Bisoprolol/hctz 10mg/6.25mg Tabs

Bisoprolol is a beta-1 selective (cardioselective) adrenergic blocking agent that decreases heart rate, myocardial contractility, and renin release, leading to reduced blood pressure. Hydrochlorothiazide is a thiazide diuretic that inhibits sodium and chloride reabsorption in the distal convoluted tubule, increasing the excretion of sodium, chloride, and water, and to a lesser extent, potassium and magnesium. This leads to a reduction in plasma volume and peripheral vascular resistance.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or tightness in the chest or throat
+ Difficulty breathing, swallowing, or talking
+ Unusual hoarseness or swelling of the mouth, face, lips, tongue, or throat
Signs of fluid and electrolyte problems, including:
+ Mood changes or confusion
+ Muscle pain or weakness
+ Abnormal or rapid heartbeat
+ Severe dizziness or fainting
+ Increased thirst or seizures
+ Feeling extremely tired or weak
+ Decreased appetite
+ Urination problems (inability to pass urine or changes in urine output)
+ Dry mouth, dry eyes, or severe stomach upset or vomiting
Signs of pancreatitis (pancreas problems), such as:
+ Severe stomach pain
+ Severe back pain
+ Severe stomach upset or vomiting
Signs of kidney problems, including:
+ Urination difficulties (inability to pass urine or changes in urine output)
+ Blood in the urine
+ Sudden weight gain
New or worsening chest pain
Slow heartbeat
Shortness of breath, sudden weight gain, or swelling in the arms or legs
Dark urine or yellowing of the skin and eyes
Abnormal burning, numbness, or tingling sensations

Eye Problems:

This medication can cause certain eye problems, which may lead to permanent vision loss if left untreated. If you experience any eye problems, symptoms usually occur within hours to weeks of starting the medication and may include changes in vision or eye pain. Seek medical help immediately if you notice any of these symptoms.

Lupus:

If you have lupus, this medication may cause your condition to become active or worsen. Inform your doctor right away if you experience any new or worsening symptoms.

Skin Cancer:

Rarely, people taking hydrochlorothiazide have developed certain types of skin cancer. Protect your skin from the sun and follow your doctor's instructions for skin checks. Contact your doctor immediately if you notice any changes in the color or size of a mole, or any new or changing skin lumps or growths.

Other Side Effects:

Most people do not experience significant side effects, but some may occur. If you are bothered by any of the following side effects or if they persist, contact your doctor or seek medical help:

Dizziness, tiredness, or weakness
* Headache

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
A known sulfa allergy.
Certain health conditions, including:
+ Respiratory problems like asthma or chronic obstructive pulmonary disease (COPD).
+ Heart conditions, such as heart block, heart failure (weak heart), shock caused by heart problems, or a slow heartbeat.
+ Inability to urinate.
Current medications, including:
+ Lithium.
+ Dofetilide.
+ Any other medications similar to this one. If you are unsure, consult your doctor or pharmacist.
* All your prescription and over-the-counter (OTC) medications, natural products, and vitamins. This is not an exhaustive list of potential interactions.

To ensure your safety, it is crucial to discuss all your medications and health conditions with your doctor and pharmacist. They will help determine if it is safe to take this medication with your other medications and health conditions. Never start, stop, or change the dose of any medication without first consulting your doctor.

Important Warnings and Cautions

It is crucial to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication.

Caution with Daily Activities
Until you understand how this medication affects you, avoid driving and other tasks that require alertness. To minimize the risk of dizziness or fainting, stand up slowly after sitting or lying down, and be cautious when climbing stairs.

Monitoring Your Condition
Follow your doctor's instructions for checking your blood pressure and heart rate. Additionally, have your blood work and other laboratory tests done as directed by your doctor. Be aware that this medication may interfere with certain lab tests, so inform all your healthcare providers and lab personnel that you are taking this medication.

Interactions with Other Substances
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter (OTC) medications that may cause drowsiness, discuss the potential risks with your doctor.

Low Blood Sugar Risks
This medication may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged low blood sugar. This is particularly concerning for individuals with diabetes, children, and those who are fasting, undergoing surgery, or experiencing nausea and vomiting. If you have questions or concerns, consult your doctor. If you have diabetes, it is essential to closely monitor your blood sugar levels.

Stopping the Medication
Do not stop taking this medication abruptly, as this can lead to worsened chest pain or even a heart attack, especially if you have certain types of heart disease. To avoid adverse effects, your doctor will guide you on how to gradually stop taking this medication. If you experience new or worsening chest pain or other heart problems, seek medical attention immediately.

Additional Precautions
Be aware of the risk of gout attacks and take precautions in hot weather or during physical activity by drinking plenty of fluids to prevent dehydration. Before taking OTC products that may increase blood pressure, such as cough or cold medications, diet pills, stimulants, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or certain natural products, consult your doctor.

Dehydration and Low Blood Pressure
Inform your doctor if you experience excessive sweating, fluid loss, vomiting, or diarrhea, as these can lead to low blood pressure.

Sun Sensitivity
This medication may increase your risk of sunburn. Take necessary precautions when exposed to the sun, and inform your doctor if you experience increased sun sensitivity.

Thyroid Conditions
This medication may make it more challenging to recognize symptoms of an overactive thyroid, such as a rapid heartbeat. If you have an overactive thyroid and stop taking this medication suddenly, your condition may worsen and become life-threatening. Discuss your condition with your doctor.

Allergic Reactions
If you have a history of severe allergic reactions, inform your doctor, as you may be at risk of a more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, consult your doctor, as this medication may reduce the effectiveness of epinephrine.

Pregnancy and Breastfeeding
If you are pregnant, plan to become pregnant, or are breastfeeding, discuss the benefits and risks of this medication with your doctor to ensure the best possible outcome for you and your baby.

• Anuria (due to HCTZ)

• Lithium (HCTZ decreases renal clearance, increasing lithium toxicity)
• Digoxin (HCTZ-induced hypokalemia can potentiate digoxin toxicity)
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (may reduce antihypertensive effect of both components, increase risk of renal impairment)
• Calcium Channel Blockers (e.g., verapamil, diltiazem) (additive negative chronotropic and inotropic effects, increased risk of AV block and heart failure)
• Other Antihypertensives (additive hypotensive effects)
• Fingolimod (FTY720) (additive bradycardia)

• Corticosteroids (may potentiate HCTZ-induced hypokalemia)
• Antidiabetic Agents (HCTZ may decrease glucose tolerance, requiring dose adjustment of antidiabetics)
• Cholestyramine, Colestipol (may reduce HCTZ absorption)
• Skeletal Muscle Relaxants, Non-depolarizing (HCTZ may potentiate their effect)
• Pressor Amines (e.g., norepinephrine) (bisoprolol may blunt their pressor effect)
• Class I Antiarrhythmics (e.g., disopyramide, quinidine) (additive negative inotropic effects)
• Amiodarone (increased risk of bradycardia and AV block)
• Barbiturates, Narcotics, Alcohol (additive orthostatic hypotension)

• Allopurinol (increased risk of hypersensitivity reactions with HCTZ)
• Amantadine (increased risk of amantadine toxicity with HCTZ)
• Cytotoxic agents (e.g., cyclophosphamide, methotrexate) (HCTZ may reduce renal excretion, increasing myelosuppressive effects)

• Dizziness
• Lightheadedness
• Fatigue
• Bradycardia (slow heart rate)
• Shortness of breath
• Swelling in ankles/feet (edema)
• Muscle cramps or weakness (signs of electrolyte imbalance)
• Increased thirst or urination (signs of hyperglycemia or dehydration)
• Gout flares (joint pain, swelling)

Category D. Not recommended during pregnancy, especially during the second and third trimesters, due to potential fetal harm (e.g., fetal/neonatal bradycardia, hypoglycemia, growth retardation, and neonatal jaundice, thrombocytopenia from HCTZ). Use only if the potential benefit justifies the potential risk to the fetus.

Both bisoprolol and hydrochlorothiazide are excreted into breast milk. Due to the potential for serious adverse reactions in the nursing infant (e.g., bradycardia, hypotension, hypokalemia), a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother.

Safety and effectiveness in pediatric patients have not been established. Not recommended for use in children.

No overall differences in safety or effectiveness have been observed between elderly and younger patients, but greater sensitivity of some older individuals cannot be ruled out. Start with lower doses and titrate carefully due to increased likelihood of impaired renal or hepatic function and polypharmacy. Monitor for orthostatic hypotension and electrolyte imbalances.

• This combination is useful for patients who require both a beta-blocker and a diuretic for blood pressure control.
• Always advise patients not to discontinue the medication abruptly due to the beta-blocker component, especially if they have underlying coronary artery disease.
• Monitor electrolytes (especially potassium) regularly, as HCTZ can cause hypokalemia. Potassium supplementation or potassium-sparing diuretics may be needed.
• Caution in patients with asthma/COPD (though bisoprolol is beta-1 selective, high doses or sensitive patients may experience bronchospasm), diabetes (can mask hypoglycemia symptoms and affect glucose control), and gout (HCTZ can increase uric acid levels).
• Take in the morning to avoid nocturia due to the diuretic effect.

• ACE Inhibitors (e.g., Lisinopril)
• Angiotensin Receptor Blockers (ARBs) (e.g., Valsartan)
• Calcium Channel Blockers (e.g., Amlodipine)
• Other Diuretics (e.g., Loop diuretics, Potassium-sparing diuretics)
• Alpha-blockers (e.g., Doxazosin)
• Direct Renin Inhibitors (e.g., Aliskiren)

If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about this medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication, including the amount taken and the time it happened, to help healthcare professionals provide the best possible care.