Bisoprolol and Hydrochlorothiazide

Pronunciation

(bis OH proe lol & hye droe klor oh THYE a zide)

U.S. Brand Names

Ziac®

Synonyms

Hydrochlorothiazide and Bisoprolol

Generic Available

Yes

Canadian Brand Names

Ziac®

Use

Treatment of hypertension

Pregnancy Risk Factor

C/D (2nd and 3rd trimesters)

Lactation

Enters breast milk/use caution

Adverse Reactions

>10%: Central nervous system: Fatigue

1% to 10%:

Cardiovascular: Chest pain, edema, bradycardia, hypotension

Central nervous system: Headache, dizziness, depression, abnormal dreams

Dermatologic: Rash, photosensitivity

Endocrine & metabolic: Hypokalemia, fluid and electrolyte imbalances (hypocalcemia, hypomagnesemia, hyponatremia), hyperglycemia

Gastrointestinal: Constipation, diarrhea, dyspepsia, nausea, insomnia, flatulence

Genitourinary: Micturition (frequency)

Hematologic: Rarely blood dyscrasias

Neuromuscular & skeletal: Arthralgia, myalgia

Ocular: Abnormal vision

Renal: Prerenal azotemia

Respiratory: Rhinitis, cough, dyspnea

<1% (Limited to important or life-threatening): Angioedema, bronchospasm, CNS depression (sedation), exfoliative dermatitis, gout, hypercalcemia, orthostasis, pancreatitis, paresthesia, Peyronie's disease, syncope, vasculitis

Drug Interactions

Bisoprolol: Substrate of CYP2D6 (minor), 3A4 (major)

Also see individual agents.

Pharmacodynamics/Kinetics

See individual agents.

Dosage

Oral: Adults: Dose is individualized, given once daily

Patient Education

See individual agents. Pregnancy/breast-feeding precautions: Inform prescriber if you are or intend to become pregnant. Consult prescriber if breast-feeding.

Nursing Implications

Monitor blood pressure, ECG

Cardiovascular Considerations

Combination therapy for the treatment of hypertension should be individualized for each patient. Potential advantages for bisoprolol and hydrochlorothiazide combination therapy may include improved compliance and synergistic reductions in blood pressure with an accomplished reduction in side effects. Beta-blockers and thiazide diuretics are first-line therapies for the treatment of hypertension. See Special Cardiovascular Considerations for individual agents.

Dental Health: Effects on Dental Treatment

Bisoprolol is a cardioselective beta-blocker. Local anesthetic with vasoconstrictor can be safely used in patients medicated with bisoprolol. Nonselective beta-blockers (ie, propranolol, nadolol) enhance the pressor response to epinephrine, resulting in hypertension and bradycardia; this has not been reported for bisoprolol. Many nonsteroidal anti-inflammatory drugs, such as ibuprofen and indomethacin, can reduce the hypotensive effect of beta-blockers after 3 or more weeks of therapy with the NSAID. Short-term NSAID use (ie, 3 days) requires no special precautions in patients taking beta-blockers.

Dental Health: Vasoconstrictor/Local Anesthetic Precautions

No information available to require special precautions

Mental Health: Effects on Mental Status

Fatigue is common; may cause insomnia, confusion, depression, dizziness, headache, sleep disturbance, vivid dreams, anxiety, restlessness, and decreased concentration

Mental Health: Effects on Psychiatric Treatment

Barbiturates may decrease the effects of beta-blockers; may decrease lithium clearance, resulting in elevated serum lithium levels and potential lithium toxicity; monitor serum lithium levels

Dosage Forms

Tablet:

2.5/6.25: Bisoprolol fumarate 2.5 mg and hydrochlorothiazide 6.25 mg

5/6.25: Bisoprolol fumarate 5 mg and hydrochlorothiazide 6.25 mg

10/6.25: Bisoprolol fumarate 10 mg and hydrochlorothiazide 6.25 mg

References

Chobanian AV, Bakris GL, Black HR, et al, "The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report," JAMA , 2003, 289(19):2560-71.

Kaplan NM and Sever PS, "Combination Therapy: A Key to Comprehensive Patient Care," Am J Hypertens , 1997, 10(7 Pt 2):127S.

Moser M and Black HR, "The Role of Combination Therapy in the Treatment of Hypertension," Am J Hypertens , 1998, 11(6 Pt 2):73S-8S, 95S-100S.

International Brand Names

Ziac® (CA)

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