provider image
Welcome! You’re in GoodRx for healthcare professionals. Now, you’ll enjoy a streamlined experience created specifically for healthcare professionals.
Skip to main content
Bisoprolol / HCTZ Coupon - Bisoprolol / HCTZ 5mg/6.25mg tablet

bisoprolol / HCTZ

Generic Ziac
Used for Hypertension
Used for Hypertension

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.

Reviewed by:
reviewer
Kristianne Hannemann, PharmD
reviewer
Cydnee Ng, PharmD
Last reviewed on March 12, 2025
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageInteractionsCostContraindicationsAlternativesLatest newsImagesReferencesPricesMedicare
basics-icon

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.

Are you looking for information on bisoprolol or hydrochlorothiazide instead?
When does Ziac (bisoprolol / hydrochlorothiazide) start working?
Time passed since treatment started:
HOURS
DAYS
WEEKS
MONTHS
Initial effect
Full effect

Drug Facts

Common BrandsZiac
Drug ClassBeta blocker / Diuretic (water pill)
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
coupon-save-icon

Get your GoodRx coupon

Avg retail price
$36.140
GoodRx discount
$36.14
See prices
basics-icon

What are the 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%)

Other 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

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

Source: DailyMed

The following 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

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

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:

Less common

Acid or sour stomach

belching

decreased interest in sexual intercourse

diarrhea

difficulty with moving

heartburn

inability to have or keep an erection

indigestion

joint pain

loss in sexual ability, desire, drive, or performance

muscle aching or stiffness

sleepiness

stomach discomfort, upset, or pain

swollen joints

Rare

Runny or stuffy nose

sneezing

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.

pros-and-cons

Pros and cons of Ziac (bisoprolol / hydrochlorothiazide)

thumbs-up

Pros

Only taken once daily

Combines two blood pressure medications into one tablet

Can take with or without food

thumbs-down

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

Pharmacist tips for Ziac (bisoprolol / hydrochlorothiazide)

pharmacist

  • 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

              Hypertension: measuring bp pills on table 1161201510

              When Should You Take Blood Pressure Medication?

              Written by Alice Perlowski, MD, MA, FACC
              faqs

              Frequently asked questions about Ziac (bisoprolol / hydrochlorothiazide)

              When is the best time to take 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).
              How long does Ziac (bisoprolol / hydrochlorothiazide) take to work?
              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.
              Can you eat grapefruit with Ziac (bisoprolol / hydrochlorothiazide)?
              Yes. You can eat grapefruit while taking Ziac (bisoprolol / hydrochlorothiazide). Bisoprolol and hydrochlorothiazide both don't usually interact with grapefruit.
              Does Ziac (bisoprolol / hydrochlorothiazide) make you tired?
              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.
              Does Ziac (bisoprolol / hydrochlorothiazide) cause weight gain?
              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.
              Can I drink alcohol while taking Ziac (bisoprolol / hydrochlorothiazide)?
              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.
              How do you stop taking Ziac (bisoprolol / hydrochlorothiazide) safely?
              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.
              GoodRxEducationalIcon

              How to save using GoodRx

              Compare Prices
              1. Compare PricesSpecify your dosage and quantity to find out exactly how much you can save.
              Select your free coupon
              2. Select your free couponYou can use the displayed coupon, or compare prices at other pharmacies near you.
              Show coupon to your pharmacist
              3. Show coupon to your pharmacistPresent your printed or electronic coupon when you pick up your prescription.
              Get free couponLearn more
              warings-icon

              What are the 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-warning

              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-warning

                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.

                  risk-warning

                  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).

                    risk-warning

                    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).

                      risk-warning

                      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.

                        risk-warning

                        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.

                          risk-warning

                          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-warning

                          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.

                            dosage

                            Ziac (bisoprolol / hydrochlorothiazide) dosage forms

                            The average cost for 30 tablets of 5mg/6.25mg of Ziac (bisoprolol / hydrochlorothiazide) is $273.26 with a free GoodRx coupon. This is 13.16% off the average retail price of $314.68.
                            tablet
                            Tablet
                            DosageQuantityPrice as low asPrice per unit
                            2.5mg/6.25mg90 tablets$804.97$8.94
                            5mg/6.25mg30 tablets$273.26$9.11
                            10mg/6.25mg90 tablets$805.03$8.94

                            Typical dosing 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 forms

                            Ziac: ziac dosage

                            Ziac Dosages for High Blood Pressure: Your GoodRx Guide

                            Written by Alex Evans, PharmD, MBA
                            interactions

                            Interactions between Ziac (bisoprolol / hydrochlorothiazide) and other drugs

                            Ziac (bisoprolol / hydrochlorothiazide) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Ziac (bisoprolol / hydrochlorothiazide). Please note that only the generic name of each medication is listed below.

                            More on Ziac (bisoprolol / hydrochlorothiazide) interactions

                            hypertension: alcohol: holding wine glass searching on phone 1447128798

                            Can I Drink Alcohol While Taking Lisinopril, Losartan, Metoprolol, and Other Blood Pressure Medications?

                            Written by Christina Aungst, PharmD

                            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.

                            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.

                            drug-cost

                            How much does Ziac (bisoprolol / hydrochlorothiazide) cost?

                            To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
                            Ziac (brand)
                            GoodRx lowest price

                            $273.26

                            (save 13.16%)
                            Ziac (bisoprolol / hydrochlorothiazide) (generic)
                            GoodRx lowest price

                            $36.14

                            0
                            View prices & coupons
                            contraindications-icon

                            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.
                            alternatives

                            What are alternatives to Ziac (bisoprolol / hydrochlorothiazide)?

                            There are a number of medications that your doctor can prescribe in place of Ziac (bisoprolol / hydrochlorothiazide). Compare a few possible alternatives below.
                            Ziac (bisoprolol / hydrochlorothiazide)
                            Used for:
                            $36.14 Lowest GoodRx priceView Prices
                            Zestoretic (lisinopril / hydrochlorothiazide)
                            Used for:
                            $14.39 Lowest GoodRx priceView Prices
                            Tenoretic (atenolol / chlorthalidone)
                            Used for:
                            $42.78 Lowest GoodRx priceView Prices
                            images

                            Ziac (bisoprolol / hydrochlorothiazide) images

                            Pink Round 50 And B - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            This medicine is Pink, Round Tablet Imprinted With "50" And "B".Pink Round 50 And B - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            Red Round E 704 - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            This medicine is Red, Round Tablet Imprinted With "E 704".Red Round E 704 - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            Blue Round 503 And M - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            This medicine is Blue, Round Tablet Imprinted With "503" And "M".Blue Round 503 And M - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            Pink Round Ul And I I - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            This medicine is Pink, Round Tablet Imprinted With "Ul" And "I I".Pink Round Ul And I I - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            Pink Round 114 - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            This medicine is Pink, Round Tablet Imprinted With "114".Pink Round 114 - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            Pink Round 114 - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            This medicine is Pink, Round Tablet Imprinted With "114".Pink Round 114 - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            Pink Round 114 - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet
                            This medicine is Pink, Round Tablet Imprinted With "114".Pink Round 114 - Bisoprolol Fumarate / Hydrochlorothiazide 5mg-6.25mg Tablet

                            Get savings updates for Ziac (bisoprolol / hydrochlorothiazide)

                            Receive price alerts, news, and other messages from GoodRx about Ziac (bisoprolol / hydrochlorothiazide) and other healthcare topics and relevant savings offers.

                            By signing up, I agree to GoodRx's Terms and Privacy Policy, and to receive marketing messages from GoodRx.

                            References

                            Best studies we found

                            MedlinePlus. (2024). Thyroid storm.

                            Mylan Pharmaceuticals Inc. (2024). Bisoprolol fumarate and hydrochlorothiazide tablet, film coated [package insert]. DailyMed.

                            National Heart, Lung, and Blood Institute. (2022). Cardiogenic shock.

                            View All References (3)

                            Vue, M. H., et al. (2011). Drug-induced glucose alterations part 1: Drug-induced hypoglycemia. Diabetes Spectrum.

                            GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.
                            Was this page helpful?

                            Compare other Hypertension drugs

                            Hydrochlorothiazide vs ZiacLopressor vs ZiacTenoretic vs ZiacZiac vs DutoprolZiac vs Exforge
                            View More

                            Browse medications

                            View All

                            Research prescriptions and over-the-counter medications from A to Z, compare drug prices, and start saving.