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bisoprolol and hydrochlorothiazide (Ziac): Side Effects & Dosage

What is bisoprolol and hydrochlorothiazide, and how does it work (mechanism of action)?

Ziac is a combination product containing bisoprolol (Zebeta) and hydrochlorothiazide (HCTZ). Bisoprolol is a beta-adrenergic receptor blocking agent used for treating high blood pressure and heart pain (angina). Bisoprolol prevents the neurotransmitters (chemicals that nerves use to communicate with other nerves), norepinephrine and epinephrine (adrenaline), from binding to beta adrenergic receptors on nerves. By blocking the effect of norepinephrine and epinephrine on the nerves reaching the heart and blood vessels, beta blockers reduce heart rate and the force with which the heart contracts and reduce blood pressure by dilating blood vessels. It also may constrict air passages by stimulating the muscles that surround the air passages. Hydrochlorothiazide (HCTZ) is a diuretic (water pill) used for treating high blood pressure (hypertension) and accumulation of fluid. It works by blocking salt and fluid reabsorption in the kidneys, causing increased urine output (diuresis). The mechanism of its action in lowering high blood pressure is not well understood. The combination of bisoprolol and HCTZ reduces blood pressure better than either drug alone. Ziac was approved in March 1993.

What brand names are available for bisoprolol and hydrochlorothiazide?


Is bisoprolol and hydrochlorothiazide available as a generic drug?


Do I need a prescription for bisoprolol and hydrochlorothiazide?


What are the uses for bisoprolol and hydrochlorothiazide?

The combination of bisoprolol and hydrochlorothiazide is prescribed for the treatment of high blood pressure and angina.

What are the side effects of bisoprolol and hydrochlorothiazide?

The most common side effects are:

Serious side effects of Ziac include:

What is the dosage for bisoprolol and hydrochlorothiazide?

The dose of Ziac is tailored to the patient's needs. The initial dose is 2.5/6.25 mg daily. The dose may be increased very two weeks and the maximum dose is 20/12.5 mg once daily.


Salt and sodium are the same.
See Answer

Which drugs or supplements interact with bisoprolol and hydrochlorothiazide?

Rifampin may increase the metabolism (destruction) of bisoprolol, possibly making bisoprolol less effective. Certain calcium channel blockers (CCBs), especially verapamil (Calan, Isoptin) and diltiazem (Cardizem, Tiazac), may enhance the effect of bisoprolol on the heart. In some patients, this may cause excessive slowing of the heart rate or reduce the heart's ability to beat. The use of digoxin (Lanoxin) with bisoprolol also may cause an excessive reduction in heart rate.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin, Advil) and naproxen (Naprosyn, Anaprox, Aleve), can reduce the blood pressure lowering effects of beta blockers.

Hydrochlorothiazide reduces the elimination of lithium (Lithobid, Eskalith) by the kidneys and can lead to lithium toxicity. Nonsteroidal anti-inflammatory drugs, for example, ibuprofen, may reduce the blood pressure effects of hydrochlorothiazide.

Blood sugar levels can be elevated by HCTZ, necessitating adjustment in the doses of medications that are used for treating diabetes.

Combining HCTZ with corticosteroids may increase the risk for low levels of blood potassium and other electrolytes. Low blood potassium can increase the toxicity of digoxin (Lanoxin). Cholestyramine (Questran, Questran Light) and colestipol (Colestid) bind to hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by 43%-85%.

Is bisoprolol and hydrochlorothiazide safe to take if I’m pregnant or breastfeeding?

There is no information about the effects of Ziac on the fetus in pregnant women. Physicians may elect to use Ziac if its benefits are deemed to outweigh potential risks.

Thiazides are secreted in breast milk. It is not known whether bisoprolol is secreted in breast milk.

What else should I know about bisoprolol and hydrochlorothiazide?

What preparations of bisoprolol and hydrochlorothiazide are available?

Tablets (bisoprolol/hydrochlorothiazide): 2.5/6.25 mg, 5/6.25 mg, and 10/6.25 mg.

How should I keep bisoprolol and hydrochlorothiazide stored?

Ziac should be stored at room temperature, 59 F – 86 F (15 C – 30 C) in a tight container.


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