Ziac Side Effects

Generic name: bisoprolol / hydrochlorothiazide

Medically reviewed by Drugs.com. Last updated on Sep 28, 2024.

Note: This document provides detailed information about Ziac.

Applies to bisoprolol / hydrochlorothiazide: oral tablet Side Effects associated with bisoprolol / hydrochlorothiazide. Some dosage forms listed on this page may not apply specifically to the brand name Ziac.

Applies to bisoprolol / hydrochlorothiazide: oral tablet.

Precautions

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

This medicine may cause or worsen heart failure in some patients. Check with your doctor right away if you have chest pain or discomfort, dilated neck veins, irregular breathing, an irregular heartbeat, swelling of the face, fingers, feet, or lower legs, trouble breathing, weight gain, or unusual tiredness or weakness.

This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, hoarseness, trouble breathing, trouble swallowing, or any swelling of your hands, face, lips, tongue, or throat while you are using this medicine.

Do not interrupt or Stop taking bisoprolol/hydrochlorothiazide without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely. Some conditions may become worse when the medicine is stopped suddenly, which can be dangerous.

This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.

Make sure any doctor or dentist who treats you knows that you are using this medicine. You may need to stop using this medicine several days before having surgery or medical tests.

Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. This could be a signs of a serious eye problem. Your doctor will want you to have your eyes checked by an ophthalmologist (eye doctor).

Check with your doctor right away if you have dry mouth, increased thirst, muscle cramps, nausea or vomiting, unusual tiredness or weakness, severe drowsiness or dizziness, seizures, a decrease in urine, or a fast heartbeat while you are using this medicine. These may be symptoms of dehydration or mineral imbalance.

This medicine may cause some people to become less alert than they are normally. If this side effect occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert while taking this medicine.

This medicine may increase your risk of getting skin cancer (eg, non-melanoma skin cancer). Avoid sun exposure. Be sure to apply sunscreen before going outside, and wear protective clothing and a hat. Avoid sunlamps and tanning beds. Talk to your doctor if you have concerns about this risk.

Alcohol, narcotic pain relievers, or sleeping pills may cause you to feel more lightheaded, dizzy, or faint when used with this medicine. Tell your doctor if you are drinking alcohol or using pain relievers or sleeping pills.

Do not take other medicines unless they have been discussed with your doctor. This especially includes prescription or nonprescription (over-the-counter) medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems, since they may increase your blood pressure.

Serious side effects of Ziac

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:

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
• dilated neck veins
• dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• drowsiness
• dry mouth
• fast or pounding heartbeat or pulse
• fast, weak pulse
• frequent urination
• 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
• seeing, hearing, or feeling things that are not there
• seizures
• shakiness
• slurred speech
• sweating
• swelling of the face, hands, fingers, feet, ankles, or lower legs
• tightness in the chest
• trembling
• unconsciousness
• unusual drowsiness, dullness, or feeling of sluggishness
• unusual excitement, nervousness, or restlessness
• very drowsy or sleepy
• weakness and heaviness of legs
• weight gain

Other side effects of Ziac

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:

For healthcare professionals

Applies to bisoprolol / hydrochlorothiazide: oral tablet.

General adverse events

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]

Cardiovascular

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

Bisoprolol:

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

Hydrochlorothiazide:

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

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

Gastrointestinal

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

Bisoprolol:

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

Hydrochlorothiazide:

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

Nervous system

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

Bisoprolol:

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

Hydrochlorothiazide:

• Frequency not reported: Vertigo, paresthesia^[Ref]

Musculoskeletal

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

Bisoprolol:

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

Hydrochlorothiazide:

• Frequency not reported: Cramping, muscle spasm^[Ref]

Respiratory

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

Bisoprolol:

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

Hydrochlorothiazide:

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

Other

• Common (1% to 10%): Fatigue

Bisoprolol:

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

Hydrochlorothiazide:

• Frequency not reported: Weakness, fever^[Ref]

Genitourinary

• Common (1% to 10%): Impotence

Bisoprolol:

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

Hydrochlorothiazide:

• Frequency not reported: Sexual dysfunction^[Ref]

Metabolic

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

Bisoprolol:

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

Hydrochlorothiazide:

• 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]

Psychiatric

• Frequency not reported: Insomnia, loss of libido

Bisoprolol:

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

Hydrochlorothiazide:

• Frequency not reported: Restlessness^[Ref]

Immunologic

Bisoprolol:

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

Renal

Bisoprolol:

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

Hydrochlorothiazide:

• 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]

Dermatologic

Bisoprolol:

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

Hydrochlorothiazide:

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

Ocular

Bisoprolol:

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

Hydrochlorothiazide:

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

Hematologic

Bisoprolol:

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

Hydrochlorothiazide:

• 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]

Hypersensitivity

Bisoprolol:

• Frequency not reported: Angioedema

Hydrochlorothiazide:

• Frequency not reported: Urticaria, anaphylactic reactions^[Ref]

Hepatic

Bisoprolol:

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

Hydrochlorothiazide:

• Frequency not reported: Intrahepatic cholestatic jaundice, cholecystitis^[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]

See also:

Further information

Ziac side effects can vary depending on the individual. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Note: Medication side effects may be underreported. If you are experiencing side effects that are not listed, submit a report to the FDA by following this guide.

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