Warnings

Bisoprolol-Hydrochlorothiazide

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Apr 26, 2023

Warnings

Bisoprolol and Hydrochlorothiazide Risks, Warnings, and Complications

Bisoprolol and hydrochlorothiazide can cause or worsen health problems in some people. Talk to your doctor or pharmacist about taking other blood pressure medications if you are at increased risk of complications from this combination therapy.

RISK OF CARDIAC FAILURE: Beta blockers are generally avoided in patients with heart failure. In some people, the continued use of beta blockers can cause heart failure even if there is no prior history. If you have uncontrolled heart failure, your healthcare provider will not prescribe bisoprolol and hydrochlorothiazide unless they think the benefits outweigh the risks. If they do prescribe this medication, they will monitor you carefully. Call your doctor right away if you develop symptoms of heart failure, such as trouble breathing, rapid weight gain, or swelling in your ankles and feet.
RISKS ASSOCIATED WITH SUDDENLY STOPPING BISOPROLOL AND HYDROCHLOROTHIAZIDE : Stopping bisoprolol and hydrochlorothiazide suddenly can increase the risk of chest pain (angina), coronary artery disease, heart attack, and heart rhythm abnormalities. Do not stop taking this medication without your doctor’s advice. Get emergency medical care if you develop chest tightness or pain, lightheadedness, shortness of breath, and fatigue. If you need to stop taking bisoprolol and hydrochlorothiazide, your healthcare provider will tell you how to gradually lower the dose safely.
WORSENING PERIPHERAL VASCULAR DISEASE: Beta blockers such as bisoprolol can worsen the symptoms of peripheral vascular disease (PVD). Tell your doctor if you have blood vessel disease before starting this medication.
BRONCHOSPASM: Beta blocker medications are generally not recommended for people with certain lung problems, such as asthma and chronic obstructive pulmonary disease. However, since bisoprolol is cardioselective, it may be used with caution in people with lung disease if they do not respond to other antihypertensive treatments. Your healthcare provider will use the lowest effective dose of bisoprolol and hydrochlorothiazide and monitor you carefully if you have asthma or some other breathing disorder.
RISKS ASSOCIATED WITH MAJOR SURGERY: Taking beta blockers can increase the risks associated with major surgery done using anesthesia. Your healthcare team will optimize your blood pressure medicine before your procedure.
MASKING SYMPTOMS OF HYPOGLYCEMIA: Beta blockers can hide the symptoms of hypoglycemia (low blood sugar), such as tremors and fast heartbeat in people with diabetes. Because bisoprolol is cardioselective, this risk is lower compared to some other beta blockers. However, if you are taking insulin or oral diabetes medication to lower your blood sugar, you may not be able to rely on the typical warning symptoms of hypoglycemia (dangerously low blood sugar). Talk to your provider about how to carefully monitor blood sugar after starting bisoprolol and hydrochlorothiazide.
RISK OF THYROTOXICOSIS : Beta blockers can mask the clinical signs of hyperthyroidism, such as a fast heart rate. Abruptly stopping beta blockers can lead to a worsening of hyperthyroidism and a condition called thyroid storm with symptoms such as high fever and rapid heartbeat. Talk to your healthcare provider before stopping bisoprolol and hydrochlorothiazide.
RISK OF KIDNEY PROBLEMS: Bisoprolol and hydrochlorothiazide are cleared from the body by the kidneys. If the kidneys are not working properly, the medications can build up in the body and cause side effects. Tell your healthcare professional if you have a history of kidney problems. Your doctor will monitor you carefully to make sure your kidneys are functioning normally. If there are signs of kidney problems, they may adjust your dose or discontinue this combination antihypertensive therapy.
SERIOUS ELECTROLYTE IMBALANCE: Bisoprolol and hydrochlorothiazide can cause changes in fluid levels and electrolytes in the body. This risk is greater in people over 65 years of age, those with a history of kidney or liver problems, and those taking other medications that also affect fluid and electrolytes. Tell your doctor without delay if you develop weakness, leg cramps, upper stomach pain, nausea, or vomiting. Keep all your healthcare appointments during treatment because your provider may want to regularly check blood work for electrolytes.
EYE PROBLEMS: Hydrochlorothiazide is a sulfonamide and has been linked to acute angle-closure glaucoma (increased eye pressure). This risk is higher in people with a history of allergic reactions to sulfa drugs. Symptoms of glaucoma, such as decreased visual acuity and eye pain, can start within hours to weeks of starting treatment with the blood pressure medicine. This can lead to permanent blindness if left untreated. Stop taking the medicine and tell your health care professional immediately if you develop any vision changes or eye pain.

Precautions Before Starting Bisoprolol and Hydrochlorothiazide

Tell your doctor if you have ever had allergic reactions to bisoprolol or hydrochlorothiazide, any of the active or inactive ingredients in bisoprolol and hydrochlorothiazide tablets, other beta blockers, other diuretics, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible interactions between your medications.

Give your health care professional a complete medical history. Bisoprolol and hydrochlorothiazide may not be right for people with certain medical conditions such as kidney disease, liver disease, thyroid disease, lung disease, glaucoma, circulation problems, sick sinus syndrome, congestive heart failure, and certain muscle diseases.

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Bisoprolol and Hydrochlorothiazide

Keep all your medical and lab appointments while on this medication. Your provider may want to keep an eye on kidney function and electrolytes during treatment.

Keep a log of your blood pressure readings at home and bring it to your appointments. Your provider may adjust your medication dose based on your response.

Try to take bisoprolol and hydrochlorothiazide in the morning or afternoon or at least 4 hours before bedtime. This medication can make you urinate more, and taking it later in the day can lead to awakenings at night to urinate.

Bisoprolol and hydrochlorothiazide can cause dizziness and a lightheaded feeling, especially when you first start taking it and after dose adjustments, as the body adjusts to the medicine. Do not drive, operate machinery, or do any other hazardous activity until you know how it affects you. You should know that alcohol can make these side effects worse.

Taking this combination therapy can cause dizziness, lightheadedness, and fainting when going from a sitting or lying position to standing. Get out of bed slowly to avoid falls.

Do not stop taking bisoprolol and hydrochlorothiazide without talking to your doctor. Stopping this medication suddenly can lead to a dangerous rise in blood pressure and increase your risk of heart attack and stroke.

Hydrochlorothiazide can make your skin more sensitive to sunlight and increase your risk of skin cancer. Wear protective clothing and use sunscreen when outdoors.

If you have diabetes (high blood sugar) and are taking medications to treat it, talk to your doctor about how often you should monitor blood sugar levels. Bisoprolol and hydrochlorothiazide can hide the symptoms of low blood sugar.

Tell your doctor if you become pregnant while on bisoprolol and hydrochlorothiazide.

Tell all your doctors you are on bisoprolol and hydrochlorothiazide before any surgery or medical tests, including dental procedures.

Bisoprolol and Hydrochlorothiazide Drug Interactions

Certain other drugs can affect how bisoprolol and hydrochlorothiazide work. Possible drug interactions with other medicines can increase the risk of severe adverse effects. The following medications can have interactions with bisoprolol and hydrochlorothiazide:

Other beta blockers.
Other antihypertensive agents such as reserpine, guanethidine, clonidine, verapamil, and diltiazem.
Antiarrhythmic agents such as disopyramide.
Heart medications such as digoxin.
Antibiotics such as rifampin.

The above list may not describe all the potential interactions of bisoprolol and hydrochlorothiazide. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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