bisoprolol / HCTZ
Ziac, the brand name for bisoprolol/hydrochlorothiazide or bisoprolol/HCTZ, is a combination medication. It's used to treat high blood pressure in adults. It contains two classes of medications: a beta blocker (bisoprolol) and a diuretic (hydrochlorothiazide). It comes as a tablet that's taken by mouth once a day. Some side effects include dizziness and tiredness.
What is Ziac (bisoprolol / hydrochlorothiazide)?
What is Ziac (bisoprolol / hydrochlorothiazide) used for?
How Ziac (bisoprolol / hydrochlorothiazide) works
Ziac (bisoprolol / hydrochlorothiazide) is a combination of two different medications that both help lower blood pressure.
- Bisoprolol is a beta blocker. It works by blocking certain chemicals from attaching to beta receptors on the heart. This slows down your heart rate and lowers your blood pressure.
- Hydrochlorothiazide is a thiazide diuretic (water pill). It works in your kidneys and move extra water and certain electrolytes into your urine. This helps remove extra water from your body. As a result, it helps lower your blood pressure.
Drug facts
Side effects of Ziac (bisoprolol / hydrochlorothiazide)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Dizziness (5%)
- Tiredness (5%)
- Headache (5%)
- Diarrhea (4%)
Less Common Side Effects
- Muscle pain
- Muscle cramps
- Chest pain
- Swelling in the hands, ankles, or feet
- Cough
- Upper respiratory infection
- Stomach upset
- Trouble sleeping
- Difficulty getting or maintaining an erection
Ziac (bisoprolol / hydrochlorothiazide) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe allergic reaction: trouble breathing; swelling of the tongue, mouth, or throat; hives
- Heart problems: trouble breathing; sudden weight gain; tiredness; chest pain; irregular heartbeat; swelling in the legs, ankles, or feet
- Trouble breathing: tightness in the chest, trouble catching your breath, wheezing, cough, dizziness, extreme tiredness
- Eye problems: sudden changes in vision, eye pain
The following Ziac (bisoprolol / hydrochlorothiazide) side effects have also been reported
Along with its needed effects, a medicine 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:
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
slow or irregular heartbeat
tingling of the hands or feet
trouble breathing
unusual tiredness or weakness
unusual weight gain or loss
Incidence not known
Persistent non-healing sore
pink growth
reddish patch or irritated area
shiny bump
white, yellow or waxy scar-like area
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
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
decrease in amount of urine
dilated neck veins
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
drowsiness
fast or pounding heartbeat or pulse
fast, weak pulse
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
Some side effects 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:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Ziac (bisoprolol / hydrochlorothiazide)
Pros
- Only taken once daily
- Combines two blood pressure medications into one tablet
- Can take with or without food
Cons
- Comes in fixed dosage strengths, so it's harder to adjust the doses of the individual ingredients
- Can make you urinate more often
- Not a good option for people with a sulfa allergy
Pharmacist tips for Ziac (bisoprolol / hydrochlorothiazide)
- Ziac (bisoprolol / hydrochlorothiazide) can make you urinate more often. Try to take the medication in the morning or early afternoon. This helps you to avoid having to get up and use the restroom at night.
- You might feel dizzy while taking Ziac (bisoprolol / hydrochlorothiazide). It can happen when you first start treatment or after your dose gets raised. You might also feel dizzy when standing up after sitting or lying down, which could lead to falls or fainting. This side effect usually gets better after a few days as your body gets used to the medication. But talk to your prescriber if it happens often.
- Ziac (bisoprolol / hydrochlorothiazide) can sometimes cause dizziness and tiredness. Avoid activities that need your full attention, like driving or using other machinery, until you know how the medication affects you. This helps prevent accidents.
- Be sure to wear a hat and use a sunscreen with an SPF of at least 30 when you go outside, even on overcast and winter days. The diuretic in Ziac (bisoprolol / hydrochlorothiazide) can make your skin more sensitive to the sun and make it easier for you to get sunburns.
- If you have a surgery coming up, tell the surgery team that you're taking Ziac (bisoprolol / hydrochlorothiazide). They'll closely monitor your heart rate to keep you safe.
- Don't stop taking Ziac (bisoprolol / hydrochlorothiazide) suddenly without talking to your prescriber. It can cause your blood pressure to rise to very high levels. It can also raise your risk of serious heart problems like chest pain or heart attack.
More on Ziac (bisoprolol / hydrochlorothiazide) tips
Common questions about Ziac (bisoprolol / hydrochlorothiazide)
Take Ziac (bisoprolol / hydrochlorothiazide) at the same time each day to stay consistent. This medication contains a diuretic (water pill) that makes you urinate more. So you might want to take it earlier in the day to avoid waking up at night to use the bathroom. Ask your pharmacist if you need help choosing the best time to take Ziac (bisoprolol / hydrochlorothiazide).
You might see noticeable changes in blood pressure within a week of starting Ziac (bisoprolol / hydrochlorothiazide). But it can take up to 3 weeks of regular use before you see the full effect of the medication on your blood pressure. Ask your prescriber if you have questions about how long it's taking Ziac (bisoprolol / hydrochlorothiazide) to lower your blood pressure.
Yes. You can eat grapefruit while taking Ziac (bisoprolol / hydrochlorothiazide). Bisoprolol and hydrochlorothiazide both don't usually interact with grapefruit.
Yes, Ziac (bisoprolol / hydrochlorothiazide) can make you feel more tired than usual. This happens because it lowers your blood pressure and slows your heart rate. You might feel extra tired during the first few weeks of treatment as you get used to the medication. Talk to your prescriber if your tiredness doesn't get better or if it negatively affects your daily activities. There could be another reason why you you have low energy.
Weight gain doesn't seem to be a usual side effect of Ziac (bisoprolol / hydrochlorothiazide). Some people who took bisoprolol by itself have had weight gain, though. Talk to a healthcare professional if you notice any concerning weight gain. They can discuss with you about possible causes for your weight gain and how to manage it.
It's best to avoid alcohol while taking Ziac (bisoprolol / hydrochlorothiazide). Alcohol can worsen some side effects like dizziness and drowsiness. It can also make the medication work less well at lowering blood pressure. Talk to a healthcare professional about your drinking habits while taking this medication.
If you need to stop taking Ziac (bisoprolol / hydrochlorothiazide), talk to your prescriber. They'll come up with a safe plan for you. Usually, your prescriber will lower your dose slowly over about a week or two. This is because stopping the medication too suddenly can cause your blood pressure to go back up. It can also put you at risk of serious problems like an irregular heartbeat or heart attack.
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Risks and warnings for Ziac (bisoprolol / hydrochlorothiazide)
Ziac (bisoprolol / hydrochlorothiazide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of heart problems after stopping Ziac (bisoprolol / hydrochlorothiazide) suddenly
- Risk factors: Stopping Ziac (bisoprolol / hydrochlorothiazide) suddenly | Coronary artery disease
Don’t stop taking Ziac (bisoprolol / hydrochlorothiazide) suddenly. It can raise your risk of serious heart problems, like chest pain, heart attack, or irregular heart rhythm. The risk might be higher for people with coronary artery disease (CAD).
Get medical help if you have chest pain, pain that spreads to your shoulder and neck, shortness of breath, dizziness, fatigue, or irregular heartbeat. These can be signs of serious heart problems.
If you need to stop Ziac (bisoprolol / hydrochlorothiazide), talk to your prescriber. They can help lower your dose safely over about a week or two before stopping completely.
Risk of heart failure
- Risk factors: Heart failure
In some cases, beta blockers like the bisoprolol in Ziac can raise the risk of heart failure. This is because beta blockers can affect how the heart beats. If you already have heart failure, your healthcare professional (HCP) will only prescribe Ziac (bisoprolol / hydrochlorothiazide) if they believe the benefits outweigh the risks.
Get medical help right away if you have signs of heart failure. Watch for any trouble breathing, fast or irregular pulse, sudden weight gain, or swelling in your feet or ankles.
Changes in fluids and electrolytes in the body
- Risk factors: Liver problems | Dehydration
Ziac (bisoprolol / hydrochlorothiazide) can cause your body to lose fluids and change your electrolyte levels. If you have liver problems, small changes in fluid and electrolyte levels can raise your risk for liver complications.
Tell your care team if you have dry mouth, weakness, muscle cramps, tiredness, fast or irregular heart rate, nausea, or vomiting. These can be signs of abnormal fluid and electrolyte levels. Your HCP might recommend regular blood tests to check your electrolyte levels while taking Ziac (bisoprolol / hydrochlorothiazide).
Hidden symptoms of low blood sugar
- Risk factors: Diabetes | Fasting (e.g., related to getting surgery, not eating regularly, vomiting)
Beta blockers, like the bisoprolol in Ziac, can make it harder to notice signs of low blood sugar. Some signs, like a fast heartbeat, tremors, hunger, and irritability, might not be as noticeable. Sweating might be the only sign you have warning you of a dangerous drop in your blood sugar levels. This is especially important for people with diabetes to be aware of. Speak with your HCP about when and how to check your blood sugar if you start Ziac (bisoprolol / hydrochlorothiazide).
Hidden symptoms of overactive thyroid
- Risk factors: Hyperthyroidism
If you have hyperthyroidism (overactive thyroid), talk to your HCP before stopping Ziac (bisoprolol / hydrochlorothiazide). The bisoprolol in Ziac can hide signs of hyperthyroidism, like a fast heart rate. Suddenly stopping this medication can worsen symptoms of hyperthyroidism. It can also lead to a serious condition called a "thyroid storm,” which can cause high fever and rapid heartbeat.
Caution use in people with breathing problems
- Risk factors: History of asthma | History of chronic obstructive pulmonary disease (COPD) | History of lung problems
Tell your prescriber if you have any breathing problems, like asthma. Medications with beta blockers, such as Ziac (bisoprolol / hydrochlorothiazide), can worsen breathing problems. This medication has a lower chance of causing breathing problems than other beta blockers because it mainly affects the heart. But you should still be aware of this risk. Keep a rescue inhaler nearby in case you have sudden trouble breathing if you have lung problems.
Caution use in people with peripheral artery disease (PAD)
Let your prescriber know if you have peripheral artery disease (PAD). This medication can cause symptoms of PAD to get worse. Your prescriber can make sure it's safe for you to take. Tell your care team if you notice that your PAD symptoms get worse while taking Ziac (bisoprolol / hydrochlorothiazide).
Risk of vision problems and glaucoma
- Risk factors: History of sulfa or penicillin allergy
Hydrochlorothiazide, one of the ingredients in Ziac, can rarely cause glaucoma and a rise in eye pressure. This can lead to sudden changes in vision or eye pain that can happen within hours to weeks of starting the medication. Stop taking Ziac (bisoprolol / hydrochlorothiazide) and call your eye specialist right away if you notice sudden vision changes or eye pain. If left untreated, it can possibly lead to permanent blindness.
Ziac (bisoprolol / hydrochlorothiazide) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 2.5mg/6.25mg | 90 tablets | $29.05 | $0.32 |
| 10mg/6.25mg | 90 tablets | $31.02 | $0.34 |
| 5mg/6.25mg | 30 tablets | $15.50 | $0.52 |
Typical dosage for Ziac (bisoprolol / hydrochlorothiazide)
The typical starting dose is 2.5 mg/6.25 mg (bisoprolol/hydrochlorothiazide) by mouth once daily. If needed, your prescriber will raise your dose every 2 weeks.
The maximum recommended dose is 20 mg/12.5 mg (bisoprolol/hydrochlorothiazide) by mouth once daily.
More on Ziac (bisoprolol / hydrochlorothiazide) dosage
Interactions between Ziac (bisoprolol / hydrochlorothiazide) and other drugs
More on Ziac (bisoprolol / hydrochlorothiazide) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Aceclofenac
- Acemetacin
- Acetyldigoxin
- Albuterol
- Amphetamine
- Amtolmetin Guacil
- Arsenic Trioxide
- Aspirin
- Benzphetamine
- Bromfenac
- Bufexamac
- Celecoxib
- Ceritinib
- Choline Salicylate
- Clonidine
- Clonixin
- Crizotinib
- Deslanoside
- Desmopressin
- Dexibuprofen
- Dexketoprofen
- Dextroamphetamine
- Diclofenac
- Diflunisal
- Digitalis
- Digitoxin
- Digoxin
- Diltiazem
- Dipyrone
- Dronedarone
- Droperidol
- Droxicam
- Etodolac
- Etofenamate
- Etoricoxib
- Felbinac
- Fenoldopam
- Fenoprofen
- Fepradinol
- Feprazone
- Fingolimod
- Flecainide
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Formoterol
- Ibuprofen
- Indacaterol
- Indomethacin
- Iohexol
- Ketanserin
- Ketoprofen
- Ketorolac
- Lacosamide
- Levalbuterol
- Levomethadyl
- Lisdexamfetamine
- Lithium
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Methamphetamine
- Methotrexate
- Metildigoxin
- Morniflumate
- Nabumetone
- Naproxen
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Olodaterol
- Ouabain
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenylbutazone
- Piketoprofen
- Piroxicam
- Ponesimod
- Porfimer
- Proglumetacin
- Propyphenazone
- Proquazone
- Proscillaridin
- Rivastigmine
- Rofecoxib
- Salicylic Acid
- Salmeterol
- Salsalate
- Siponimod
- Sodium Salicylate
- Sotalol
- Sulindac
- Tenoxicam
- Terbutaline
- Tiaprofenic Acid
- Tolfenamic Acid
- Tolmetin
- Valdecoxib
- Verapamil
- Vilanterol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Acarbose
- Aceclofenac
- Acemetacin
- Acetyldigoxin
- Albiglutide
- Alfuzosin
- Alogliptin
- Aminolevulinic Acid
- Amtolmetin Guacil
- Arbutamine
- Aspirin
- Bepridil
- Bromfenac
- Bufexamac
- Bunazosin
- Canagliflozin
- Carbamazepine
- Celecoxib
- Chlorpropamide
- Cholestyramine
- Choline Salicylate
- Clonixin
- Dapagliflozin
- Deslanoside
- Dexibuprofen
- Dexketoprofen
- Diclofenac
- Diflunisal
- Digitoxin
- Digoxin
- Dipyrone
- Doxazosin
- Droxicam
- Dulaglutide
- Empagliflozin
- Ertugliflozin
- Etodolac
- Etofenamate
- Etoricoxib
- Exenatide
- Felbinac
- Fenoprofen
- Fepradinol
- Feprazone
- Floctafenine
- Flufenamic Acid
- Flurbiprofen
- Ginkgo
- Glimepiride
- Glipizide
- Glyburide
- Gossypol
- Ibuprofen
- Indomethacin
- Insulin Aspart, Recombinant
- Insulin Degludec
- Insulin Detemir
- Insulin Glargine, Recombinant
- Insulin Glulisine
- Insulin Human Inhaled
- Insulin Human Isophane (NPH)
- Insulin Human Regular
- Insulin Lispro, Recombinant
- Ketoprofen
- Ketorolac
- Licorice
- Linagliptin
- Liraglutide
- Lixisenatide
- Lornoxicam
- Loxoprofen
- Lumiracoxib
- Meclofenamate
- Mefenamic Acid
- Meloxicam
- Metformin
- Methyldopa
- Metildigoxin
- Mibefradil
- Miglitol
- Morniflumate
- Moxisylyte
- Nabumetone
- Naproxen
- Nateglinide
- Nepafenac
- Niflumic Acid
- Nimesulide
- Nimesulide Beta Cyclodextrin
- Oxaprozin
- Oxyphenbutazone
- Parecoxib
- Phenoxybenzamine
- Phentolamine
- Phenylbutazone
- Piketoprofen
- Pioglitazone
- Piroxicam
- Pramlintide
- Pranoprofen
- Prazosin
- Proglumetacin
- Propyphenazone
- Proquazone
- Repaglinide
- Rifapentine
- Rofecoxib
- Rosiglitazone
- Salicylic Acid
- Salsalate
- Saxagliptin
- Sitagliptin
- Sodium Salicylate
- St John's Wort
- Sulindac
- Tamsulosin
- Tenoxicam
- Terazosin
- Tiaprofenic Acid
- Tolazamide
- Tolbutamide
- Tolfenamic Acid
- Tolmetin
- Topiramate
- Trimazosin
- Urapidil
- Valdecoxib
- Vildagliptin
How much does Ziac (bisoprolol / hydrochlorothiazide) cost?
Ziac (bisoprolol / hydrochlorothiazide) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Ziac (bisoprolol / hydrochlorothiazide) will not be safe for you to take.
- Slow heart rate
- Second- or third-degree heart block
- Cardiac shock
- Certain cases of heart failure
- Not making urine (not urinating)
- Allergy to sulfa-containing medications
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