Lisinopril 20mg / Hydrochlorothiazide 12.5mg tablets

Background Control of hypertension remains a critical global health challenge, particularly in lower to middle-income nations where access is constrained. This is complicated by the side effects associated with conventional antihypertensive medications and the preference towards natural remedies. Hibiscus sabdariffa (HS) is emerging as a non-pharmacological medicinal solution given its cardio-protective and antihypertensive effects. Objective To systematically review the evidence for the efficacy, side effects and interactions of Hibiscus sabdariffa in blood pressure management among hypertensive adults. Methods A comprehensive search of major databases (PubMed, Academia, ResearchGate, AJOL and Google Scholar) was conducted, identifying randomized controlled studies, systematic reviews and review articles published from January 2015 up till September 2024 that assessed the antihypertensive effects of Hibiscus sabdariffa. The review was registered in PROSPERO (PROSPERO2025CRD420251007414) and followed the PRISMA guidelines. The study considered hypertensive adults aged 18 to 64 years and HS was tested as monotherapy. Risk of bias was evaluated using Cochrane Handbook guidelines. Results From the 884 articles retrieved, 18 studies matched the inclusion criteria and were reviewed. HS was shown to decrease both systolic and diastolic blood pressure across different ethnic groups and population centres. HS was shown to have equivalent efficacy as standard antihypertensive agents in comparative studies such as with hydrochlorothiazide and lisinopril. Additional findings suggest HS may also have lipid-lowering, antidiabetic, and organ-protective effects. Minimum adverse effects were reported and safety profile was generally favourable. The potential for herb-drug interaction with diuretics was noted but remains insufficiently explored. Conclusion Hibiscus sabdariffa shows promise as an effective, safe, and affordable alternative or adjunct in the management of mild to moderate hypertension. There is, however, a need for more standardized trials to establish dosage, treatment duration, and interactions with conventional antihypertensive medications.

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The objective was to investigate the effect of co-administration of hydrochlorothiazide and lisinopril as fixed dose combination on their intestinal absorption. The scope was extended to enhance intestinal absorption of both drugs. In situ rabbit intestinal absorption through the duodenum and jejuno-ileum was used to monitor membrane permeability of both drugs when perfused alone or in combination. Niosomes containing glycerols (glyceroniosomes) were loaded with both drugs. Glyceroniosomes comprised Span 60 or Tween 40 in combination with cholesterol and glycerol were prepared by bath sonication. Glyceroniosomes were characterized with respect to vesicle size, drug entrapment efficiency and were examined using transmission electron microscope (TEM). The prepared vesicles were nanosized spherical vesicles with average size of 202.4 nm and 108.8 nm for span free and span containing glyceroniosomes, respectively. The recorded Zeta potential values suggested good stability of the prepared formulations. Intestinal absorption studies reflected incomplete absorption of hydrocholothiazide and lisinopril correlating with their categorization as class IV and III drugs, respectively. Co-perfusion of both drugs reduced the intestinal absorption of lisinopril. Simultaneous encapsulation in glyceroniosomes enhanced the intestinal absorption of both drugs. Tween based systems were more efficient. The study introduced glyceroniosomes as carriers of simultaneous delivery of hydrochlorothiazide and lisinopril.

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Angiotensin-converting enzyme inhibitor-induced angioedema is a rare, potentially life-threatening disorder. This mostly manifests with swelling of the lips, tongue, and face with no known reports of angiotensin-converting enzyme inhibitor-induced angioedema from soft-tissue infections. We present herein a case of a 47-year-old male with a history of chronic kidney disease stage III who developed acute upper lip angioedema and severe acute kidney injury while on lisinopril/hydrochlorothiazide, following tattoo-related cellulitis. We propose that inflammatory activation from cellulitis amplified kallikrein-kinin system activity and bradykinin generation, precipitating angioedema in the setting of angiotensin-converting enzyme inhibition and transient renal dysfunction. This case highlights a rare but important intersection between infection-driven inflammation and angiotensin-converting enzyme inhibitor-induced angioedema.

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In general, angioedema can be caused by a hereditary C1 esterase deficiency or by an allergy-related cascade involving either a histamine or a bradykinin-induced cascade. Angioedema secondary to angiotensin-converting enzyme inhibitors (ACEi) typically induces an allergy-related angioedema and typically presents complications associated with the upper airway, and rarely presents intra-abdominally. This case discussed how a 54-year-old male with a recent diagnosis of hypertension presented with acute abdominal pain. He was started on a lisinopril-hydrochlorothiazide combination two days before the presentation. Differentials were considered for an acute abdomen, and a CT abdomen was obtained, which was significant for the thickening of the jejunum and sigmoid colon with surrounding mucosal edema and inflammatory changes. The patient was ultimately treated for bowel angioedema successfully with dexamethasone, diphenhydramine, and famotidine, and his lisinopril was discontinued. This case report aims to discuss and evaluate bowel angioedema in the setting of ACEi use and how it should be considered as a differential for an acute abdomen and its relevant empirical management with steroids due to the indistinguishable etiology of histamine or bradykinin mediated.

Abstract licence: CC BY