Ziac

Generic name: hydrochlorothiazide and bisoprolol (HYE droe klor oh THYE a zide and bi SOE proe lol)
Brand name: Ziac
Drug class: Beta blockers with thiazides

Ziac contains a combination of hydrochlorothiazide and bisoprolol. Hydrochlorothiazide is a thiazide diuretic (water pill). Bisoprolol is a beta-blocker.

Ziac is used to treat high blood pressure (hypertension).

Ziac tablets are available in three different strengths; 2.5 mg/6.25 mg (bisoprolol fumarate 2.5 mg and hydrochlorothiazide 6.25 mg), 5 mg/6.25 mg (bisoprolol fumarate 5 mg and hydrochlorothiazide 6.25 mg), and 10 mg/6.25 mg (bisoprolol fumarate 10 mg and hydrochlorothiazide 6.25 mg).

Warnings

You should not use Ziac if you are unable to urinate. You should not use Ziac if you have a serious heart condition such as "sick sinus syndrome" or "AV block," severe heart failure, or slow heartbeats that have caused you to faint.

Before using Ziac, tell your doctor if you have congestive heart failure, circulation problems, kidney or liver disease, cirrhosis, glaucoma, asthma, bronchospastic lung disease, a thyroid disorder, lupus, gout, diabetes, or a penicillin allergy.

If you are diabetic, check your blood sugar carefully. Using bisoprolol can make it harder for you to tell when you have low blood sugar. Your insulin or diabetic medication needs may change while you are taking Ziac. Talk with your doctor before changing any doses.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Keep using Ziac even if you feel fine. High blood pressure often has no symptoms

Before taking this medicine

You should not use Ziac if you are allergic to hydrochlorothiazide or bisoprolol, or if you have:

• severe or uncontrolled heart failure;
• slow heartbeats that have caused you to faint;
• a serious heart condition called "sick sinus syndrome" or "AV block" (2nd or 3rd degree);
• an allergy to sulfa drugs; or
• if you are unable to urinate.

To make sure Ziac is safe for you, tell your doctor if you have:

• congestive heart failure;
• asthma or other breathing disorder;
• diabetes;
• a thyroid disorder;
• glaucoma;
• peripheral vascular disease such as Raynaud's syndrome;
• kidney disease;
• liver disease (or cirrhosis);
• lupus;
• gout; or
• an allergy to sulfa drugs or penicillin.

It is not known whether Ziac will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant.

You should not breastfeed while using this medicine.

Ziac is not approved for use by anyone younger than 18 years old.

How should I take Ziac?

Take Ziac exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Your doctor may occasionally change your dose.

Call your doctor if you are sick with vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking Ziac. This can lead to very low blood pressure, a serious electrolyte imbalance, or kidney failure.

Your blood pressure will need to be checked often. Your blood and urine may both be tested if you have been vomiting or are dehydrated.

If you are diabetic, check your blood sugar carefully. Taking bisoprolol may make it harder for you to tell when you have low blood sugar. Your insulin or diabetes medication needs may change while you are taking Ziac. Do not change your medication dose or schedule without your doctor's advice.

If you need surgery or medical tests, tell the doctor you currently use this medicine. You may need to stop for a short time.

Do not skip doses or stop using Ziac suddenly. Stopping suddenly may make your condition worse. Follow your doctor's instructions about tapering your dose.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medicine for the rest of your life.

Store at room temperature, away from heat and moisture. Keep the bottle tightly closed when not in use.

Dosing information

Usual Adult Dose of Ziac for Hypertension:

Initial dose: Bisoprolol 2.5 mg-Hydrochlorothiazide 6.25 mg orally once a day
Maximum dose: Bisoprolol 20 mg-Hydrochlorothiazide 12.5 mg orally once a day

Comments:
-Increase the dose every 14 days if optimal response not achieved.
-This drug may be substituted for titrated individual components (e.g., inadequate control on bisoprolol 2.5 to 20 mg or adequate control on hydrochlorothiazide 50 mg but with significant potassium loss).
-Abrupt discontinuation should be avoided; taper therapy gradually over approximately 2 weeks.
-If withdrawal symptoms occur, therapy may be temporarily reinstituted.

What happens if I miss a dose?

Take the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not take two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include confusion, leg cramps, numbness and tingling, slow heartbeats or fainting.

What should I avoid while taking Ziac?

Avoid drinking alcohol. It may increase your blood levels of bisoprolol.

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Hydrochlorothiazide may increase your risk of skin cancer. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors. Your doctor may want you to have skin examinations on a regular basis.

Ziac side effects

Get emergency medical help if you have signs of an allergic reaction to Ziac (hives, difficult breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Call your doctor at once if you have:

• chest pain;
• fast, slow, or uneven heartbeats;
• a light-headed feeling, like you might pass out;
• blurred vision, tunnel vision, eye pain, or seeing halos around lights;
• shortness of breath (even with mild exertion), swelling, rapid weight gain;
• liver problems - nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
• signs of an electrolyte imbalance - increased thirst or urination, constipation, muscle pain or weakness, leg cramps, numbness or tingling, feeling jittery, irregular heartbeats, fluttering in your chest, or a choking feeling;
• low blood sugar - headache, hunger, sweating, irritability, dizziness, fast heart rate, and feeling anxious or shaky.

Common Ziac side effects may include:

• dizziness;
• feeling weak or tired;
• diarrhea, nausea, indigestion;
• headache; or
• cough.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Ziac?

Tell your doctor about all your other medicines, especially:

• colestipol or cholestyramine;
• insulin or oral diabetes medicine;
• lithium;
• sedatives or narcotic medicine;
• heart or blood pressure medicine - clonidine, digoxin, diltiazem, disopyramide, reserpine, verapamil, and others;
• NSAIDs (nonsteroidal anti-inflammatory drugs) - aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others; or
• steroid medicine - prednisone and others.

This list is not complete. Other drugs may interact with hydrochlorothiazide and bisoprolol, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.