Bisoprolol/ hydrochlorothiazide

Generic Name: bisoprolol/hydrochlorothiazide (BIS-oh-PROE-lol/HYE-droe-KLOR-oh-THYE-a-zide)
Brand Name: Ziac

Bisoprolol/ hydrochlorothiazide is used for:

Treating high blood pressure.

Bisoprolol/hydrochlorothiazide is a beta-blocker and diuretic combination. The beta-blocker works by slowing down the heartbeat, helping the heart beat more regularly, and reducing the amount of work the heart has to do. The diuretic increases the elimination of excess fluid, which helps to decrease blood pressure.

Do NOT use bisoprolol/ hydrochlorothiazide if:

  • you are allergic to any ingredient in bisoprolol/hydrochlorothiazide or to a sulfonamide medicine (eg, sulfamethoxazole, probenecid, glyburide)
  • you have uncontrolled heart failure, heart block, a very slow heart rate, or shock caused by serious heart problems
  • you are unable to urinate
  • you are taking another beta-blocker (eg, propranolol), dofetilide, or mibefradil

Contact your doctor or health care provider right away if any of these apply to you.

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Before using bisoprolol/ hydrochlorothiazide:

Some medical conditions may interact with bisoprolol/hydrochlorothiazide. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have asthma, bronchitis, lung disease (eg, chronic obstructive pulmonary disease [COPD]), diabetes, gout, an overactive thyroid, low blood levels of potassium or sodium, blood vessel or circulation problems, an adrenal gland tumor (pheochromocytoma), lupus, liver disease, or kidney problems
  • if you have low blood pressure or a history of chest pain or angina, heart attack, slow or irregular heartbeat, or other heart problems (eg, heart failure)
  • if you will be having surgery or receiving anesthesia
  • if you have recently had a certain type of nerve surgery (sympathectomy)

Some MEDICINES MAY INTERACT with bisoprolol/hydrochlorothiazide. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Antiarrhythmics (eg, disopyramide, flecainide), calcium channel blockers (eg, verapamil, diltiazem), cimetidine, digoxin, fingolimod, or other medicines for blood pressure because side effects, such as slow or irregular heart beat or low blood pressure, may occur
  • Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril), barbiturates (eg, phenobarbital), diazoxide, mefloquine, mibefradil, narcotics (eg, codeine), or nifedipine because the actions and side effects of bisoprolol/hydrochlorothiazide and these medicines may be increased
  • Adrenocorticotropic hormone (ACTH), other beta-blockers (eg, propranolol), corticosteroids (eg, prednisone), guanethidine, or reserpine because they may increase the risk of bisoprolol/hydrochlorothiazide's side effects
  • Cholestyramine, colestipol, nonsteroidal anti-inflammatory drugs (NSAIDs) (eg, ibuprofen), or rifamycins (eg, rifampin) because they may decrease bisoprolol/hydrochlorothiazide's effectiveness
  • Allopurinol, amantadine, dofetilide, insulin or other medicines for diabetes (eg, glyburide), ketanserin, or lithium because their actions and the risk of their side effects may be increased
  • Clonidine because stopping it or bisoprolol/hydrochlorothiazide suddenly can lead to a rapid increase in blood pressure

This may not be a complete list of all interactions that may occur. Ask your health care provider if bisoprolol/hydrochlorothiazide may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use bisoprolol/ hydrochlorothiazide:

Use bisoprolol/hydrochlorothiazide as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Take bisoprolol/hydrochlorothiazide by mouth with or without food.
  • If you also take cholestyramine or colestipol, ask your doctor or pharmacist how to take it with bisoprolol/hydrochlorothiazide.
  • Bisoprolol/hydrochlorothiazide may increase the amount of urine or cause you to urinate more often when you first start taking it. To keep this from disturbing your sleep, try to take your dose before 6 pm.
  • Take bisoprolol/hydrochlorothiazide on a regular schedule to get the most benefit from it.
  • Continue to take bisoprolol/hydrochlorothiazide even if you feel well. Do not miss any doses.
  • If you miss a dose of bisoprolol/hydrochlorothiazide, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use bisoprolol/hydrochlorothiazide.

Important safety information:

  • Bisoprolol/hydrochlorothiazide may cause dizziness or light-headedness. These effects may be worse if you take it with alcohol or certain medicines. Use bisoprolol/hydrochlorothiazide with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
  • Bisoprolol/hydrochlorothiazide may cause dizziness, light-headedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
  • Drink plenty of fluids while taking bisoprolol/hydrochlorothiazide and avoid engaging in activities that cause excessive sweating. Dehydration, excessive sweating, vomiting, or diarrhea may lead to a fall in blood pressure. Contact your health care provider at once if any of these occur.
  • Bisoprolol/hydrochlorothiazide may decrease the amount of potassium in your body. If your doctor has also prescribed a potassium supplement for you, follow the dosing directions carefully. Check with your doctor before taking additional potassium on your own or including foods high in potassium (eg, bananas, orange juice) in your diet.
  • Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms.
  • Bisoprolol/hydrochlorothiazide contains a sulfonamide called hydrochlorothiazide, which can cause certain eye problems (myopia, angle-closure glaucoma). Your risk may be increased if you are allergic to sulfonamide medicines (eg, sulfamethoxazole) or to penicillin antibiotics (eg, amoxicillin). Untreated angle-closure glaucoma can lead to permanent vision loss. If these eye problems occur, symptoms usually occur within hours to weeks of starting bisoprolol/hydrochlorothiazide. Contact your doctor immediately if you experience symptoms such as vision changes (eg, decreased vision clearness) or eye pain.
  • Do not suddenly stop taking bisoprolol/hydrochlorothiazide. Sharp chest pain, irregular heartbeat, and sometimes heart attack may occur if you suddenly stop taking bisoprolol/hydrochlorothiazide. The risk may be greater if you have certain types of heart disease. Your doctor should slowly lower your dose. When stopping treatment with bisoprolol/hydrochlorothiazide, your doctor will need to slowly decrease your dose over a period of 1 to 2 weeks and will watch you closely for side effects. If new or worsened chest pain or other heart problems occur, contact your doctor right away. You may need to start taking bisoprolol/hydrochlorothiazide again. Because heart artery disease is common and you may not know you have it, it may be safer not to stop bisoprolol/hydrochlorothiazide quickly even if you are only being treated for high blood pressure.
  • Bisoprolol/hydrochlorothiazide may cause you to become sunburned more easily. Avoid the sun, sunlamps, or tanning booths until you know how you react to bisoprolol/hydrochlorothiazide. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
  • Tell your doctor or dentist that you take bisoprolol/hydrochlorothiazide before you receive any medical or dental care, emergency care, or surgery.
  • If you have high blood pressure, do not use nonprescription products that contain stimulants. These products may include diet pills or cold medicines. Contact your doctor if you have any questions or concerns.
  • Diabetes patients - Bisoprolol/hydrochlorothiazide may hide signs of low blood sugar, such as a rapid heartbeat. Be sure to watch for other signs of low blood sugar. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your vision change; give you a headache, chills, or tremors; or make you more hungry. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine.
  • If you have a history of any severe allergic reaction, talk with your doctor. You may be at risk of an even more severe allergic reaction if you come into contact with the substance that caused your allergy. Some medicines used to treat severe allergies may also not work as well while you are taking bisoprolol/hydrochlorothiazide.
  • Bisoprolol/hydrochlorothiazide may interfere with certain lab tests, including parathyroid function. Be sure your doctor and lab personnel know you are taking bisoprolol/hydrochlorothiazide.
  • Lab tests, including blood pressure, heart rate, and blood electrolytes, may be performed while you use bisoprolol/hydrochlorothiazide. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
  • Use bisoprolol/hydrochlorothiazide with caution in the ELDERLY; they may be more sensitive to its effects.
  • Bisoprolol/hydrochlorothiazide should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
  • PREGNANCY and BREAST-FEEDING: It is not known if bisoprolol/hydrochlorothiazide can cause harm to the fetus. If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using bisoprolol/hydrochlorothiazide while you are pregnant. Bisoprolol/hydrochlorothiazide is found in breast milk. Do not breast-feed while taking bisoprolol/hydrochlorothiazide.

Possible side effects of bisoprolol/ hydrochlorothiazide:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Diarrhea; dizziness; headache; light-headedness; tiredness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); chest pain; chills, fever, or sore throat; cold hands or feet; decreased urination; drowsiness; dry mouth or eyes; eye pain; fainting; mood or mental changes (eg, anxiety, decreased concentration, decreased memory, depression, hallucinations); muscle pain, cramps, or weakness; nausea; red, swollen, blistered, or peeling skin; restlessness; ringing in the ears or decreased hearing; severe or persistent dizziness or light-headedness; severe or persistent stomach pain; shortness of breath; slow, fast, or irregular heartbeat; sudden, unexplained weight gain; swelling of the hands, ankles, or feet; symptoms of low blood sodium levels (eg, confusion, seizures, sluggishness); unusual bruising or bleeding; unusual thirst, weakness, or fatigue; vision changes (eg, blurred vision, decreased vision clearness); vomiting; wheezing; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include fainting; loss of consciousness; severe dizziness or light-headedness; slow heart rate; symptoms of blood electrolyte problems (eg, confusion; irregular heartbeat; mental or mood changes; muscle pain, weakness, or cramping; seizures; sluggishness); symptoms of dehydration (eg, drowsiness; dry mouth or eyes; fast heartbeat; nausea or vomiting; unusual thirst, weakness, or fatigue); trouble breathing.

Proper storage of bisoprolol/hydrochlorothiazide:

Store bisoprolol/hydrochlorothiazide at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep bisoprolol/hydrochlorothiazide out of the reach of children and away from pets.

General information:

  • If you have any questions about bisoprolol/hydrochlorothiazide, please talk with your doctor, pharmacist, or other health care provider.
  • Bisoprolol/hydrochlorothiazide is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take bisoprolol/hydrochlorothiazide or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about bisoprolol/hydrochlorothiazide. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to bisoprolol/hydrochlorothiazide. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using bisoprolol/hydrochlorothiazide.

Issue Date: July 2, 2014
Database Edition 14.3.1.001
Copyright © 2014 Wolters Kluwer Health, Inc.

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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