Ziac

Per 2.5 mg/6.25 mg FC tab Bisoprolol fumarate 2.5 mg, hydrochlorothiazide 6.25 mg. Per 5 mg/6.25 mg FC tab Bisoprolol fumarate 5 mg, hydrochlorothiazide 6.25 mg. Per 10 mg/6.25 mg FC tab Bisoprolol fumarate 10 mg, hydrochlorothiazide 6.25 mg

Essential HTN.

Starting dose: One 2.5 mg/6.25 mg tab once daily. If antihypertensive effect is inadequate, increase to one 5 mg/6.25 mg tab once daily & if response is still inadequate, increase to one 10 mg/6.25 mg tab once daily.

May be taken with or without food: Take in the morning. Swallow whole w/ some liqd, do not chew.

Hypersensitivity to bisoprolol, hydrochlorothiazide, other thiazides, sulphonamides. Acute heart failure or during episodes of heart failure decompensation requiring IV inotropic therapy; cardiogenic shock; 2nd or 3rd degree AV block w/o a pacemaker; sick sinus syndrome; SA block; symptomatic bradycardia; severe bronchial asthma; severe forms of peripheral arterial occlusive disease or Raynaud's syndrome; untreated pheochromocytoma; metabolic acidosis; refractory hypokalemia. Severe renal (CrCl <30 mL/min) & hepatic impairment.

Avoid abrupt w/drawal. Patients w/ accompanying heart failure, DM showing large fluctuations in blood glucose values (symptoms of hypoglycemia can be masked), strict fasting, 1st degree AV block, Prinzmetal's angina, peripheral arterial occlusive disease (aggravation of symptoms may occur especially when starting therapy), hypovolemia, impaired liver function. Patients w/ or w/ history of psoriasis. Monitoring of serum electrolytes, creatinine, urea, serum lipids, uric acid & blood glucose is recommended during long-term therapy. Risk of gout attacks. Metabolic alkalosis may worsen due to disturbance of fluid & electrolyte hemostasis. Acute cholecystitis. May impair the ability to drive and use machines. Not recommended during pregnancy & lactation. Childn. Bisoprolol fumarate: May increase sensitivity to allergens & severity of anaphylactic reactions. Sypmtoms of thyrotoxicosis may be masked. Not to be administered until after α-receptor blockade in patients w/ pheochromocytoma. Gradually w/draw β-blocker therapy for about 48 hr before surgery to avoid β-blockade. Avoid in patients w/ obstructive airways diseases. Hydrochlorothiazide: Photosensitivity reactions may occur w/ thiazide diuretics. Increased risk of non-melanoma skin cancer. Limit exposure to sunlight & UV rays. Fluid & electrolyte disturbances. Idiosyncratic reaction, choroidal effusion w/ visual field defect resulting in acute myopia & acute-angle glaucoma. Acute resp distress syndrome.

Dizziness, headache; feeling of coldness or numbness in extremities (hands or feet); GI complaints eg, nausea, vomiting, diarrhea, constipation; tiredness (fatigue).

May intensify cardiotoxic & neurotoxic effect of lithium. -ve effect on contractility & AV conduction w/ Ca antagonists of the verapamil type & to a lesser extent of the diltiazem type. Further reduction in heart rate & cardiac output & vasodilatation w/ centrally-acting antihypertensive agents (eg, clonidine, methyldopa, moxonodine, rilmenidine). May increase risk of hypotension w/ Ca antagonists of the dihydropyridine type (eg, nifedipine, amlodipine), other antihypertensive agents & other medicinal products w/ BP lowering potential (eg, TCAs, barbiturates, phenothiazines). Risk of significant fall in BP &/or acute renal failure during initiation of ACE inhibitor therapy (eg, captopril, enalapril) in patients w/ preexisting Na depletion. May potentiate AV impulse conduction time & increase -ve inotropic effect w/ class I antiarrhythmic agents (eg, quinidine, disopyramide, lidocaine, phenytoin, flecainide, propafenone). May potentiate AV impulse conduction time w/ class III antiarrhythmic agents (eg, amiodarone). May induce torsades de pointes w/ class IA (eg, quinidine, hydroquinidine, disopyramide), class III (eg, amiodarone, sotalol, dofetilide, ibutilide) antiarrhythmics & non-antiarrhythmic drugs (eg, astemizole, erythromycin IV, halofantrine, pentamidine, sparfloxacin, terfenadine, vincamine). May increase AV conduction time & risk of bradycardia w/ parasympathomimetics. Increase of blood sugar lowering effect of insulin & oral antidiabetic agents. Attenuation of the reflex tachycardia & increase of the risk of hypotension w/ anesth agents. Increase of AV conduction time & reduction in heart rate w/ digitalis glycosides. Reduced hypotensive effect w/ NSAIDs. Increased K losses w/ K-wasting medicinal products (eg, corticosteroids, ACTH, carbenoxolone, amphotericin B, furosemide or laxatives). Attenuate effect of uric-acid lowering agents. Increased risk of decelerating the heart rate w/ mefloquine. Enhanced hypotensive effect of the β-blockers & risk of hypertensive w/ MAOIs (except MAO-B inhibitors). Reduced antihypertensive effect due to corticosteroid-induced water & Na retention w/ corticosteroids. In high dose salicylate administration, the toxic effect of salicylates on the CNS may be enhanced. Exacerbation of peripheral circulatory disturbances w/ ergot derivatives. Bisoprolol: Additive systemic effect w/ topical β-blockers (eg, eye drops for glaucoma treatment). Reduced effect of β-sympathomimetics (eg, isoprenaline, dobutamine). May lead to BP increase & exacerbate intermittent claudication w/ sympathomimetics that active both β- & α-adrenoceptors (eg, norepinephrine, epinephrine). Slight reduction of t_1/2 due to the induction of hepatic drug-metabolizing enzymes w/ rifampicin. Hydrochlorothiazide: Hemolysis due to the formation of Abs w/ methyldopa (isolated cases). Reduced absorption w/ cholestyramine & colestipol.

Beta-Blockers / Diuretics

C07BB07 - bisoprolol and thiazides ; Belongs to the class of selective beta-blocking agents in combination with thiazides. Used in the treatment of cardiovascular diseases.

Rx