Bisoprolol and Hydrochlorothiazide (Oral)

Bisoprolol and hydrochlorothiazide combination is used in the treatment of hypertension (high blood pressure).


Bisoprolol and hydrochlorothiazide combination is sold in the US under the brand name Ziac. The medication is used to treat hypertension (high blood pressure).

In patients who suffer from hypertension, high blood pressure places greater strain on the heart and arteries. If the condition is allowed to persist untreated, the heart and arteries may cease to work efficiently, causing damage to the vessels that supply the brain, kidneys, and heart. This can cause heart failure, kidney failure, or a stroke. People who have hypertension are also at greater risk of suffering a heart attack. Treatment with bisoprolol and hydrochlorothiazide combination over the long-term controls the patient's blood pressure, greatly reducing the likelihood of the complications caused by hypertension.

Bisoprolol is a beta-blocker. Beta-blockers work by disrupting the nerve impulses to the heart and to other parts of the body, causing the heart to beat more slowly and thus lower the patient's blood pressure. As the blood pressure is reduced, the volume of blood and therefore the supply of oxygen to the heart is increased. Hydrochlorothiazide is a thiazide diuretic, or ‘water pill'. This drug stops the body from absorbing too much salt, effectively reducing the amount of water retained in the body, and also increases the production of urine. Both these effects work to alleviate fluid retention, and therefore help to lower the patient's blood pressure.

Bisoprolol and hydrochlorothiazide combination comes in tablet form and is only available on prescription from your doctor or treating specialist.

Conditions treated

Type of medicine

  • beta-blocker
  • thiazide diuretic
  • tablet

Side effects

Although bisoprolol and hydrochlorothiazide combination undoubtedly provides many benefits, some patients do suffer a few unwanted side effects. You may not experience any adverse effects during the course of your treatment with this drug. However, if you do notice any unusual effects or if you begin to feel worse, you should consult your treating physician.

The side effects detailed below can occasionally occur in people taking bisoprolol and hydrochlorothiazide combination. If you experience any of these effects, report them to your treating physician straight away:

  • shortness of breath or trouble breathing normally
  • swelling or bloating of the face, hand, arms, feet, or lower legs
  • discomfort of pain in the chest
  • feeling lightheaded, faint, or dizzy
  • rapid weight gain
  • a slow or irregular heartbeat
  • tingling sensations in the hands or feet
  • feeling unusually tired or weak
  • unexpectedly losing or gaining weight

There are a few side effects that sometimes occur in patients who are taking bisoprolol and hydrochlorothiazide combination that do not usually need any further medical attention. These effects generally resolve themselves relatively quickly as your body becomes familiarized with the medication. If the effects are particularly persistent or bothersome, your doctor will give you more advice on how to prevent or reduce many of them.

  • sour or acid stomach
  • belching, indigestion, or heartburn
  • decreased libido
  • diarrhea
  • mobility problems
  • inability to gain or maintain an erection
  • joint pain or swelling
  • muscle aches or stiffness
  • feeling unusually tired or sleepy
  • stomach pain or discomfort
  • runny or stuffy nose
  • sneezing

This list of side effects is not necessarily exhaustive. If you begin to experience any other unexpected effects, you should consult your treating physician without delay.


You will be issued a Medication Guide when your medication is dispensed by your pharmacist. Make sure that you read the Guide thoroughly so that you understand how to take the medication. If you are unsure, check with your doctor or pharmacist.

Always take this medication as directed by your doctor. Do not exceed the prescribed dose or take the medicine more often that you have been told to. Do not carry on taking the drug for a longer period than you are instructed to by your doctor. Do not omit any doses; to do so could make side effects more likely and could also mean that the medication will not work as effectively.

The prescribed dose of bisoprolol and hydrochlorothiazide combination that patients are given will vary. Always keep to your doctor's instructions or the directions given on the product label. The dose outlined in this guide is based solely on the average. If the dose you have been prescribed is different, do not change it, unless your doctor tells you to. The dose and frequency of bisoprolol and hydrochlorothiazide combination that you are prescribed will depend on the strength of the tablets. The length of your course of treatment may also be adjusted by your doctor, depending on how your body responds to the drug.

Your hypertension treatment programme may also include elements of weight control, and you may also be required to change the types of foods you eat. For example, many people who are having treatment for high blood pressure are advised to eat a diet that is low in salt. Your treating physician will give you more advice on your diet and you should check with them before making any changes yourself.

You may have high blood pressure and not even realize it. For this reason, it is extremely important that you take your medication precisely as instructed by your doctor. You must also keep any check-up appointments that you have, as these are designed to enable your doctor to monitor your progress, deal with any side effects, and change your dosing regimen if necessary.

Treatment with bisoprolol and hydrochlorothiazide combination will not cure your hypertension, but it will help to control and manage it. It is possible that you will need to take the medication for the rest of your life.

For the treatment of hypertension

  • Adults: take one or two tablets daily, as one dose or in divided doses as instructed by your doctor. Your doctor may alter your dose during the course of your treatment.
  • Children: the use and dose of this medication must be determined by your doctor.

You should take these tablets whole. Do not chew, break, or crush up the tablets. You may take the tablets before or after you have eaten. If possible, try to take your medication at the same time every day to reduce the chance that you might forget a dose.

If you do miss a dose of your treatment, you should try to take the omitted dose as soon as possible. If the usual time of your next dose is almost due, skip the one you have missed and pick up your usual dosage schedule. Do NOT take a double dose to try to catch up.

Do not share your bisoprolol and hydrochlorothiazide tablets with anyone else.

If you begin to feel worse after you begin taking this medication, or if you think that your condition has failed to improve, you should consult your doctor or specialist immediately.

If you inadvertently take more of your medication than your prescribed dose, you may experience one or more of the following symptoms:

  • feeling anxious, depressed, or irritable
  • experiencing mood swings
  • visual disturbances, including blurred vision
  • sensation of burning, itching, crawling, pricking, "pins and needles", numbness, or tingling on your skin
  • fainting
  • chills
  • cold, clammy skin, or cold sweats
  • confusion, disorientation, or hallucinations
  • cool, pale skin
  • cough
  • decrease in urine production, need to urinate frequently, pale, very dilute urine
  • breathing difficulties, including shortness of breath
  • dilated neck veins
  • feeling dizzy, faint, or lightheaded when rising suddenly from a lying or seated position
  • feeling drowsy or extremely tired
  • dry mouth
  • a rapid or pounding pulse or heartbeat
  • a fast, weak pulse
  • holding false beliefs that cannot be changed by fact
  • increased hunger or thirst
  • muscle pain or cramps
  • nausea or vomiting
  • nightmares
  • seizures
  • shaking or trembling
  • slurring speech
  • sweating
  • feeling unusually excited, nervous, or restless
  • weakness and heaviness of the legs

If you do overdose, call 911 and summon emergency help immediately. Do not wait to make a doctor's appointment.

Major drug interactions

Some types of drugs should never be used at the same time. To do so may affect how your medicines work and could make the risk of serious side effects more likely. However, in some cases, it may be possible to take a number of different medications concurrently, even though an interaction may occur. If this applies to you, your doctor may change the dose of one or more of your medicines. Alternatively, your doctor may put forward some ways in which you can prevent or manage the effect of any interactions.

Before starting your course of treatment with bisoprolol and hydrochlorothiazide, compile a list of all medicines that you currently use. Your list should cover all prescription and non-prescription drugs, herbal preparations, and vitamin products that you take regularly. Show this list to your doctor before commencing your treatment. Do not change the dose or frequency of any of your prescribed or other non-prescription medications without first consulting your doctor.

Although using bisoprolol and hydrochlorothiazide with the following medications is not recommended, it may be necessary for some patients. Your treating physician will tell you if it is necessary to alter the dose or frequency of use of any of your medications.

  • Dofetilide
  • Verapamil
  • Valdecoxib
  • Tolmetin
  • Tolfenamic Acid
  • Tiaprofenic Acid
  • Tenoxicam
  • Sulindac
  • Sotalol
  • Sodium Salicylate
  • Salsalate
  • Salicylic Acid
  • Rofecoxib
  • Rivastigmine
  • Proscillaridin
  • Proquazone
  • Propyphenazone
  • Proglumetacin
  • Piroxicam
  • Piketoprofen
  • Phenylbutazone
  • Parecoxib
  • Oxyphenbutazone
  • Oxaprozin
  • Ouabain
  • Nimesulide Beta Cyclodextrin
  • Nimesulide
  • Niflumic Acid
  • Nepafenac
  • Naproxen
  • Nabumetone
  • Morniflumate
  • Metildigoxin
  • Methotrexate
  • Meloxicam
  • Mefenamic Acid
  • Meclofenamate
  • Lumiracoxib
  • Loxoprofen
  • Lornoxicam
  • Lithium
  • Levomethadyl
  • Lacosamide
  • Ketorolac
  • Ketoprofen
  • Ketanserin
  • Indomethacin
  • Ibuprofen
  • Flurbiprofen
  • Flufenamic Acid
  • Floctafenine
  • Flecainide
  • Fingolimod
  • Feprazone
  • Fepradinol
  • Fenoprofen
  • Fenoldopam
  • Felbinac
  • Etoricoxib
  • Etofenamate
  • Etodolac
  • Droxicam
  • Droperidol
  • Dronedarone
  • Dipyrone
  • Diltiazem
  • Digoxin
  • Digitoxin
  • Digitalis
  • Diflunisal
  • Diclofenac
  • Dexketoprofen
  • Dexibuprofen
  • Deslanoside
  • Cyclophosphamide
  • Crizotinib
  • Clonixin
  • Clonidine
  • Choline Salicylate
  • Celecoxib
  • Bufexamac
  • Bromfenac
  • Aspirin
  • Arsenic Trioxide
  • Amtolmetin Guacil
  • Amphetamine
  • Acetyldigoxin
  • Acemetacin
  • Aceclofenac
  • Ginkco
  • St John's wort

Some types of food, alcohol, or tobacco should not be used with certain medications as they may cause an interaction. You should discuss this with your doctor if you have a preference for certain types of food, or if you routinely use alcohol or tobacco.

It should be noted that this list is not necessarily all-inclusive. You should mention to your doctor if you are already taking any other medicines before you start your course of treatment with bisoprolol and hydrochlorothiazide combination.


During the course of your treatment with bisoprolol and hydrochlorothiazide combination, you will need to have regular check-ups with your treating physician. These check-ups are very important as they allow your doctor to check that the treatment is working properly. These meetings will also allow you to mention any unwanted side effects that you may be suffering and to ask any questions that you may have about your new drug regimen. During your course of treatment, your doctor may carry out blood tests to check for any unwanted effects that the drug may be causing.

Tell your doctor if you have any allergies to food colorings, certain foodstuffs, preservatives, or animal derivatives.

While you are taking this medication, your doctor may suggest that you change your diet to one that is low in salt.

If you already suffer from any existing medical conditions, you should tell your doctor, as this could affect the use of this drug.

If you suffer from angina, this drug could provoke chest pain if you stop taking it abruptly.

Do not take bisoprolol and hydrochlorothiazide combination if you suffer from or have a history of any of the following conditions:

Bisoprolol and hydrochlorothiazide combination can make the following conditions worse, so it should be used with caution if chosen as a treatment option:

  • blood vessel or circulatory diseases
  • hypercalcemia
  • hypokalemia
  • hypomagnesemia
  • hyponatremia
  • gout
  • hyperuricemia
  • systemic lupus erythematosus (SLE)

Bisoprolol and hydrochlorothiazide combination should be used with caution with any of the following conditions, as it can obscure some of the symptoms, making diagnosis and treatment problematic:

  • diabetes
  • hypethyroidism
  • hypoglycemia

Using bisoprolol and hydrochlorothiazide combination in patients with kidney or liver disease can cause problems, because these conditions can cause the slower removal of the drug from the body, potentially leading to overdose.

Patients who have lung diseases, including asthma, emphysema, or bronchitis, may suffer breathing difficulties if treated with bisoprolol and hydrochlorothiazide combination.

If you have undergone a sympathectomy procedure, you may find that the effects of taking bisoprolol and hydrochlorothiazide combination are increased.

If you think you might be pregnant, you should tell your doctor before taking bisoprolol and hydrochlorothiazide combination. Although there is no evidence to suggest that this drug could harm your unborn baby, you should discuss the risks and benefits it provides with your doctor.

There is no evidence that this medication passes into breast milk. However, you may prefer not to breastfeed or express milk to feed your baby while using this drug. Ask your doctor or midwife for more advice on alternatives for feeding your baby.

Note that this condition may increase the risk of heart failure in some patients. If you experience any of the following effects, you should speak with your doctor immediately:

  • wheezing
  • weight gain
  • swelling of the face, fingers, feet, or lower legs
  • shortness of breath
  • irregular heartbeat
  • irregular breathing
  • extreme fatigue
  • dilated neck veins
  • chest pain or discomfort

This drug can cause a serious allergic reaction called anaphylaxis. This condition can be life-threatening and always requires emergency medical attention. If you experience any of the following effects within a few minutes of taking the tablets, call 911:

  • trouble swallowing
  • trouble breathing
  • swelling of your hands, face, lips, tongue, or throat
  • itching
  • hoarseness
  • a rash

Do not cease treatment with bisoprolol and hydrochlorothiazide combination, unless instructed to do so by your doctor. Stopping this medicine too quickly can make your condition worse and could be dangerous.

Bisoprolol and hydrochlorothiazide combination can cause changes in your blood sugar levels, and may also mask signs of low blood sugar.

If you are scheduled for any dental or surgical procedures, be sure to tell your dentist or surgical team that you are taking this medication. You may need to stop taking the drug a few days prior to your procedure if instructed to do so by your doctor.

This drug can cause serious eye problems. If you begin to suffer any of the following effects, consult an ophthalmologist or your doctor immediately:

  • blurred vision
  • problems reading
  • eye pain

Long-term use of this medication can cause mineral imbalance and dehydration. Check with your doctor immediately if you notice any of the following effects:

  • unusual tiredness or weakness
  • severe drowsiness or dizziness
  • seizures
  • nausea or vomiting
  • muscle cramps
  • increased thirst
  • dry mouth
  • a fast heartbeat
  • a decrease in urine output

In some people, this medication can cause them to become less alert than usual. If you are affected in this way, do not drive, use machinery, or take part in any activity that could be dangerous.

You may also notice that your skin is more sensitive to sunlight than usual while you are taking this medication. Make sure that you take adequate care to protect yourself when going outside by using sunscreen, wearing long sleeves, trousers, and a hat.


Keep your supply of bisoprolol and hydrochlorothiazide in a sealed, airtight container. This drug must be kept at room temperature. Do not freeze or refrigerate the medication. Keep the tablets dry and do not place the packet in direct sunlight or where it could be affected by sources of extreme heat, such as radiators or fires.

Always keep your medication where it cannot be accessed by children or pets. If a pet does consume your tablets, you should seek immediate veterinary advice.

Do not keep any unused bisoprolol and hydrochlorothiazide tablets. Do not use any prescriptions that have exceeded their use-by date. Do not flush any of your unwanted tablets down the toilet or throw them into the drains. Do not discard unused medication with your trash; tablets are often mistaken for candy and consumed by children.


Bisoprolol and hydrochlorothiazide combination is sold in the US under the brand name, Ziac. The medication is used to treat hypertension (high blood pressure). Although the drug is very effective in managing this condition, it cannot cure it.

High blood pressure can present a greater risk of heart attacks, kidney disease, and stroke in sufferers. Bisoprolol and hydrochlorothiazide combination works by lowering the blood pressure, effectively reducing the risk of these complications.

There are a considerable number of prescription-only and over-the-counter drugs, including standard cough and cold remedies, which can interact adversely with this medication. There are also a considerable number of existing medical conditions that can be exacerbated by using this drug. It is therefore very important that patients discuss their medical history fully with their doctor, before starting treatment with bisoprolol and hydrochlorothiazide combination.

Bisoprolol and hydrochlorothiazide combination are extremely effective in managing and controlling hypertension. If you are to enjoy the many benefits offered by this medication, it is essential that you work closely with your doctor or specialist in order to work out the best dose and dosage schedule for the medication. You will also be required to attend regular check-ups and have blood and urine tests to make sure that the drug is working correctly and to ensure that no unwanted or harmful side effects are evident.

Last Reviewed:
December 24, 2017
Last Updated:
May 06, 2018
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