Adult Dosing
Hypertension
- Initial therapy
- Start: 2.5 mg/6.25 mg PO qd; if needed titrate dose in 2wk intervals
- Max: [20 mg/12.5 mg]/day
Note: Taper dose gradually over 2wks to discontinue
- Replacement Therapy
- Substitute this combination drug for the titrated individual components
Pediatric Dosing
- Safety and effectiveness in pediatric patients have not been established
[Outline]
Renal Dose Adjustment (Based on CrCl)
- <40 mL/min: Use with caution; dose adjustments not defined
- Anuria: Contraindicated
- Progressive renal impairment: Discontinue therapy
Hepatic Dose Adjustment
- Hepatic impairment/progressive hepatic disease: Use with caution; dose adjustments not defined
- Avoid beta-blockers in patients with overt congestive failure. However, in some individuals with compensated cardiac failure it may be essential to utilize these agents
- In some patients, continued depression of the myocardium with beta-blockers may precipitate cardiac failure. Consider discontinuation of therapy at the first signs or symptoms of heart failure. In some individuals, therapy with this drug can be continued while heart failure is treated with other drugs
- Abrupt cessation of therapy with beta-blockers may lead to exacerbations of angina pectoris and in some instances, myocardial infarction or ventricular arrhythmia in patients with coronary artery disease; caution such patients against interruption or discontinuation of therapy without the physician’s advice. Taper therapy over approximately 1wk with careful observation even in patients without overt coronary artery disease. On occurrence of withdrawal symptoms, reinstitute beta-blocker at least temporarily
- Beta-blocker component is associated with precipitating or aggravating symptoms of arterial insufficiency in patients with peripheral vascular disease
- Therapy with this drug is not recommended in patients with bronchospastic pulmonary disease. Exercise caution in patients with bronchospastic disease who do not respond to or who cannot tolerate other antihypertensive agents. Use lowest possible dose of this drug. Readily keep beta2 agonist (bronchodilator) available
- Avoid withdrawal of chronically administered beta-blocker prior to major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli can augment the risks of general anesthesia and surgical procedures
- Beta-blocker component is associated with masking some of the manifestations of hypoglycemia, particularly tachycardia. Potentiation of insulin-induced hypoglycemia and delay in recovery of serum glucose levels may occur. Also manifestations of latent diabetes mellitus may occur and diabetic patients given thiazides may require adjustment of insulin dose
- Beta-adrenergic component is also associated with masking of clinical signs of hyperthyroidism such as tachycardia. Exacerbation of the symptoms of hyperthyroidism or precipitation of thyroid storm may occur following abrupt withdrawal of beta-blockade
- Cumulative effects of the drug may occur in patients with impaired renal function; azotemia may be precipitated in such patients. Plasma half-life of bisoprolol fumarate component is increased up to three fold as compared to healthy subjects in patients with CrCl <40 mL/min. Discontinue this drug if progressive renal impairment becomes apparent
- Minor alterations of fluid and electrolyte balance may precipitate hepatic coma. Elimination of bisoprolol component is significantly slower in patients with cirrhosis
- Hydrochlorothiazide component of this drug can cause an idiosyncratic reaction resulting in acute transient myopia and acute angle-closure glaucoma; if untreated it may lead to permanent vision loss. Primary measure is to discontinue this drug as earliest as possible. Promptly provide medical or surgical treatments if the intraocular pressure remains uncontrolled. History of sulfonamide or penicillin allergy are the risk factors for developing acute angle-closure glaucoma
- At appropriate intervals, periodically determine serum electrolytes to detect possible electrolyte imbalance. Observe patients receiving thiazide therapy for clinical signs of fluid or electrolyte imbalance. Determine serum and urine electrolyte when the patient is vomiting excessively or receiving parenteral fluids. Hypokalemia with brisk diuresis have occurred in presence of severe cirrhosis, during concurrent use of corticosteroids or adrenocorticotropic hormone (ACTH) or after long term therapy. Cardiac arrhythmia has occurred in association with hypokalemia resulting in sensitization or exaggeration of the response of the heart to the toxic effects of digitalis. Chloride replacement may be essential for treatment of metabolic alkalosis. Dilutional hyponatremia has occurred in edematous patients in hot weather; Impose water restriction rather than administration of salt except in rare occasions when the hyponatremia is fatal. In actual salt depletion provide appropriate replacement therapy. Thiazide component is associated with hyperuricemia or precipitation of acute gout in certain patients
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Progressive hepatic disease
- Peripheral vascular disease
- Diabetes mellitus
- Arrhythmias
- Seizure disorder
- Bronchospastic disease
- Volume depletion
- Electrolyte abnormalities
- Pheochromocytoma
- Thyroid disorder
- History of gout
- History of pancreatitis
- SLE
- Post-sympathectomy
- Major surgery
- Wolff-Parkinson-White syndrome
- History of severe anaphylactic reaction
- Geriatrics
Pregnancy Category:C
Breastfeeding: Bisoprolol is extensively excreted in breast milk. Limited published experience with bisoprolol during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant. Hydrochlorothiazide doses of 
50 mg/day are acceptable during lactation. Intense diuresis with higher doses may decrease breast milk production. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 26 May 2011). This combination drug exhibits potential for adverse effects on the nursing infant, a decision should be made whether to discontinue nursing or the drug, taking into account the importance of the drug to the mother.
US Trade Name(s)
US Availability
bisoprolol/hydrochlorothiazide (generic)
- TABS:
- 2.5 mg/6.25 mg
- 5 mg/6.25 mg
- 10 mg/6.25 mg
Ziac (bisoprolol/hydrochlorothiazide)
- TABS:
- 2.5 mg/6.25 mg
- 5 mg/6.25 mg
- 10 mg/6.25 mg
Canadian Trade Name(s)
Canadian Availability
UK Trade Name(s)
UK Availability
Australian Trade Name(s)
Australian Availability
[Outline]
Pricing data from www.DrugStore.com in U.S.A.
- Ziac 2.5-6.25 MG TABS [Bottle] (TEVA/WOMENS HEALTH)
30 mg = $114.63
90 mg = $319.88 - Ziac 5-6.25 MG TABS [Bottle] (TEVA/WOMENS HEALTH)
30 mg = $115
90 mg = $318.98 - Ziac 10-6.25 MG TABS [Bottle] (TEVA/WOMENS HEALTH)
30 mg = $113.99
90 mg = $322.99
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.