bisoprolol and hydrochlorothiazide, Ziac (cont.)
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets (bisoprolol/hydrochlorothiazide): 2.5/6.25 mg, 5/6.25 mg, and 10/6.25 mg.
STORAGE: Ziac should be stored at room temperature, 59- 86 F (15-30 C) in a tight container.
PRESCRIBED FOR: Ziac is used for treating patients with high blood pressure who have not adequately responded to either individual agent alone.
DOSING: The dose of Ziac is tailored to the patient's needs. The initial dose is 2.5/6.25 mg daily. The dose may be increased very two weeks and the maximum dose is 20/12.5 mg once daily.
DRUG INTERACTIONS: Rifampin may increase the metabolism (destruction) of bisoprolol, possibly making bisoprolol less effective. Certain calcium channel blockers (CCBs), especially verapamil (Calan, Isoptin) and diltiazem (Cardizem, Tiazac), may enhance the effect of bisoprolol on the heart. In some patients, this may cause excessive slowing of the heart rate or reduce the heart's ability to beat. The use of digoxin (Lanoxin) with bisoprolol also may cause an excessive reduction in heart rate.
Hydrochlorothiazide reduces the elimination of lithium (Lithobid, Eskalith) by the kidneys and can lead to lithium toxicity. Nonsteroidal anti-inflammatory drugs, for example, ibuprofen, may reduce the blood pressure effects of hydrochlorothiazide.
Blood sugar levels can be elevated by HCTZ, necessitating adjustment in the doses of medications that are used for treating diabetes.
Combining HCTZ with corticosteroids may increase the risk for low levels of blood potassium and other electrolytes. Low blood potassium can increase the toxicity of digoxin (Lanoxin). Cholestyramine (Questran, Questran Light) and colestipol (Colestid) bind to hydrochlorothiazide and reduce its absorption from the gastrointestinal tract by 43%-85%.
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