipril It is not known whether moexipril passes into breast milk. However, this medicine has not been reported to cause problems in nursing babies.
• Quinapril Passes into breast milk. However, this medicine has not been reported to cause problems in nursing babies.
• Hydrochlorothiazide Passes into breast milk. However, this medicine has not been reported to cause problems in nursing babies.

Children Children may be especially sensitive to the blood pressurelowering effect of ACE inhibitors. This may increase the chance of side effects or other problems during treatment. Extra caution may be necessary when using hydrochlorothiazide in infants with jaundice because it can make this condition worse. Therefore, it is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

Older adults Dizziness or lightheadedness and symptoms of too much potassium loss may be more likely to occur in the elderly, who may be more sensitive to the effects of this medicine.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When taking ACE inhibitors and hydrochlorothiazide it is especially important that your health care professional know if you are taking any of the following:

• Cholestyramine or
• Colestipol Use with thiazide diuretics may prevent the diuretic from working properly; the diuretic should be taken at least 1 hour before or 4 hours after cholestyramine or colestipol

• Diabetes medication (insulin or tablets) Blood sugar levels may change; extra care in self monitoring is necessary

• Digitalis glycosides (heart medicine) If potassium levels in the body are decreased, symptoms of digitalis toxicity may occur

• Diuretics (water pills) Effects on blood pressure may be increased

• Lithium (e.g., Lithane) Risk of lithium overdose, even at low doses, may be increased

• Potassium-containing medicines or supplements or
• Salt substitutes or
• Low-salt milk Use of these substances with ACE inhibitors may result in an unusually high potassium level in the blood, which can lead to heart rhythm and other problems

• Tetracycline Use with quinapril will decrease the effects of tetracycline

• Diabetes mellitus (sugar diabetes) Increased risk of potassium levels in the body becoming too high

• Gout (or history of) Hydrochlorothiazide may increase the amount of uric acid in the body, which can lead to gout

• Heart or blood vessel disease or
• Heart attack or stroke (recent) Lowering blood pressure may make problems resulting from these conditions worse

• Kidney disease or
• Liver disease Effects may be increased because of slower removal from the body

• Kidney transplant Increased risk of kidney disease caused by ACE inhibitors

• Pancreatitis (inflammation of the pancreas) Hydrochlorothiazide can make this condition worse

• Systemic lupus erythematosus (SLE) (or history of) Hydrochlorothiazide may worsen the condition, and there is an increased risk of blood problems caused by ACE inhibitors

• Previous reaction to benazepril, captopril, enalapril, lisinopril, moexipril, or quinapril involving hoarseness; swelling of face, mouth, hands, or feet; or sudden trouble in breathing Reaction is more likely to occur again