Bisoprolol/hctz 5mg/6.25mg Tabs
It is used to treat high blood pressure.
Drug Class
Antihypertensive
Pharmacologic Class
Beta-adrenergic blocker (selective beta-1) and Thiazide diuretic
Pregnancy Category
Category D
FDA Approved
Aug 1992
DEA Schedule
Not Controlled
Overview
What is this medicine?
This medication is a combination of two drugs: a 'beta-blocker' (bisoprolol) and a 'water pill' (hydrochlorothiazide). It works by relaxing blood vessels and helping your body get rid of extra salt and water. This helps to lower your blood pressure, which reduces your risk of heart attack and stroke.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
It's essential to establish a routine when taking this medication. Try to take it at the same time every day to help you remember. Since this medication may increase urine production, it's best to avoid taking it close to bedtime to minimize sleep disruptions.
If you're taking cholestyramine or colestipol, consult with your pharmacist to determine the best way to take these medications together. Additionally, if you're on a low-salt or salt-free diet, discuss this with your doctor to ensure safe and effective use of your medication.
Storing and Disposing of Your Medication
To maintain the quality and safety of your medication, store it at room temperature in a dry place, away from the bathroom. Keep all medications in a secure location, out of reach of children and pets.
When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless instructed to do so. Instead, consult with your pharmacist for guidance on the proper disposal method. You may also want to explore local drug take-back programs for a safe and environmentally friendly way to dispose of your medications.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
To get the most benefit from your medication, take it exactly as directed by your doctor. Carefully read all the information provided with your prescription, and follow the instructions closely. Continue taking your medication as prescribed by your doctor or healthcare provider, even if you start to feel better.
It's essential to establish a routine when taking this medication. Try to take it at the same time every day to help you remember. Since this medication may increase urine production, it's best to avoid taking it close to bedtime to minimize sleep disruptions.
If you're taking cholestyramine or colestipol, consult with your pharmacist to determine the best way to take these medications together. Additionally, if you're on a low-salt or salt-free diet, discuss this with your doctor to ensure safe and effective use of your medication.
Storing and Disposing of Your Medication
To maintain the quality and safety of your medication, store it at room temperature in a dry place, away from the bathroom. Keep all medications in a secure location, out of reach of children and pets.
When disposing of unused or expired medications, do not flush them down the toilet or pour them down the drain unless instructed to do so. Instead, consult with your pharmacist for guidance on the proper disposal method. You may also want to explore local drug take-back programs for a safe and environmentally friendly way to dispose of your medications.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses to make up for the missed one.
Lifestyle & Tips
- Take this medication exactly as prescribed, usually once daily in the morning.
- Do not stop taking this medication suddenly, especially if you have heart disease, as it can worsen your condition. Your doctor will tell you how to slowly reduce the dose if needed.
- Monitor your blood pressure and heart rate regularly at home as advised by your doctor.
- Limit alcohol intake, as it can further lower blood pressure and cause dizziness.
- Maintain a healthy diet, low in sodium, and engage in regular physical activity as recommended by your doctor.
- Avoid standing up too quickly from a sitting or lying position to prevent dizziness.
- Stay hydrated, but avoid excessive fluid intake unless advised by your doctor.
- Inform your doctor or dentist that you are taking this medication before any surgery or dental procedures.
Available Forms & Alternatives
Dosing & Administration
Adult Dosing
Standard Dose:
One 5mg/6.25mg tablet orally once daily
Dose Range:
2.5 - 20 mg
Condition-Specific Dosing:
hypertension:
Initial dose typically 2.5mg/6.25mg or 5mg/6.25mg once daily. May be titrated up to a maximum of 20mg bisoprolol/12.5mg HCTZ once daily based on patient response and tolerability. Doses should be individualized.
Pediatric Dosing
Neonatal:
Not established
Infant:
Not established
Child:
Not established
Adolescent:
Not established
Dose Adjustments
Renal Impairment:
Mild:
No initial dose adjustment required (CrCl > 50 mL/min).
Moderate:
Use with caution. For CrCl 30-49 mL/min, consider starting with lower doses (e.g., 2.5mg/6.25mg) and titrate slowly. HCTZ may be less effective.
Severe:
Contraindicated (CrCl < 30 mL/min or anuria) due to hydrochlorothiazide component. Bisoprolol alone may require dose adjustment.
Dialysis:
Contraindicated due to hydrochlorothiazide component. Bisoprolol is not significantly dialyzable.
Hepatic Impairment:
Mild:
No initial dose adjustment required.
Moderate:
Use with caution. Consider starting with lower doses (e.g., 2.5mg/6.25mg) and titrate slowly. Bisoprolol metabolism may be impaired.
Severe:
Use with caution. Bisoprolol clearance may be reduced. Thiazides should be used with caution in severe hepatic impairment as they may precipitate hepatic coma.
Pharmacology
Mechanism of Action
Bisoprolol is a highly selective beta1-adrenergic blocking agent. It decreases heart rate, myocardial contractility, and renin release, leading to a reduction in blood pressure. Hydrochlorothiazide is a thiazide diuretic that inhibits the reabsorption of sodium and chloride ions in the distal convoluted tubule, leading to increased excretion of sodium, chloride, and water, as well as potassium and magnesium. This reduces plasma volume and peripheral vascular resistance.
Pharmacokinetics
Absorption:
Bioavailability:
Bisoprolol: ~90%; Hydrochlorothiazide: 65-75%
Tmax:
Bisoprolol: 2-4 hours; Hydrochlorothiazide: 1-2.5 hours
FoodEffect:
Bisoprolol: Minimal effect; Hydrochlorothiazide: Can slightly increase absorption.
Distribution:
Vd:
Bisoprolol: ~226 L; Hydrochlorothiazide: 0.8 L/kg
ProteinBinding:
Bisoprolol: ~30%; Hydrochlorothiazide: 40-68%
CnssPenetration:
Bisoprolol: Limited; Hydrochlorothiazide: Limited
Elimination:
HalfLife:
Bisoprolol: 9-12 hours; Hydrochlorothiazide: 5.6-14.8 hours
Clearance:
Bisoprolol: ~15 L/hr; Hydrochlorothiazide: Not available
ExcretionRoute:
Bisoprolol: Renal (50% unchanged), Hepatic (50% metabolites); Hydrochlorothiazide: Renal (primarily unchanged)
Unchanged:
Bisoprolol: ~50%; Hydrochlorothiazide: ~95%
Pharmacodynamics
OnsetOfAction:
Bisoprolol: 1-2 hours; Hydrochlorothiazide: ~2 hours
PeakEffect:
Bisoprolol: 2-4 hours; Hydrochlorothiazide: 4-6 hours
DurationOfAction:
Bisoprolol: 24 hours; Hydrochlorothiazide: 6-12 hours
Confidence:
Medium
Safety & Warnings
BLACK BOX WARNING
Abrupt cessation of therapy with beta-blocking agents should be avoided, especially in patients with ischemic heart disease. If discontinuation is necessary, the dosage should be gradually reduced over a period of 1 to 2 weeks. If angina worsens or acute coronary insufficiency develops, bisoprolol/HCTZ administration should be reinstituted promptly, at least temporarily, and other measures appropriate for the management of angina pectoris should be taken. Because coronary artery disease is common and may be unrecognized, it may be prudent not to discontinue bisoprolol/HCTZ therapy abruptly even in patients treated only for hypertension.
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of fluid and electrolyte problems: mood changes, confusion, muscle pain or weakness, fast or abnormal heartbeat, severe dizziness or fainting, increased thirst, seizures, feeling extremely tired or weak, decreased appetite, inability to urinate or changes in urine output, dry mouth, dry eyes, or severe nausea and vomiting.
Signs of pancreatitis (pancreas problem): severe stomach pain, severe back pain, or severe nausea and vomiting.
Signs of kidney problems: inability to urinate, changes in urine output, blood in the urine, or 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 (jaundice).
Abnormal burning, numbness, or tingling sensations.
Eye Problems
This medication can cause certain eye problems, which can lead to permanent vision loss if left untreated. If you experience any changes in vision or eye pain, usually within hours to weeks of starting this medication, contact your doctor immediately.
Lupus
If you have lupus, this medication can 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 lump or growth.
Other Side Effects
Like all medications, this drug can cause side effects. While many people do not experience any side effects or only have mild ones, it is essential to contact your doctor if you are bothered by any of the following:
Dizziness, tiredness, or weakness.
* Headache.
If you experience any other side effects or have concerns, contact your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, this medication can cause severe and potentially life-threatening side effects. If you experience any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of fluid and electrolyte problems: mood changes, confusion, muscle pain or weakness, fast or abnormal heartbeat, severe dizziness or fainting, increased thirst, seizures, feeling extremely tired or weak, decreased appetite, inability to urinate or changes in urine output, dry mouth, dry eyes, or severe nausea and vomiting.
Signs of pancreatitis (pancreas problem): severe stomach pain, severe back pain, or severe nausea and vomiting.
Signs of kidney problems: inability to urinate, changes in urine output, blood in the urine, or 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 (jaundice).
Abnormal burning, numbness, or tingling sensations.
Eye Problems
This medication can cause certain eye problems, which can lead to permanent vision loss if left untreated. If you experience any changes in vision or eye pain, usually within hours to weeks of starting this medication, contact your doctor immediately.
Lupus
If you have lupus, this medication can 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 lump or growth.
Other Side Effects
Like all medications, this drug can cause side effects. While many people do not experience any side effects or only have mild ones, it is essential to contact your doctor if you are bothered by any of the following:
Dizziness, tiredness, or weakness.
* Headache.
If you experience any other side effects or have concerns, contact your doctor for advice. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe dizziness or fainting
- Very slow heart rate (less than 50 beats per minute)
- Shortness of breath, especially with exertion, or swelling in your ankles/feet (signs of worsening heart failure)
- New or worsening chest pain
- Unusual tiredness or weakness
- Muscle cramps or weakness, irregular heartbeat (signs of electrolyte imbalance)
- Persistent nausea, vomiting, or dry mouth
- Sudden decrease in vision or eye pain (rare, but can be a sign of acute angle-closure glaucoma)
Before Using This Medicine
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.
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.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. This will help ensure they are aware of any potential interactions or effects.
To minimize the risk of accidents, avoid driving and other activities that require alertness until you understand how this medication affects you. When changing positions, such as standing up from a sitting or lying down position, do so slowly to reduce the likelihood of dizziness or fainting. Be cautious when navigating stairs.
Regularly monitor your blood pressure and heart rate as instructed by your doctor. Additionally, follow your doctor's recommendations for blood work and other laboratory tests. Be aware that this medication may interfere with certain lab tests, so inform all your healthcare providers and laboratory personnel that you are taking this medication.
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter medications that may cause drowsiness, consult with your doctor. This medication may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged hypoglycemia, particularly in individuals with diabetes, children, and those who are fasting or have undergone surgery. If you have questions or concerns, discuss them with your doctor.
If you have diabetes, it is crucial to closely monitor your blood sugar levels. Do not abruptly stop taking this medication, as this may lead to worsened chest pain or even a heart attack, especially if you have pre-existing heart disease. To avoid adverse effects, your doctor will guide you on how to gradually discontinue the medication. If you experience new or worsening chest pain or other heart problems, seek medical attention immediately.
Be aware of the potential for gout attacks and take precautions to stay hydrated, especially in hot weather or during physical activity. Drink plenty of fluids to prevent dehydration. Before using over-the-counter 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 with your doctor.
If you experience excessive sweating, fluid loss, vomiting, or diarrhea, inform your doctor, as these symptoms may lead to low blood pressure. This medication may also increase your susceptibility to sunburn, so take necessary precautions when exposed to the sun and inform your doctor if you experience unusual sun sensitivity.
Additionally, 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 abruptly, your condition may worsen and become life-threatening. Discuss any concerns with your doctor.
If you have a history of severe allergic reactions, inform your doctor, as you may be at increased risk of a more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, consult with your doctor, as this medication may reduce the effectiveness of epinephrine.
Finally, 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.
To minimize the risk of accidents, avoid driving and other activities that require alertness until you understand how this medication affects you. When changing positions, such as standing up from a sitting or lying down position, do so slowly to reduce the likelihood of dizziness or fainting. Be cautious when navigating stairs.
Regularly monitor your blood pressure and heart rate as instructed by your doctor. Additionally, follow your doctor's recommendations for blood work and other laboratory tests. Be aware that this medication may interfere with certain lab tests, so inform all your healthcare providers and laboratory personnel that you are taking this medication.
Before consuming alcohol, marijuana, or other forms of cannabis, or taking prescription or over-the-counter medications that may cause drowsiness, consult with your doctor. This medication may mask symptoms of low blood sugar, such as a rapid heartbeat, which can increase the risk of severe or prolonged hypoglycemia, particularly in individuals with diabetes, children, and those who are fasting or have undergone surgery. If you have questions or concerns, discuss them with your doctor.
If you have diabetes, it is crucial to closely monitor your blood sugar levels. Do not abruptly stop taking this medication, as this may lead to worsened chest pain or even a heart attack, especially if you have pre-existing heart disease. To avoid adverse effects, your doctor will guide you on how to gradually discontinue the medication. If you experience new or worsening chest pain or other heart problems, seek medical attention immediately.
Be aware of the potential for gout attacks and take precautions to stay hydrated, especially in hot weather or during physical activity. Drink plenty of fluids to prevent dehydration. Before using over-the-counter 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 with your doctor.
If you experience excessive sweating, fluid loss, vomiting, or diarrhea, inform your doctor, as these symptoms may lead to low blood pressure. This medication may also increase your susceptibility to sunburn, so take necessary precautions when exposed to the sun and inform your doctor if you experience unusual sun sensitivity.
Additionally, 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 abruptly, your condition may worsen and become life-threatening. Discuss any concerns with your doctor.
If you have a history of severe allergic reactions, inform your doctor, as you may be at increased risk of a more severe reaction if you are exposed to the allergen again. If you use epinephrine to treat severe allergic reactions, consult with your doctor, as this medication may reduce the effectiveness of epinephrine.
Finally, 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.
Overdose Information
Overdose Symptoms:
- Severe bradycardia (very slow heart rate)
- Profound hypotension (very low blood pressure)
- Acute cardiac failure
- Bronchospasm (difficulty breathing)
- Hypoglycemia (low blood sugar)
- Lethargy, confusion
- Electrolyte imbalances (e.g., severe hypokalemia, hyponatremia)
- Dehydration
What to Do:
Seek immediate medical attention. Call 911 or your local emergency number. For poison control, call 1-800-222-1222. Treatment is supportive and symptomatic, including atropine for bradycardia, vasopressors for hypotension, glucagon for severe beta-blocker overdose, and fluid/electrolyte replacement.
Drug Interactions
Contraindicated Interactions
- Anuria (due to HCTZ)
- Cardiogenic shock (due to bisoprolol)
- Overt cardiac failure (due to bisoprolol)
- Second or third degree AV block (without a pacemaker, due to bisoprolol)
- Severe bradycardia (due to bisoprolol)
Major Interactions
- Lithium (HCTZ decreases renal clearance of lithium, increasing toxicity)
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs) (may reduce antihypertensive effect of both components)
- Other antihypertensives (additive hypotensive effects)
- Class I antiarrhythmics (e.g., disopyramide, quinidine) and Class III antiarrhythmics (e.g., amiodarone) (potential for additive negative inotropic and dromotropic effects with bisoprolol)
- Calcium channel blockers (e.g., verapamil, diltiazem) (potential for additive negative inotropic and dromotropic effects with bisoprolol, leading to severe bradycardia or heart block)
- Digitalis glycosides (HCTZ-induced hypokalemia can potentiate digitalis toxicity; bisoprolol can prolong AV conduction time)
Moderate Interactions
- Antidiabetic agents (insulin, oral hypoglycemics) (bisoprolol may mask symptoms of hypoglycemia; HCTZ may increase blood glucose levels)
- Corticosteroids, ACTH (increased risk of electrolyte depletion, particularly hypokalemia with HCTZ)
- Skeletal muscle relaxants, non-depolarizing (HCTZ may prolong effects)
- Cholestyramine, colestipol (may impair absorption of HCTZ)
- Pressor amines (e.g., norepinephrine) (bisoprolol may blunt pressor effect)
- CYP2D6 inhibitors (e.g., quinidine, fluoxetine, paroxetine) (may increase bisoprolol plasma concentrations, though bisoprolol metabolism via CYP2D6 is minor)
Minor Interactions
- Alcohol (may potentiate orthostatic hypotension)
- Barbiturates, narcotics (may potentiate orthostatic hypotension)
Monitoring
Baseline Monitoring
Blood Pressure (BP) and Heart Rate (HR)
Rationale: To establish baseline cardiovascular status and guide initial dosing.
Timing: Prior to initiation
Serum Electrolytes (Potassium, Sodium, Magnesium, Calcium)
Rationale: Hydrochlorothiazide can cause electrolyte imbalances (hypokalemia, hyponatremia, hypomagnesemia, hypercalcemia).
Timing: Prior to initiation
Renal Function (BUN, Serum Creatinine, eGFR)
Rationale: To assess kidney function, as both drugs are renally eliminated to some extent and HCTZ is contraindicated in severe renal impairment.
Timing: Prior to initiation
Blood Glucose
Rationale: Hydrochlorothiazide can cause hyperglycemia; bisoprolol can mask hypoglycemia symptoms.
Timing: Prior to initiation
Uric Acid
Rationale: Hydrochlorothiazide can increase serum uric acid levels, potentially precipitating gout.
Timing: Prior to initiation
Liver Function Tests (LFTs)
Rationale: Bisoprolol is metabolized by the liver; HCTZ should be used with caution in severe hepatic impairment.
Timing: Prior to initiation
Routine Monitoring
Blood Pressure (BP) and Heart Rate (HR)
Frequency: Regularly, e.g., weekly during titration, then monthly or every 3-6 months once stable.
Target: Individualized, typically <130/80 mmHg for most adults.
Action Threshold: Persistent BP above target, or symptomatic bradycardia (<50 bpm) or hypotension.
Serum Electrolytes (Potassium, Sodium)
Frequency: Within 1-2 weeks of initiation/dose change, then every 3-6 months or as clinically indicated.
Target: Potassium: 3.5-5.0 mEq/L; Sodium: 135-145 mEq/L.
Action Threshold: Potassium <3.0 mEq/L or >5.5 mEq/L; Sodium <130 mEq/L or >150 mEq/L; symptomatic electrolyte imbalance.
Renal Function (BUN, Serum Creatinine)
Frequency: Within 1-2 weeks of initiation/dose change, then every 6-12 months or as clinically indicated.
Target: Stable within patient's baseline range.
Action Threshold: Significant increase in creatinine (>30% from baseline) or decrease in eGFR.
Blood Glucose
Frequency: Periodically, especially in diabetic patients or those at risk.
Target: Individualized based on diabetes management goals.
Action Threshold: Persistent hyperglycemia or new onset diabetes.
Symptom Monitoring
- Dizziness or lightheadedness (especially upon standing)
- Fatigue or weakness
- Bradycardia (slow heart rate)
- Shortness of breath or worsening of asthma/COPD symptoms
- Swelling in ankles or feet (edema)
- Muscle cramps or weakness (signs of hypokalemia)
- Dry mouth, thirst, nausea, vomiting (signs of dehydration/electrolyte imbalance)
- Symptoms of gout (joint pain, swelling)
Special Patient Groups
Pregnancy
Category D. Not recommended during pregnancy due to potential fetal harm. Hydrochlorothiazide can cause fetal or neonatal jaundice, thrombocytopenia, and possibly other adverse reactions seen in adults. Bisoprolol can cause bradycardia, hypoglycemia, and growth retardation in the fetus/neonate. Use only if the potential benefit justifies the potential risk to the fetus.
Trimester-Specific Risks:
First Trimester:
Limited data, but potential for teratogenicity with HCTZ cannot be excluded. Bisoprolol generally not associated with major malformations.
Second Trimester:
Risk of fetal growth restriction, bradycardia, and hypoglycemia with bisoprolol. Risk of electrolyte disturbances and impaired placental perfusion with HCTZ.
Third Trimester:
Increased risk of neonatal bradycardia, hypoglycemia, and respiratory depression with bisoprolol. Risk of neonatal jaundice, thrombocytopenia, and electrolyte disturbances with HCTZ.
Lactation
Both bisoprolol and hydrochlorothiazide are excreted into breast milk. Due to the potential for serious adverse reactions in the breastfed infant (e.g., bradycardia, hypoglycemia from bisoprolol; electrolyte imbalance, jaundice from HCTZ), a decision should be made whether to discontinue nursing or discontinue the drug, taking into account the importance of the drug to the mother. L3 risk.
Infant Risk:
Moderate risk. Potential for bradycardia, hypoglycemia, and respiratory depression in infants exposed to bisoprolol. Potential for electrolyte disturbances, jaundice, and thrombocytopenia in infants exposed to HCTZ. Monitor infant for signs of adverse effects.
Pediatric Use
Safety and effectiveness in pediatric patients have not been established. Not recommended for use in children.
Geriatric Use
Elderly patients may be more sensitive to the effects of bisoprolol/HCTZ, particularly regarding blood pressure lowering and potential for bradycardia or electrolyte imbalances. Lower initial doses and careful titration are recommended. Renal function should be closely monitored.
Clinical Information
Clinical Pearls
- This combination is often used when monotherapy with either a beta-blocker or a diuretic is insufficient to control hypertension.
- Take the medication in the morning to avoid nocturia (increased urination at night) due to the diuretic component.
- Patients should be advised not to discontinue the medication abruptly, especially if they have underlying coronary artery disease, due to the risk of rebound hypertension or cardiac events.
- Monitor for signs of electrolyte imbalance, particularly hypokalemia, which can be exacerbated by the diuretic. Potassium supplementation or potassium-sparing diuretics may be considered if hypokalemia develops.
- Caution is advised in patients with asthma, COPD, or other bronchospastic diseases, as bisoprolol, even though beta-1 selective, can cause bronchospasm at higher doses or in susceptible individuals.
- Diabetic patients should be closely monitored for blood glucose levels, as HCTZ can increase glucose and bisoprolol can mask hypoglycemia symptoms.
- Patients with a history of gout should be monitored for increased uric acid levels and potential gout flares.
Alternative Therapies
- 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)
- Other beta-blockers (e.g., Carvedilol, Metoprolol)
- Alpha-blockers (e.g., Doxazosin)
- Direct vasodilators (e.g., Hydralazine)
Cost & Coverage
Average Cost:
Varies widely, typically $10-$50 per 30 tablets
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (Generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it is essential to contact your doctor promptly. 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 it's a good idea to check with your pharmacist. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide detailed information about the overdose, including the medication taken, the amount, and the time it occurred.