Trade Names:Ziac- Tablets 6.25 mg hydrochlorothiazide/2.5 mg bisoprolol fumarate- Tablets 6.25 mg hydrochlorothiazide/5 mg bisoprolol fumarate- Tablets 6.25 mg hydrochlorothiazide/10 mg bisoprolol fumarate
Blocks beta receptors, primarily affecting CV system and lungs (bisoprolol); inhibits reabsorption of sodium and chloride in ascending loop of Henle and early distal tubules (hydrochlorothiazide).
Management of hypertension.
Cardiogenic shock; overt cardiac failure; second or third degree AV block; marked sinus bradycardia; anuria; hypersensitivity to either component of product or other sulfonamide derivatives.
PO Give once daily in the morning with or without food. Start with 2.5 mg bisoprolol/6.25 mg hydrochlorothiazide daily, increasing the dose in 14-day intervals until optimal response is obtained (max recommended dose 20 mg bisoprolol/12.5 mg hydrochlorothiazide).
Store tablets at controlled room temperature (59° to 86°F). Keep container tightly closed.
Use with caution.Antihypertensives
Actions of other antihypertensive agents may be potentiated.Beta-blockers
Do not combine with other beta-blockers.Catecholamine-depleting agents (eg, guanethidine, reserpine)
Sympathetic action may be considerably reduced.Clonidine
If discontinuing clonidine after coadministration with bisoprolol/hydrochlorothiazide, discontinue bisoprolol/hydrochlorothiazide several days before withdrawal of clonidine.Hydrochlorothiazide Alcohol, barbiturates, narcotics
Increased risk of orthostatic hypotension.Antidiabetic agents
Dose adjustments in antidiabetic agent may be needed.Antihypertensives
Actions of other antihypertensive agents may be potentiated.Cholestyramine, colestipol resins
Absorption of hydrochlorothiazide may be impaired.Adrenocorticotropic hormone, corticosteroids
Increased risk of electrolyte depletion (eg, hypokalemia).Pressor amines (eg, norepinephrine)
Decreased response to pressor amine.Nondepolarizing skeletal muscle relaxants (eg, tubocurarine)
Responsiveness to muscle relaxant may be increased.Lithium
Plasma levels of lithium may be elevated, increasing the risk of toxicity.NSAIDs
The antihypertensive, diuretic, and natriuretic effect of hydrochlorothiazide may be reduced.
Serum levels of protein-bound iodine may be decreased without signs of thyroid dysfunction.
Bradycardia; arrhythmia; peripheral ischemia; chest pain; palpitations and rhythm disturbances, cold extremities, claudication, hypotension; orthostatic hypotension, chest pain, CHF (bisoprolol); orthostatic hypotension (hydrochlorothiazide).
Fatigue; dizziness; headache; insomnia; somnolence; loss of libido; impotence; unsteadiness, vertigo, syncope, paresthesia, hyperesthesia, sleep disturbances, vivid dreams, depression, anxiety, restlessness, decreased concentration, catatonia, hallucinations, time and place disorientation, emotional lability, clouded sensorium (bisoprolol); vertigo, paresthesia, restlessness (hydrochlorothiazide).
Cutaneous vasculitis; rash, acne, eczema, psoriasis, skin irritation, pruritus, purpura, flushing, sweating, alopecia, dermatitis (bisoprolol); photosensitivity (hydrochlorothiazide).
Diarrhea; constipation; nausea; dyspepsia; gastric, epigastric, and abdominal pain, peptic ulcer, gastritis, vomiting, dry mouth, taste abnormalities, mesenteric arterial thrombosis, ischemic colitis (bisoprolol); anorexia, gastric irritation, cramping, pancreatitis, sialadenitis, dry mouth (hydrochlorothiazide).
Cystitis, renal colic, polyuria (bisoprolol); sexual dysfunction, renal failure, renal function impairment, interstitial nephritis (hydrochlorothiazide).
Agranulocytosis, thrombocytopenia; leukopenia, aplastic anemia, hemolytic anemia (hydrochlorothiazide).
Jaundice, cholecystitis (hydrochlorothiazide).
Rhinitis; pharyngitis, sinusitis, visual disturbances, ocular pain and pressure, abnormal lacrimation, tinnitus, decreased hearing, earache (bisoprolol); transient blurred vision, xanthopsia (hydrochlorothiazide).
Gout; increased serum triglycerides; small decrease in HDL cholesterol; weight gain (bisoprolol); hyperglycemia, glucosuria, edema, hyperuricemia, hypokalemia, hyperlipidemia, hypercalcemia (hydrochlorothiazide).
Bronchospasm; cough; upper respiratory infection; asthma, bronchitis, dyspnea (bisoprolol).
Asthenia; peripheral edema; muscle cramps; myalgia; arthralgia, muscle and joint pain, back and neck pain, twitching, tremor, malaise, allergy (fever, aching, sore throat, laryngospasm, respiratory distress) (bisoprolol); weakness, muscle spasm, hypersensitivity (purpura, photosensitivity, rash, urticaria, necrotizing angitis [vasculitis and cutaneous vasculitis], fever, respiratory distress [including pneumonitis and pulmonary edema], anaphylactic reaction) (hydrochlorothiazide).
Monitor blood sugar in diabetic patient when drug is started or dose is changed. Report significant changes to health care provider. Withhold drug and notify health care provider if the following symptoms occur: hypotension, bradycardia, difficulty breathing, edema of hands or feet.
Category C .
Excreted in breast milk.
Safety and efficacy not established.
Dosage adjustment or discontinuation may be necessary; azotemia may be precipitated.
Use with caution.
Use with caution if therapy cannot be avoided.
Exacerbations of angina pectoris and MI or ventricular arrhythmias may occur in patients with coronary artery disease following abrupt cessation of therapy.
Precipitation or exacerbation of symptoms of arterial insufficiency in patients with peripheral vascular disease may occur.
Use with caution if therapy cannot be avoided.
May mask symptoms of hypoglycemia.
May mask clinical signs of hyperthyroidism (eg, tachycardia).
Bradycardia, hypotension, lethargy, delirium, coma, convulsions, respiratory arrest, CHF, bronchospasm, hypoglycemia, acute loss of fluid and electrolytes (eg, hypokalemia, hyponatremia, hypochloremia), tachycardia, shock, weakness, confusion, dizziness, calf cramps, paresthesia, fatigue, impaired consciousness, nausea, vomiting, thirst, polyuria, oliguria, anuria, alkalosis, increased BUN.
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