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Bisoprolol / hydrochlorothiazide Side Effects

In Summary

More frequently reported side effects include: diarrhea, dizziness, headache, and rhinitis. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to bisoprolol / hydrochlorothiazide: oral tablet

Along with its needed effects, bisoprolol/hydrochlorothiazide may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking bisoprolol / hydrochlorothiazide:

Less common
  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • chest pain or discomfort
  • lightheadedness, dizziness, or fainting
  • rapid weight gain
  • shortness of breath
  • slow or irregular heartbeat
  • tingling of the hands or feet
  • unusual tiredness or weakness
  • unusual weight gain or loss

Get emergency help immediately if any of the following symptoms of overdose occur while taking bisoprolol / hydrochlorothiazide:

Symptoms of overdose
  • Anxiety
  • blurred vision
  • burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
  • change in consciousness
  • chills
  • cold, clammy skin
  • cold sweats
  • confusion as to time, place, or person
  • cool, pale skin
  • cough
  • decrease in amount of urine
  • depression
  • difficulty breathing
  • dilated neck veins
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • drowsiness
  • dry mouth
  • extreme fatigue
  • fast or pounding heartbeat or pulse
  • fast, weak pulse
  • frequent urination
  • hallucinations
  • holding false beliefs that cannot be changed by fact
  • increased hunger
  • increased thirst
  • increased volume of pale, dilute urine
  • irregular breathing
  • irritability
  • loss of appetite
  • loss of consciousness
  • mood changes
  • muscle pain or cramps
  • nausea or vomiting
  • nervousness
  • nightmares
  • no breathing
  • noisy breathing
  • not able to pass urine
  • numbness or tingling in the hands, feet, or lips
  • pain or aching in the lower legs
  • seizures
  • shakiness
  • slurred speech
  • sweating
  • swelling of the face, hands, fingers, feet, ankles, or lower legs
  • tightness in the chest
  • trembling
  • troubled breathing
  • unconsciousness
  • unusual drowsiness, dullness, or feeling of sluggishness
  • unusual excitement, nervousness, or restlessness
  • very drowsy or sleepy
  • weakness and heaviness of legs
  • weight gain
  • wheezing

Some side effects of bisoprolol / hydrochlorothiazide may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common
  • Acid or sour stomach
  • belching
  • decreased interest in sexual intercourse
  • diarrhea
  • difficulty with moving
  • heartburn
  • inability to have or keep an erection
  • indigestion
  • joint pain
  • loss in sexual ability, desire, drive, or performance
  • muscle aching or stiffness
  • sleepiness
  • stomach discomfort, upset, or pain
  • swollen joints
  • Runny nose
  • sneezing
  • stuffy nose

For Healthcare Professionals

Applies to bisoprolol / hydrochlorothiazide: oral tablet


Frequency not reported side effects were seen with hydrochlorothiazide doses of generally 25 mg and higher.[Ref]

The more commonly reported side effects observed with this drug are fatigue, dizziness, and diarrhea.[Ref]


Common (1% to 10%): Bradycardia, chest pain, peripheral edema
Frequency not reported: Arrhythmia, peripheral ischemia

Frequency not reported: Bradycardia, palpitations, rhythm disturbances, cold extremities, claudication, hypotension, orthostatic hypotension, chest pain, congestive heart failure, exertional dyspnea, edema

Frequency not reported: Orthostatic hypotension, necrotizing angiitis, vasculitis[Ref]

Orthostatic hypotension may be potentiated by alcohol, barbiturates, or narcotics.[Ref]


Common (1% to 10%): Diarrhea, nausea, dyspepsia

Frequency not reported: Gastric pain, epigastric pain, abdominal pain, peptic ulcer, gastritis, dyspepsia, nausea, vomiting, diarrhea, constipation, dry mouth, mesenteric arterial thrombosis, ischemic colitis

Frequency not reported: Gastric irritation, constipation, pancreatitis, sialadenitis, dry mouth[Ref]

Nervous system

Common (1% to 10%): Dizziness, somnolence
Frequency not reported: Headache

Frequency not reported: Unsteadiness, dizziness, vertigo, headache, syncope, paresthesia, hypoesthesia, hyperesthesia, somnolence, decreased concentration, decreased memory, tremor, taste abnormality, slightly clouded sensorium

Frequency not reported: Vertigo, paresthesia[Ref]


Common (1% to 10%): Muscle cramps, myalgia

Frequency not reported: Arthralgia, muscle pain, joint pain, back pain, neck pain, muscle cramps, twitching

Frequency not reported: Cramping, muscle spasm[Ref]


Common (1% to 10%): Cough, upper respiratory tract infection
Uncommon (0.1% to 1%): Rhinitis

Frequency not reported: Asthma, bronchospasm, bronchitis, dyspnea, pharyngitis, rhinitis, sinusitis, upper respiratory infection, sore throat, laryngospasm, respiratory distress

Frequency not reported: Respiratory distress, pneumonitis, pulmonary edema[Ref]


Common (1% to 10%): Fatigue

Frequency not reported: Tinnitus, decreased hearing, earache, fatigue, asthenia, malaise, fever, aching

Frequency not reported: Weakness, fever[Ref]


Common (1% to 10%): Impotence

Frequency not reported: Impotence, polyuria, Peyronie's disease

Frequency not reported: Sexual dysfunction[Ref]


Uncommon (0.1% to 1%): Hypokalemia
Frequency not reported: Increased uric acid, increased serum triglycerides, decreased HDL

Frequency not reported: Gout, weight gain, increased serum triglycerides, increased uric acid, increased serum potassium, increased glucose, increased phosphorus

Common (1% to 10%): Hypokalemia
Frequency not reported: Anorexia, gout, hyperglycemia, hyperuricemia, hyperlipidemia, hypercalcemia, increased uric acid, other electrolyte imbalances[Ref]

Bisoprolol: Uric acid, serum potassium, glucose, and phosphorus increases associated with use of this drug were not of clinical importance and rarely resulted in discontinuation.[Ref]


Frequency not reported: Insomnia, loss of libido

Frequency not reported: Sleep disturbance, vivid dreams, insomnia, depression, anxiety, restlessness, decreased libido, hallucination, disorientation to time and space, emotional lability

Frequency not reported: Restlessness[Ref]


Of the 15% of patients who converted to a positive ANA status, one-third of the patients converted back to a negative ANA titer with continued use.[Ref]

Very common: Antinuclear antibody (ANA) conversions to a positive titer (up to 15%)[Ref]


Frequency not reported: Cystitis, renal colic, increased creatinine, increased BUN

Frequency not reported: Renal failure, renal dysfunction, interstitial nephritis, glycosuria[Ref]

Creatinine and BUN were associated with slightly increased levels, but these effects were generally not of clinical importance and rarely resulted in discontinuation.[Ref]


Frequency not reported: Rash, acne, eczema, psoriasis, skin irritation, pruritus, flushing, sweating, alopecia, dermatitis, cutaneous vasculitis, exfoliative dermatitis

Frequency not reported: Photosensitivity, rash, cutaneous vasculitis, erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, toxic epidermal necrolysis[Ref]


Frequency not reported: Visual disturbances, ocular pain, ocular pressure, abnormal lacrimation

Frequency not reported: Transient blurred vision, xanthopsia[Ref]


Frequency not reported: Purpura, decreased WBCs, decreased platelets, eosinophilia, agranulocytosis, thrombocytopenia

Frequency not reported: Purpura, leukopenia, agranulocytosis, thrombocytopenia, aplastic anemia, hemolytic anemia[Ref]

During treatment with this drug, eosinophilia and decreased levels of WBCs and platelets were not of clinical importance and rarely resulted in discontinuation.[Ref]


Frequency not reported: Angioedema

Frequency not reported: Urticaria, anaphylactic reactions[Ref]


SGOT and SGPT elevations of 1 to 2 times the upper limit of normal were reported in 6.2% of patients, with a multiple occurrence rate of 1.9%. Generally, this increase was the result of underlying disorders or resolved with continued use of this drug.[Ref]

Common (1% to 10%): Increased serum glutamic oxaloacetic transaminase (SGOT) and serum glutamic pyruvic transaminase (SGPT)

Frequency not reported: Intrahepatic cholestatic jaundice, cholecystitis[Ref]


1. "Product Information. Ziac (bisoprolol-hydrochlorothiazide)." Lederle Laboratories, Wayne, NJ.

Some side effects of bisoprolol / hydrochlorothiazide may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.

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