Advertisement

Generic Name:

bisoprolol-hydrochlorothiazide, Oral tablet

All Brands

  • Ziac
SECTION 1 of 4

Highlights for bisoprolol-hydrochlorothiazide

Oral tablet
1

Bisoprolol/hydrochlorothiazide is a combination of two medications in a single form that work in different ways to lower your high blood pressure (hypertension). This drug can be used alone or with other blood pressure medications.

2

The standard starting dose is bisoprolol 2.5 mg/hydrochlorothiazide 6.25 mg taken by mouth once per day. Your doctor may adjust your dose based on how you respond to the drug.

3

This drug shouldn’t be used in people who have unstable heart failure or who have active symptoms of heart failure. It may make your condition worse. Your doctor will decide if this medication is right for you.

4

Don’t stop taking bisoprolol/hydrochlorothiazide suddenly. Doing so may cause chest pain (angina), irregular heart rate, and even a heart attack. Your risk for these problems may be higher if you already have a heart problem. If you need to stop taking this drug, your doctor will slowly decrease your dose over two weeks.

5

Common side effects include tiredness, a slower than normal heart rate, dizziness, headache, diarrhea, upset stomach, muscle aches and pains, and being unable to get or keep an erection (erectile dysfunction).

IMPORTANT INFORMATION

Stopping the drug

If you have a history of heart problems, stopping this drug suddenly may cause serious side effects. It can cause chest pain (angina), irregular heart rate, and even a heart attack. Don’t stop taking this drug without speaking with your doctor first.

What is bisoprolol/hydrochlorothiazide?

This drug is a prescription drug. It’s available as an oral tablet.

This drug is available as a generic drug. Generic drugs usually cost less. Talk to your healthcare provider to see if the generic will work for you.

This drug is a combination of two drugs in a single form. It’s important to know about all the drugs in the combination because they each may have unique traits.

This drug may be taken as part of a combination therapy with other medications to treat high blood pressure

Why it's used

This drug is a combination of two medications in a single form that work in different ways to lower your high blood pressure. Lowering your blood pressure will reduce your chance of having a stroke or heart attack.

How it works

This drug is a combination of two blood pressure medications.

More Details

How it works

This drug is a combination of two blood pressure medications. Bisoprolol belongs to a class of drugs called beta-blockers. A class of drugs refers to medications that work similarly. They have a similar chemical structure and are often used to treat similar conditions.

Bisoprolol works by relaxing your blood vessels and slowing down your heart rate. This reduces high blood pressure.

Hydrochlorothiazide belongs to a class of drugs called thiazide diuretics. Thiazide diuretics work in your kidneys to remove sodium and water from your body. This helps lower your blood pressure.

Advertisement
SECTION 2 of 4

bisoprolol-hydrochlorothiazide Side Effects

Oral tablet

More Common Side Effects

The more common side effects that occur with bisoprolol/hydrochlorothiazide include:

  • tiredness

  • slower than normal heart rates

  • dizziness

  • headache

  • diarrhea

  • upset stomach

  • muscle aches and pains

  • being unable to get or keep an erection (erectile dysfunction)

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk to your doctor or pharmacist.

Serious Side Effects

If you experience any of these serious side effects, call your doctor right away. If your symptoms are potentially life threatening, or if you think you’re experiencing a medical emergency, call 9-1-1.

  • very low blood pressure. Symptoms include:

    • severe dizziness
    • lightheadedness
    • fainting
  • a drop in blood pressure when you stand up from a sitting or lying position (orthostatic hypotension). Symptoms include:

    • dizziness
    • lightheadedness
    • fainting
  • very slow heart rate. Symptoms include:

    • tiredness
    • severe dizziness
    • lightheadedness
    • fainting
  • irregular heart rate or palpitations. Symptoms include:

    • feeling like your heart is fluttering
    • feeling like your heart is pounding
  • poor circulation. Symptoms include:

    • cold or blue fingers or toes
  • tingling in your skin

  • extreme weakness

  • severe allergic reaction. Symptoms include:

    • itching
    • hives
    • swelling of your throat or tongue
    • trouble breathing or swallowing
  • blistering or peeling skin

  • depression

  • liver damage. Symptoms include:

    • yellowing of your skin and the whites of your eyes
    • nausea
    • not wanting to eat
    • dark-colored urine
    • tiredness
  • systemic lupus erythematosus (SLE), a condition where your immune system attacks parts of your body. Symptoms include:

    • severe skin rash
    • mouth sores
    • tiredness
  • heart failure. Symptoms include:

    • shortness of breath
    • chronic coughing or wheezing
    • swelling or buildup of fluid in legs/ankles and/or chest
    • tiredness
    • lightheadedness
    • nausea
    • lack of appetite
    • confusion or trouble thinking
    • fast heart rate
  • electrolyte imbalances. Symptoms include:

    • dry mouth
    • increased thirst
    • weakness
    • fatigue
    • restlessness
    • muscle pain or cramps
    • muscle weakness
    • producing less urine than normal
    • faster heart rate
    • nausea
    • vomiting
  • eye problems, including nearsightedness and glaucoma. Symptoms include:

    • being unable to see far away
    • eye pain
    • blurry vision
    • bright circles (halos) around objects
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug can cause drowsiness.

Bisoprolol/hydrochlorothiazide works to lower your blood pressure. You should monitor your blood pressure closely, especially when you first start taking this drug.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.
SECTION 3 of 4

bisoprolol-hydrochlorothiazide May Interact with Other Medications

Oral tablet

Bisoprolol/hydrochlorothiazide can interact with other medications, herbs, or vitamins you might be taking. That’s why your doctor should manage all of your medications carefully. If you’re curious about how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Note: You can reduce your chances of drug interactions by having all of your prescriptions filled at the same pharmacy. That way, a pharmacist can check for possible drug interactions.

Alcohol interaction

Using alcohol while taking this drug can cause a sedative effect. You may have slowed reflexes, poor judgment, or sleepiness. This can worsen the drowsiness that’s common with bisoprolol/hydrochlorothiazide.

Alcohol can also increase your risk of having a sudden drop in blood pressure when you stand up from a sitting or lying position (orthostatic hypotension).

Medications that might interact with this drug

Bipolar disorder drugs
  • lithium

This drug may decrease the amount of lithium that’s removed from your body. This puts you at risk for lithium toxicity.

Cholesterol drugs
  • cholestyramine
  • colestipol

These drugs can reduce the amount of bisoprolol/hydrochlorothiazide that is absorbed by your body. This means that it may not work as well to lower your blood pressure.

Diabetes drugs
  • chlorpropamide
  • glimepiride
  • glipizide
  • glyburide
  • tolazamide
  • tolbutamide
  • nateglinide
  • repaglinide
  • insulin

This drug can mask some of the signs of low blood sugar (hypoglycemia), especially fast heart rate. If you’re on medications for diabetes, you may need to test your blood sugar levels more often. Your doctor may adjust the dose of your diabetes drugs if you have a high risk for low blood sugar.

Heart drugs
  • digoxin
  • verapamil
  • diltiazem
  • disopyramide

Taking these drugs with bisoprolol/hydrochlorothiazide can significantly slow down your heart rate.

High blood pressure drugs
  • alpha blockers, such as:
    • doxazosin
    • prazosin
    • terazosin
  • catecholamine-depleting drugs, such as:
    • reserpine
    • guanethidine
  • clonidine
  • calcium-channel blockers, such as:
    • nifedipine
    • verapamil
    • diltiazem

These drugs can make your blood pressure drop to dangerously low levels when taken with bisoprolol/hydrochlorothiazide. Some of these drugs may also slow your heart rate down too much.

Pain drugs (nonsteroidal anti-inflammatory drugs or NSAIDs)
  • diclofenac
  • etodolac
  • ibuprofen
  • indomethacin
  • ketorolac
  • meloxicam
  • nabumetone
  • naproxen

These drugs can affect the way bisoprolol/hydrochlorothiazide works in your kidneys. It may not work as well to lower your blood pressure.

Pain drugs (opioids/narcotics)
  • hydrocodone-acetaminophen
  • acetaminophen-codeine
  • morphine
  • oxycodone

These drugs can cause sudden drop in blood pressure when you stand up from a seated or lying-down position when taken with bisoprolol/hydrochlorothiazide.

Tuberculosis drug
  • rifampin

This drug can decrease the effectiveness of bisoprolol/hydrochlorothiazide. This means that it may not work as well to lower your blood pressure.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you are taking.
Drug warnings
heart problems
People with heart problems

You shouldn’t take this drug if you have these conditions:

  • unstable heart failure
  • second or third degree heart block
  • very low heart rate

This drug can make your condition worse. Anyone who stops this drug suddenly is at risk for heart attack or chest pain (angina), but your risk is higher if you have heart disease.

heart problems
People with circulation problems

This drug should be used with caution if you have a history of peripheral vascular disease. This drug can make your condition worse.

circulation problems
People with breathing problems

This drug should be used with caution if you have any breathing problems, such as asthma or chronic obstructive pulmonary disease (COPD). It can make it more difficult for you to breathe and make certain breathing medicines not work as well.

diabetes
People with diabetes

Bisoprolol can mask some of the signs of low blood sugar, especially fast heart rate. If you’re on insulin or other diabetes drugs, you may need to test your blood sugar more often.

thyroid problems
People with thyroid problems

Bisoprolol may mask the signs and symptoms of hyperthyroidism, such as a fast heart rate. If you stop taking this drug suddenly, it may make your hyperthyroidism symptoms worse and you may need medical help right away. Tell your doctor if you have thyroid problems before you start taking this drug.

liver problems
People with liver problems

Use this drug with caution if you have liver problems. This medication is processed by your liver. If your liver isn’t working well, more of this drug can stay in your body longer. This puts you at risk for more side effects. This drug may also cause fluid and electrolyte imbalances in your body. This can lead to other severe liver issues.

kidney problems
People with kidney problems

Use this drug with caution if you have kidney problems. This drug is removed from your body by your kidneys. If your kidneys aren’t working well, more of this drug can stay in your body longer. This puts you at risk for more side effects

gout
People with gout

Use of this medication may increase your levels of uric acid and the risk of gout flare-ups.

pregnant women
Pregnant women

This drug is a category C pregnancy drug. That means two things:

  1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
  2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Tell your doctor if you’re pregnant or plan to become pregnant. This drug should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

breastfeeding
Women who are breast-feeding

This drug may pass into breast milk and cause serious effects in a breast-feeding baby.

You and your doctor may need to decide if you’ll breast-feed or take this drug.

for seniors
For seniors

As you age, your organs (such as your liver or kidneys) may not work as well as they did compared to when you were younger. More of this drug may stay in your body longer. This puts you at risk for more side effects.

for children
For children

This medicine hasn’t been studied in children and shouldn’t be used in children under the age of 18 years.

call doctor
When to call the doctor

Tell your doctor about all the drugs that you take before you have any surgeries or medical procedures. This drug may make it harder for the heart to respond to adrenaline, which may increase your risk of complications with anesthesia and surgical procedures. You shouldn’t stop taking this medicine before your surgery, unless your doctor directs you to.

allergies
Allergies

This drug can cause a severe allergic reaction, causing symptoms like:

  • trouble breathing or swallowing
  • swelling of your throat or tongue
  • hives
  • rash

Don’t take this drug again if you’ve ever had an allergic reaction to it or other sulfa medications. Taking it again could be fatal (cause death).

SECTION 4 of 4

How to Take bisoprolol-hydrochlorothiazide (Dosage)

Oral tablet

All possible dosages and forms may not be included here. Your dose, form, and how often you take it will depend on:

  • your age
  • the condition being treated
  • how severe your condition is
  • other medical conditions you have
  • how you react to the first dose

What are you taking this medication for?

Hypertension

Brand: Ziac

Form: Oral tablet
Strengths: 
  • bisoprolol 2.5 mg/hydrochlorothiazide 6.25 mg
  • bisoprolol 5 mg/hydrochlorothiazide 6.25 mg
  • bisoprolol 10 mg/hydrochlorothiazide 6.25 mg

Generic: bisoprolol/hydrochlorothiazide

Form: Oral tablet
Strengths: 
  • bisoprolol 2.5 mg/hydrochlorothiazide 6.25 mg
  • bisoprolol 5 mg/hydrochlorothiazide 6.25 mg
  • bisoprolol 10 mg/hydrochlorothiazide 6.25 mg
Adult dosage (ages 18–64 years)
  • starting dose: one tablet of bisoprolol 2.5 mg/hydrochlorothiazide 6.25 mg taken by mouth once per day.
  • dose adjustments: After 2 weeks, your doctor will adjust your dose depending on how you respond to this drug.
  • maximum dose: two tablets of bisoprolol 10 mg/hydrochlorothiazide 6.25 mg taken once per day.
Child dosage (ages 0–17 years)

This medicine hasn’t been studied in children and shouldn’t be used in children under the age of 18 years.

Senior dosage (ages 65 years and older)

There are no specific recommendations for senior dosing. Older adults may process drugs more slowly. A normal adult dose may cause levels of this drug to be higher than normal in your body. If you’re a senior, you may need a lower dose or a different schedule.

Special considerations

Kidney or liver problems: Your doctor may adjust your dose of bisoprolol/hydrochlorothiazide depending on how well your liver and kidneys are working.

Warnings

Stopping therapy: If you need to stop taking bisoprolol/hydrochlorothiazide, your doctor will decrease your dose slowly over two weeks.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always to speak with your doctor or pharmacist about dosages that are right for you.
Pharmacist's Advice
Clinical Associate Professor, University of Illinois at Chicago College of Pharmacy

This drug comes with serious risks if you don't take it as prescribed.

If you don't take it at all or don’t take it on schedule

If you don’t take this drug, your blood pressure may stay high. High blood pressure increases your chance of having a stroke and heart attack.

If you stop taking It suddenly

Don’t stop taking this drug suddenly as it may lead to chest pain (angina), irregular heart rate, and even a heart attack. You’re at higher risk for these effects if you already have a heart problem. If you need to stop taking this drug, your doctor will slowly decrease your dose over two weeks.

If you take too much

If you take too much, you may have these side effects:

  • very low blood pressure (hypotension)
  • a dangerously slow heart rate (bradycardia)
  • extreme tiredness and weakness
  • dizziness
  • confusion
  • trouble breathing
  • seizures
  • coma

If you think that you’ve taken too much of this drug, call your doctor or go to the emergency room right away.

What to do if you miss a dose

If you forget to take your dose, take it as soon as you remember. If it’s just a few hours until the time for your next dose, then wait and only take one dose at that time.

Never try to catch up by taking two doses at once. This could result in toxic side effects.

How to tell if the drug is working

You may be able to tell that this drug is working if your blood pressure is lower. Your doctor will monitor your blood pressure at your checkups. You can also check your blood pressure at home. Keep a log with the date, time of day, and your blood pressure readings. Bring this diary with you to your doctor appointments.

This drug is used for long-term treatment.

Important considerations for taking this drug

Take your medication at the same time every day

This drug is a combination of two types of drugs. Hydrochlorothiazide is a diuretic. This means it may increase how often you urinate. Taking your medication in the morning may decrease the number of times you wake up during the night to use the bathroom.

Store at room temperature from 68–77°F (20–25°C)

Don’t freeze this medication.

Keep it away from high temperature.

Keep your drugs away from areas where they could get wet, such as bathrooms. Store this drug away from moisture and damp locations.

Travel

When traveling with your medication:

  • Always carry your medication with you, such as in your carry-on bag.
  • Don’t worry about airport X-ray machines. They can’t hurt your medication.
  • You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled box with you.
  • Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.

Self-management

You may need to check your blood pressure at home. You should keep a log with the date, time of day, and your blood pressure readings. Bring this diary with you to your doctor appointments.

You may need to buy your own blood pressure monitoring machine. You can buy these at most pharmacies.

Clinical monitoring

Before starting and during treatment with this drug, your doctor may monitor your: 

  • blood pressure
  • fluid and electrolyte balance
  • liver function
  • kidney function
  • heart rate

Sun sensitivity

Hydrochlorothiazide can make you more sensitive to the sun’s effects. You should do the following:

  • Avoid being outside in direct sunlight for long periods of time.
  • Wear protective clothing that covers most of your body.
  • Use sunscreen.

Hidden costs

You may need to purchase a home blood pressure monitor to check your blood pressure.

Insurance

Many insurance companies require a prior authorization for this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

Are there any alternatives?

There are other drugs available to treat your condition. Some may be more suitable for you than others. Talk to your doctor about possible alternatives.


Show Sources

Content developed in collaboration with University of Illinois-Chicago, Drug Information Group

Medically reviewed by Creighton University, Center for Drug Information and Evidence-Based Practice on September 24, 2015

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up-to-date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.
Advertisement
Advertisement
Advertisement