Home Drug Guide Bisoprolol fumarate and hydrochlorothiazide

Drug Guide

Generic Name

Bisoprolol fumarate and hydrochlorothiazide

Brand Names Ziac

Classification

Therapeutic: Antihypertensive, combination

Pharmacological: Beta-adrenergic blocker (bisoprolol), Thiazide diuretic (hydrochlorothiazide)

FDA Approved Indications

Hypertension

Mechanism of Action

Bisoprolol reduces heart rate and cardiac output by selective beta1-adrenergic blockade. Hydrochlorothiazide decreases blood volume and peripheral vascular resistance by promoting diuresis and salt excretion, leading to lowered blood pressure.

Dosage and Administration

Adult: Typically 1 tablet once daily. Dose may be adjusted based on response.

Pediatric: Not indicated for pediatric use.

Geriatric: Start at lower doses due to increased sensitivity and comorbidities.

Renal Impairment: Use caution; dose adjustments may be necessary.

Hepatic Impairment: Use with caution; monitor liver function.

Pharmacokinetics

Absorption: Well absorbed after oral administration.

Distribution: Bisoprolol is highly protein-bound (~30%).

Metabolism: Minimal hepatic metabolism; primarily excreted unchanged.

Excretion: Renally excreted; dose adjustment may be needed in renal impairment.

Half Life: Approximately 10-12 hours for bisoprolol.

Contraindications

Known hypersensitivity to bisoprolol, hydrochlorothiazide, or other sulfonamide derivatives.
Severe bradycardia, sinus node failure, or second- or third-degree AV block without a pacemaker.
Uncompensated heart failure.
Pulmonary edema.

Precautions

Use cautiously in asthma or obstructive airway disease.
Monitor for signs of hypotension or worsening heart failure.
Pregnancy category C; use only if clearly needed during pregnancy. Breastfeeding: Use with caution; consult healthcare provider.

Adverse Reactions - Common

Dizziness (Common)
Fatigue (Common)
Headache (Common)
Gastrointestinal disturbances (Common)

Adverse Reactions - Serious

Bradycardia (Serious)
Hypotension (Serious)
Electrolyte imbalance (hypokalemia, hyponatremia) (Serious)
Bronchospasm (rare) (Serious)

Drug-Drug Interactions

Other antihypertensives, digoxin, antiarrhythmics.
NSAIDs may reduce diuretic effectiveness.
Calcium channel blockers, especially non-dihydropyridines (verapamil, diltiazem).

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor blood pressure, heart rate, serum electrolytes, renal function.

Diagnoses:

Risk for electrolyte imbalance
Potential for decreased cardiac output

Implementation: Administer as directed, preferably in the morning. Monitor for side effects.

Evaluation: Assess blood pressure and heart rate regularly to ensure therapeutic effect and adjust dose accordingly.

Patient/Family Teaching

Take medication exactly as prescribed.
Do not stop abruptly; consult provider before discontinuing.
Report signs of dizziness, fatigue, or irregular heartbeat.
Limit use of alcohol and avoid hot environments to prevent hypotension.

Special Considerations

Black Box Warnings:

Use with caution in patients with bronchospastic conditions.
Potential for masking hypoglycemia symptoms in diabetics.

Genetic Factors: Pharmacogenomic differences may influence drug metabolism and response.

Lab Test Interference: Hct and serum electrolyte levels may be altered.

Overdose Management

Signs/Symptoms: Severe bradycardia, hypotension, bronchospasm, cardiogenic shock.

Treatment: Supportive care, atropine for bradycardia, vasopressors for hypotension, mechanical ventilation if needed. Consider activated charcoal if ingestion recent.

Storage and Handling

Storage: Store at room temperature, 20-25°C (68-77°F).

Stability: Stable under recommended storage conditions until expiration date.