Uses
What is bisoprolol/hydrochlorothiazide used for?
Bisoprolol/hydrochlorothiazide is commonly used to treat high blood pressure (hypertension). Lowering blood pressure may also lower the risk of heart attack or stroke.
Bisoprolol/hydrochlorothiazide may also be used for other conditions as determined by your healthcare provider.
How does bisoprolol/hydrochlorothiazide work (mechanism of action)?
Bisoprolol/hydrochlorothiazide blocks beta-1 receptors in your heart. These receptors normally bind to hormones called catecholamines. When catecholamines bind to these receptors, it causes your heart to beat harder and faster. Blocking these receptors helps your heart beat more slowly.
Bisoprolol/hydrochlorothiazide also works by increasing how much you pee. It does this by helping the kidneys remove electrolytes such as sodium (salt), and water from the body. It also appears to relax your blood vessels to allow blood to flow more freely (less resistance to flow). Together, these effects can help lower blood pressure and may reduce your risk for heart attack and stroke.
How is bisoprolol/hydrochlorothiazide supplied (dosage forms)?
Bisoprolol/hydrochlorothiazide is available as Ziac and generic bisoprolol/hydrochlorothiazide in the following dosage forms that are taken by mouth.
- 2.5 mg/6.25 mg oral tablets
- 5 mg/6.25 mg oral tablets
- 10 mg/6.25 mg oral tablets
How should I store bisoprolol/hydrochlorothiazide?
Bisoprolol/hydrochlorothiazide should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a tightly closed container, in a cool, dry place.
Side Effects
What are the most common side effects of bisoprolol/hydrochlorothiazide?
The most common side effects of bisoprolol/hydrochlorothiazide are listed below. Tell your healthcare provider if you have any of these side effects that bother you.
- Heart rate changes
- Dizziness
- Tiredness
- Headache
- Muscle pain
- Cough
- Diarrhea
There may be other side effects of bisoprolol/hydrochlorothiazide that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.
What are the serious side effects of bisoprolol/hydrochlorothiazide?
While less common, the most serious side effects of bisoprolol/hydrochlorothiazide are described below, along with what to do if they happen.
Severe Allergic Reactions. Bisoprolol/hydrochlorothiazide may cause allergic reactions, which can be serious. Stop taking bisoprolol/hydrochlorothiazide and get help right away if you have any of the following symptoms of a serious allergic reaction.
- Breathing problems or wheezing
- Racing heart
- Fever or general ill feeling
- Swollen lymph nodes
- Swelling of the face, lips, mouth, tongue, or throat
- Trouble swallowing or throat tightness
- Itching, skin rash, or pale red bumps on the skin called hives
- Nausea or vomiting
- Dizziness, feeling lightheaded, or fainting
- Stomach cramps
- Joint pain
Skin Cancer. Bisoprolol/hydrochlorothiazide may increase your risk of developing some types of skin cancer, usually squamous cell carcinoma. If you need to be in sunlight, wear sunscreen, a hat, and clothing that covers your skin. Check your skin regularly for any new growths or changes in moles, freckles, bumps, or birthmarks. Pay attention to your face, neck, ears, scalp, chest, arms, hands, legs, feet, genital area, and between your butt cheeks. Call your healthcare provider if you notice anything that looks questionable.
New or Worsening Heart Failure. Bisoprolol/hydrochlorothiazide may worsen existing heart failure or cause fluid buildup in your body. For people with heart disease or heart damage, bisoprolol/hydrochlorothiazide can potentially lead to heart failure over time. Tell your healthcare provider right away if you have any of the following symptoms.
- Shortness of breath or trouble breathing, especially while lying down
- Swelling in your feet, ankles, or legs
- Unusually fast weight gain
- Unusual tiredness
Heart Rate Changes. Bisoprolol/hydrochlorothiazide can make your heart beat slower than normal (bradycardia). Call your healthcare provider right away if you have any of the following symptoms of bradycardia.
- Feeling lightheaded, dizziness, or fainting
- Confusion
- Feeling weak or easily tired
- Chest pain
- Shortness of breath
Low Blood Pressure with Worsening Kidney Function. Water loss from bisoprolol/hydrochlorothiazide can lower your blood pressure too much and cause dehydration. Both may lead to problems that are more serious than light-headedness. Poor blood flow to important organs such as your kidneys can occur, especially if you are elderly. Drink enough water to stay hydrated, especially if you have excessive sweating, vomiting, or diarrhea. Get out of bed or from a seated position slowly. Tell your healthcare provider right away if you have any of the following symptoms.
- Dizziness, feeling lightheaded, or fainting
- Confusion
- Feeling weak or tired
- Sudden weight gain
- Confusion
- Reduced need to pee
- Increased thirst
- Dark or strong-smelling pee
- Dry mouth
- Sunken eyes
- Headache
- Fast heartbeat
Electrolyte Changes and Increased Blood Sugar. Bisoprolol/hydrochlorothiazide may increase your blood sugar (glucose) levels and cause changes to the levels of certain minerals in your body, called electrolytes. For example, it may cause low potassium levels (hypokalemia), low sodium levels (hyponatremia), low magnesium levels (hypomagnesemia), high calcium levels (hypercalcemia), or low chloride levels (hypochloremia), or high glucose levels (hyperglycemia). These changes can be serious. Your healthcare provider will do bloodwork to check your glucose and electrolyte levels, especially if you take certain other medicines. Keep your appointments to have your blood checked. Call your healthcare provider if you have any of the following symptoms.
- Weakness
- Unusual tiredness
- Muscle cramps or twitching
- Constipation
- Nausea, vomiting, or loss of appetite
- Dizziness
- Restlessness or irritability
- Difficulty breathing
- Confusion or decreased alertness
- Abnormal heart rhythm
- Seizures
Peripheral Vascular Disease. Bisoprolol/hydrochlorothiazide can cause the heart to pump less blood to the rest of the body. This can make blood flow problems to the arms, legs, and intestines worse.
Breathing Problems. Bisoprolol/hydrochlorothiazide may cause the muscles around the airways to tighten (bronchospasm) instead of relaxing, which can be serious. Stop taking bisoprolol/hydrochlorothiazide and contact your healthcare provider right away if you have trouble breathing.
Decreased Symptoms of Low Blood Sugar (Hypoglycemia). Bisoprolol/hydrochlorothiazide can decrease early signs of low blood sugar, such as fast heartbeat, and make it more likely for the low blood sugar to be serious, especially for people with diabetes. Contact your healthcare provider right away if you have trouble detecting any of the following symptoms of low blood sugar.
- Headache
- Crankiness or anxiety
- Hunger
- Dizziness or confusion
- Blurry vision
- Slurred speech
- Sweating
- Feeling jittery or shakiness
- Fast heartbeat
- Seizures
Short-Sightedness and Glaucoma. Bisoprolol/hydrochlorothiazide may make it harder to see faraway objects (short-sightedness). It also may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. These issues may be more likely with taking bisoprolol/hydrochlorothiazide if you have a sulfa or penicillin allergy. Tell your healthcare provider right away if you have any of the following symptoms.
- Trouble seeing faraway objects
- Loss of vision
- Eye pain or redness
- Severe headache or vomiting
- Seeing bright, colorful circles around lights (vision halos)
Inflammation of the Pancreas (Pancreatitis). Bisoprolol/hydrochlorothiazide may cause inflammation of the pancreas, which is called pancreatitis. Stop taking bisoprolol/hydrochlorothiazide and call your healthcare provider right away if you have symptoms of pancreatitis, including vomiting or severe pain in the upper part of your belly that travels to your back.
Liver Damage. Liver damage, also called hepatotoxicity, can happen when taking bisoprolol/hydrochlorothiazide. Call your healthcare provider right away if you have any of the following symptoms of liver damage.
- Nausea or vomiting
- Stomach or belly pain
- Fever
- Weakness or unusual tiredness
- Itching
- Loss of appetite
- Light-colored poop
- Dark-colored urine
Severe Skin Reactions. Bisoprolol/hydrochlorothiazide can cause severe skin reactions called Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) that can lead to death if not treated. If you develop a rash, stop bisoprolol/hydrochlorothiazide, and call your healthcare provider right away. Get emergency help right away if you have any of the following symptoms of SJS or TEN.
- Painful red or purple skin that looks burned and peels off
- Flat red rash or blisters on your skin, mouth, nose, and genitals
- Red, painful, watery eyes
Warnings & Precautions
Who should not use bisoprolol/hydrochlorothiazide?
Allergies to Ingredients. People who are allergic to any of the following should not take bisoprolol/hydrochlorothiazide.
- Ziac
- Bisoprolol
- Hydrochlorothiazide
- Any other medicine known as a sulfonamide (sulfa drug)
- Any of the ingredients in the specific product dispensed
Your pharmacist can tell you all of the ingredients in the specific bisoprolol/hydrochlorothiazide products they stock.
Bradycardia. Bisoprolol/hydrochlorothiazide should not be taken if your heart is beating too slow (bradycardia).
Heart Block. Bisoprolol/hydrochlorothiazide should not be taken if the electrical signals in your heart move too slow (heart block).
Severe or Worsening Heart Failure. Bisoprolol/hydrochlorothiazide should not be taken if your heart failure is severe or getting worse, causing you to feel very tired, have trouble breathing, or swelling in your legs.
No Urine Production. Do not take bisoprolol/hydrochlorothiazide if you are making very little to no pee. This condition is also called anuria.
Very Low Electrolytes. If you have low electrolytes, including low sodium or potassium, bisoprolol/hydrochlorothiazide may not be safe to take. Your healthcare provider may do bloodwork to check your electrolyte levels before starting bisoprolol/hydrochlorothiazide. Low electrolytes are not usually something you can feel, so it is important to keep your appointments to have your blood checked.
Cardiogenic Shock. Bisoprolol/hydrochlorothiazide should not be taken if you have a life-threatening condition called cardiogenic shock where your heart cannot pump enough blood to the rest of your body.
What should I know about bisoprolol/hydrochlorothiazide before using it?
Do not take bisoprolol/hydrochlorothiazide unless it has been prescribed to you by a healthcare provider. Take it as prescribed.
Do not share bisoprolol/hydrochlorothiazide with other people, even if they have the same condition as you. It may harm them.
Keep bisoprolol/hydrochlorothiazide out of the reach of children.
Bisoprolol/hydrochlorothiazide can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how bisoprolol/hydrochlorothiazide affects you.
Bisoprolol/hydrochlorothiazide can lead to low blood sugar levels, especially if you are fasting (unable to keep food/drink down because of vomiting, not eating due to upcoming surgery, etc).
Bisopolol/hydrochlorothiazide can decrease early signs of low blood sugar, such as fast heartbeat, and make it more likely for the low blood sugar to be serious, especially for people with diabetes. Talk with your healthcare provider about symptoms of low blood sugar to watch for if this happens.
Stopping bisoprolol/hydrochlorothiazide suddenly may lead to chest pain, heart attack or dangerous heart rhythms, especially in people with heart disease. Do not stop taking this medicine without talking to your healthcare provider first.
Bisoprolol/hydrochlorothiazide can make your skin more sensitive to light from the sun, sunlamps, and tanning beds. This is called photosensitivity. Exposure to this light can cause severe sunburns, blisters, and swelling. If you need to be in sunlight, wear sunscreen, a hat, and clothing that covers your skin.
What should I tell my healthcare provider before using bisoprolol/hydrochlorothiazide?
Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if bisoprolol/hydrochlorothiazide is right for you.
In particular, make sure that you discuss any of the following.
Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.
- If you need to fast or have severe or persistent vomiting or diarrhea
- Breathing problems
- Diabetes
- Low levels of electrolytes
- Abnormal heart rhythm (arrhythmias)
- Gout
- Prostate problems
- A reduced need to pee
- Heart or circulation problem
- Kidney or liver problems
- Thyroid problems
Use Epinephrine to Treat Allergic Reactions. Bisoprolol/hydrochlorothiazide may lower your response to typical doses of epinephrine when treating an allergic reaction.
Systemic Lupus Erythematosus. Bisoprolol/hydrochlorothiazide may activate or worsen systemic lupus erythematosus. Tell your healthcare provider if you develop or have a worsening rash, joint pain, fever, or unusual tiredness.
Sulfa Allergy. Some people who have a sulfa allergy may also be allergic to bisoprolol/hydrochlorothiazide. A sulfa allergy is a rash or more serious reaction to sulfa, or sulfonamide, medicines. Sulfa medicines include sulfamethoxazole, sulfadiazine silver, or sulfasalazine. Tell your healthcare provider if you have any allergies to medicines.
Other Medicines and Supplements. Bisoprolol/hydrochlorothiazide may interact with other medicines and supplements. Before taking bisoprolol/hydrochlorothiazide, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.
Pregnancy. It is not known if or how bisoprolol/hydrochlorothiazide could affect pregnancy or harm an unborn baby. Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should take bisoprolol/hydrochlorothiazide while you are pregnant or trying to get pregnant.
Breastfeeding. Hydrochlorothiazide (one of the active ingredients in bisoprolol/hydrochlorothiazide) can pass into breast milk. It is not known if bisoprolol (the other active ingredient) passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should stop breastfeeding or stop bisoprolol/hydrochlorothiazide.
Interactions
Does bisoprolol/hydrochlorothiazide interact with foods or drinks?
There are no known interactions between bisoprolol/hydrochlorothiazide and foods or drinks. However, since hydrochlorothiazide (one of the active ingredients in bisoprolol/hydrochlorothiazide) affects electrolytes, it is important to discuss your intake of electrolytes, including sodium and potassium, with your healthcare provider.
The risk of dizziness or sudden dip in blood pressure that happens when you stand up after you’ve been sitting or lying down (orthostatic hypotension) may be increased if you drink alcohol while taking bisoprolol/hydrochlorothiazide. It is best to limit the amount of alcohol you drink.
Does bisoprolol/hydrochlorothiazide interact with other medicines (drug interactions)?
Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.
In particular, make sure that you discuss if you are using any of the following before taking bisoprolol/hydrochlorothiazide.
- A barbiturate, such as phenobarbital, butalbital, or primidone, which is a medicine that may be used to treat insomnia, migraines, or seizures
- An opioid, such as oxycodone, morphine, codeine, or fentanyl, which is a medicine used for certain types of pain
- Any medicine for diabetes
- Any medicine for high blood pressure
- Any medicine for irregular heart rate or rhythm
- Another beta-blocker, such as metoprolol (Lopressor, Toprol XL, and others), atenolol (Tenormin), or propranolol (Inderal LA, Innopran XL), which is a medicine used for certain heart conditions or to reduce blood pressure
- Cholestyramine or colestipol, which are sometimes used to lower cholesterol
- A corticosteroid, such as prednisone, methylprednisolone, or dexamethasone, which is a medicine for certain inflammatory conditions
- Lithium, which is a medicine commonly used for certain mental health conditions
- A nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, naproxen, and others, which are contained in many prescription and OTC products for pain, swelling, and fever
- Clonidine, which is a medicine used to treat high blood pressure and attention deficit hyperactivity disorder (ADHD)
- Diltiazem and verapamil, which are medicines used to treat chest pain and high blood pressure
- Digoxin (Lanoxin), which is a medicine used to treat irregular heartbeat and some types of heart failure
- A diuretic, also called a water pill, which is a medicine used to reduce edema (fluid retention) and blood pressure
- Rifampin, which is a medicine commonly used to treat an infection called tuberculosis
This may not be a complete list of medicines that can interact with bisoprolol/hydrochlorothiazide. Always check with your healthcare provider.
Overdose/Missed Dose
What should I do if I accidentally use too much bisoprolol/hydrochlorothiazide?
If you or someone else has used too much bisoprolol/hydrochlorothiazide, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.
What should I do if I miss a dose of bisoprolol/hydrochlorothiazide?
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and only take the next dose. Do not take double or extra doses.
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