Bisoprolol and Hydrochlorothiazide

Bisoprolol and hydrochlorothiazide is a prescription medication used to treat high blood pressure. Bisoprolol and hydrochlorothiazide is a single product containing 2 medications: bisoprolol and hydrochlorothiazide. Bisoprolol belongs to a group of drugs called beta blockers. It works to decrease blood pressure and heart rate by blocking beta receptors in the body. Hydrochlorothiazide belongs to a group of drugs called thiazide diuretics, which work by stopping reabsorption of salt into your body. This prevents fluid from building up in the body.

This medication comes in a tablet form and is typically taken once daily with or without food. 

Common side effects of bisoprolol and hydrochlorothiazide include dizziness, tiredness (fatigue), and cough. Do not drive or operate heavy machinery until you know how this medication affects you. 

Bisoprolol and hydrochlorothiazide is a prescription medication used to treat high blood pressure.

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. 

Bisoprolol and Hydrochlorothiazide may be found in some form under the following brand names:

• Ziac

Serious side effects have been reported with bisoprolol and hydrochlorothiazide. See the "Bisoprolol and hydrochlorothiazide Precautions" section. 

Common side effects of bisoprolol and hydrochlorothiazide include the following:

• dizziness
• tiredness (fatigue)
• cough
• slow heart rate
• abnormal heart rhythm (arrhythmia)
• reduction of blood flow in limbs (peripheral ischemia)
• chest pain
• constriction of airways (bronchospasm)
• Irritation and swelling in the inside of the nose (rhinitis)
• an infection that affects the nose, throat, and airways (upper respiratory infection)
• abnormal physical weakness or lack of energy (asthenia)
• retaining fluids in limbs (peripheral edema)
• headache
• muscle cramps
• muscle pain (myalgia)
• difficulty sleeping (insomnia)
• extreme tiredness (somnolence)
• loss of sexual drive/libido
• issues in getting or maintaining an erection (impotence)
• diarrhea
• nausea
• indigestion (dyspepsia)

This is not a complete list of bisoprolol and hydrochlorothiazide side effects. Ask your doctor or pharmacist for more information.

Tell your doctor if you have any side effect that bothers you or that does not go away.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Tell your doctor about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Especially tell your doctor if you take:

• other beta blockers such as metoprolol (Toprol XL, Lopressor), carvedilol (Coreg), betaxolol (Kerlone), nebivolol (Bystolic), and propranolol (Inderal)
• drugs that deplete a substance in the body called catecholamines such as reserpine (Serpalan) or guanethidine (Ismelin)
• clonidine (Catapres)
• medications that slow the heart or help treat abnormal heart rhythms such as verapamil (Calan), diltiazem (Cardizem), disopyramide (Norpace), digoxin (Lanoxicaps, Lanoxin), digitoxin (Crystodigin), and deslanoside 
• rifampin
• alcohol, a class of drugs called barbiturates, or a type of pain medications called narcotics
• diabetic medications
• cholestyramine (Questran) and colestipol (Colestid)
• medicines that provide relief for inflamed areas of the body (corticosteroids) such as methylprednisolone (Medrol) and dexamethasone (Decadron)
• substances that raise blood pressure (pressor amines) such as norepinephrine (Levophed)
• medicines that relax skeletal muscles such as cyclobenzaprine (Flexeril) and carisoprodol (Soma)
• lithium (Lithobid)
• nonsteroidal anti-inflammatory drugs (NSAIDS) such as naproxen (Aleve) and ibuprofen (Advil)

Do not drink alcohol while taking this medication.

This is not a complete list of bisoprolol and hydrochlorothiazide drug interactions. Ask your doctor or pharmacist for more information.

Serious side effects have been reported with bisoprolol and hydrochlorothiazide including the following:

• A condition in which close objects appear clearly, but far ones don't (myopia) or a buildup of pressure in the eye that can cause blindness (glaucoma). Tell your healthcare provider right away if you experience visual changes or eye pain.
• Imbalances in the levels of salts and fluids in your body (electrolyte and fluid imbalance). Tell your healthcare provider right away if you have some or all of the following symptoms:
  • dry mouth
  • thirst
  • weakness
  • drowsiness
  • restlessness
  • muscle pains or cramps
  • low blood pressure
  • low output of urine
  • fast heart rate
  • nausea
  • vomiting
• changes in a gland next to the thyroid that secretes a substance that regulates calcium levels in a person's body (parathyroid disease)
• a condition of excess of uric acid in the blood (hyperuricemia)
• a painful joint (acute gout)

Patients who have diabetes and are receiving insulin or diabetes medications should know that bisoprolol and hydrochlorothiazide can mask certain symptoms of low blood glucose. In this case, bisoprolol and hydrochlorothiazide can mask fast heart rate that occurs when one has low blood sugar.

Do not discontinue this medication all of a sudden. Stopping this medication all of a sudden can result in chest pain or heart attack in patients with coronary artery disease. 

Bisoprolol and hydrochlorothiazide can cause drowsiness. Do not drive or operate heavy machinery until you know how this medication affects you. 

Do not take bisoprolol and hydrochlorothiazide if you(r):

• are allergic to bisoprolol and hydrochlorothiazide or any of its ingredients
• have a condition where your heart suddenly can't pump enough blood to meet your body's needs (cardiogenic shock)
• have heart failure
• have a condition that blocks the conduction of impulses in the heart (atrioventricular block or AV block) 
• have a severely slow heart rate
• have lung disease
• kidneys fail to produce urine (anuria)

Medications can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of bisoprolol and hydrochlorothiazide, there are no specific foods that you must exclude from your diet when receiving this medication. 

Before taking bisoprolol and hydrochlorothiazide, tell your doctor about all of your medical conditions. Especially tell your doctor if you:

• are allergic to bisoprolol and hydrochlorothiazide or any of its ingredients
• have a condition where your heart suddenly can't pump enough blood to meet your body's needs (cardiogenic shock)
• have heart failure
• have a condition that blocks the conduction of impulses in the heart (atrioventricular block or AV block) 
• severely slow heart rate
• your kidneys fail to produce urine (anuria)
• have a circulation disorder that affects blood vessels outside of the heart and brain (peripheral vascular disease)
• have lung disease
• are about to have major surgery
• have diabetes or low blood sugar
• have a thyroid disorder
• have kidney or liver dysfunction

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. 

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

Bisoprolol and hydrochlorothiazide falls into category C. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child. 

Tell your doctor is you are breastfeeding or plan to breastfeed. 

Bisoprolol and hydrochlorothiazide has been detected in human breast milk. Because of the possibility for adverse reactions in nursing infants from bisoprolol and hydrochlorothiazide, a choice should be made whether to stop nursing or to stop use of this medication. The importance of the drug to the mother should be considered. 

Take bisoprolol and hydrochlorothiazide exactly as prescribed. 

• Bisoprolol and hydrochlorothiazide comes in a tablet form and is taken by mouth once daily with or without food. 
• Do not suddenly stop this medication. Your doctor will decrease your dose slowly. 

If you take too much bisoprolol and hydrochlorothiazide, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away. 

• Store at 20° to 25°C (68° to 77°F)
• Dispense in a tight container.
• Keep this and all medicines out of the reach of children.