Why is Ziac prescribed?
Ziac is used to treat high blood pressure. It combines a beta-blocker (bisoprolol, which is the ingredient in the drug Zebeta) with a thiazide diuretic (hydrochlorothiazide). Beta-blockers decrease the force and rate of heart contractions, thus lowering blood pressure. Diuretics help your body produce and eliminate more urine, which also helps lower blood pressure.
Most important fact about Ziac
Ziac does not cure high blood pressure; it merely keeps it under control. Therefore, you must continue taking it even if you are feeling well. Do not stop taking Ziac unless instructed to do so by your doctor. This is especially important if you have coronary artery disease. Abruptly stopping Ziac could cause chest pain, heart rhythm problems, and even heart attack.
How should you take Ziac?
Take Ziac exactly as prescribed, even if your symptoms have disappeared. Try not to miss any doses. If Ziac is not taken regularly, your condition may worsen.
--If you miss a dose...
Take the missed dose as soon as possible. However, if it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Never take 2 doses at once.
--Storage instructions...
Store at room temperature in a tightly closed container.
What side effects may occur?
Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine whether it is safe for you to continue taking Ziac.
• More common side effects may include:
Dizziness, fatigue
Additional side effects have been reported with Ziac, although it's unknown if the drug was the cause. Be sure to tell your doctor about any unusual or severe symptoms.
Why should Ziac not be prescribed?
Do not take Ziac if you have inadequate blood supply to the circulatory system (cardiogenic shock), certain types of irregular heartbeat, a slow heartbeat, bronchial asthma, or severe congestive heart failure. Also avoid the drug if you have trouble urinating.
Do not use Ziac if you have an allergic reaction to the drug or if you're allergic to antibiotics known as sulfonamides (such as Bactrim, Cotrim, and Septra).
Special warnings about Ziac
Use Ziac cautiously if you have a history of congestive heart failure.
Do not suddenly stop taking Ziac (see "Most important fact about Ziac"). If you have to stop taking the drug, the doctor will gradually lower your dose of Ziac over a period of 2 weeks.
Call your doctor immediately if you develop breathing problems or an extremely slow heartbeat while taking Ziac.
If you suffer from asthma or other bronchial conditions, coronary artery disease, peripheral vascular disease, or kidney or liver disease, Ziac should be used with caution.
Notify your doctor or dentist that you are taking Ziac if you have a medical emergency, and before you have surgery or dental treatment.
Ziac causes some people to become drowsy or less alert. You should not drive or operate dangerous machinery or participate in any hazardous activity until you know how the drug affects you.
This medication may mask the symptoms of low blood sugar or alter blood sugar levels. In addition, diabetics who experience a severe drop in blood sugar after taking insulin may suffer a spike in blood pressure if they are also taking Ziac.
If you have a history of severe allergic reactions that have required epinephrine, you should be aware that Ziac may make your system unresponsive to the usual effective dose of epinephrine.
If you have systemic lupus erythematosus, you should be aware that Ziac could make the symptoms worse.
Ziac could mask symptoms of an overactive thyroid. Abruptly stopping the drug could make the condition worse.
In a small number of people, Ziac has interfered with the functioning of the parathyroid, causing blood levels of calcium and phosphate to rise. In rare cases, the drug has also caused gout.
There is a slight chance that Ziac could cause a drop in blood levels of electrolytes such as potassium and magnesium. Call your doctor if you develop any of the following: drowsiness, dry mouth, excessive thirst, low blood pressure, muscle pains or cramps, rapid heartbeat, restlessness, gastrointestinal problems such as nausea and vomiting, weakness or muscle fatigue, or an unusual decrease in urination.
Be aware that Ziac could make you more sensitive to sunlight.
Possible food and drug interactions when taking Ziac
If Ziac is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor when combining Ziac with the following:

Any other blood pressure drugs, including the calcium-blockers diltiazem (Cardizem), disopyramide (Norpace), and verapamil (Calan)
Alcohol
Barbiturate sedatives such as Seconal and Nembutal
Cholesterol-lowering drugs such as Colestid and Questran
Clonidine (Catapres)
Diabetes drugs (oral)
Disopyramide (Norpace) and similar drugs used to treat irregular heartbeat
Epinephrine (EpiPen)
Guanethidine (Ismelin)
Insulin
Lithium (Eskalith, Lithobid)
Muscle relaxants such as tubocurarine
Nonsteroidal anti-inflammatory drugs such as aspirin, Motrin, or Tylenol
Norepinephrine
Painkillers such as codeine or morphine
Reserpine
Rifampin (Rifadin)
Steroids such as prednisone
Special information if you are pregnant or breastfeeding
The effects of Ziac during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, inform your doctor immediately. Ziac should be used only if the benefit outweighs the potential risk.
It is not known if Ziac appears in breast milk. If Ziac is essential to your health, your doctor may advise you to discontinue breastfeeding until your treatment with Ziac is finished.
Recommended dosage
ADULTS
Dosage is tailored to each individual's needs. The usual starting dose is 2.5 milligrams of bisoprolol with 6.25 milligrams of hydrochlorothiazide once a day. If this dose is ineffective, the dose may be increased every 14 days up to a maximum of 20 milligrams bisoprolol/12.5 milligrams hydrochlorothiazide once a day.
If you have asthma, bronchial problems, or kidney or liver disease, the doctor may have you take a very low starting dose. Extreme caution should be used if the dose has to be increased.
Ziac has not been adequately studied in children.
Overdosage
Any medication taken in excess can have serious consequences. If you suspect an overdose of Ziac, seek medical attention immediately.
• Symptoms of Ziac overdose may include:
Abnormal skin sensations, cramps in the calf muscle, congestive heart failure (marked by sudden weight gain, swelling of the legs, feet, and ankles, fatigue, and shortness of breath), confusion, decreased or increased urination, difficult or labored breathing, dizziness, drowsiness, fluid or electrolyte loss, impaired consciousness, low blood pressure, low blood sugar, nausea, shock, slow or rapid heartbeat, thirst, vomiting, weakness
Large overdoses may interfere with breathing or cause delirium, coma, or convulsions.