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Doctors' Answers to "Frequently Asked Questions" - Ziac

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 05/31/2000]
Question: I have been prescribed "Ziac" for hypertension (5 mg. I have been taking it for one week and find that I am extremely drowsy during the day. I take the pill around 5 a.m. Will taking the pill in the evening offset the drowsiness?

Answer: Not a usual problem with ziac unless you are experiencing the fatigue from the beta blocker part. Since ziac is a 24 hour pill, if that is the problem, I doubt that taking it later will have any effect on the fatigue. But, worth a try. If it doesn't work, discuss changing to another with your md.

[posted 06/2/2000]
Question: I recently (5/1/2000) started taking 5 mg Ziac tablets for hypertension. I had been taking Atenelol for a year prior. Since I started taking Ziac I have experienced the following: Sunburn (have never burned before), hand tremors, fatigue, impotence (this has never happened before), muscle cramps in my calf, and almost constant stiffness or pain in the joints of my right knee and foot (I do have gout). I believe that the medicine is responsible. I've read the literature that comes with the medicine and recognize some of the side effects, but I seem to have more than listed. I am going to ask my doctor about this, but won't be able to see him for at least 30 days. All of these recent problems have me concerned that the medicine should be changed. What do you think?

Answer: Ziac has a small amount of a diuretic which was not present with the atenolol( a beta blocker like the other part of ziac). Sun sensitivity, cramps, and gout would all be a common problem with the thiazide part of the ziac. The others are common problems with any blood pressure treatment program. Call your md prior to 30 days and see what he/she wants to do.

[posted 04/23/2000]
Question: I am 41 years old white male 6' tall 255 lbs
I have been short of breath 3 times each time it happen I went to the hospital the doctors finally found that I have and Acid Reflux which am on PRILOSEC
During this time I was still short of breath
So I stop with the Prilosec now I just take Rolaids or Malox
About 1 week went by I been watching my food only juice, water and milk i have been drinking
I had another shortness of breath it last up to 1 hour
I been in the hosiptal over nite with a heart monitor and blood pressure check and a lot of blood drawn....IT turns out Am OK
Yesterday I was very light headness after cutting the grass
The doctor put me on ZIAC 2.5 mgs.
Which am only on for 2 weeks
what is the side affects and when I stop in 2 weeks with Ziac is there more danger to look forward to

Answer: I don't have the impression that they have the reason for your dyspnea. I assume you have had a stress test and a lung scan(looking for clots from your leg)? These can both kill you quickly, which reflux will usually not. Ziac has side effects of mild fatigue, nausea, sleep difficulties and low blood pressure as the common ones.

[posted 04/28/2000]
Question: I take 1 Ziac, 5mg. a day. If I take the tablet whole my blood pressure drops too much. I have been cutting it in half, but now I hear it is a timerelease medison. the tablet is pink with a coating and is scored. Is it alright to cut the tablet in half. I take one in the morning and one at night.

Answer: I'm not aware of a time release aspect, call the company-Lederle 610-688-4400 or 800-934-5556.

[posted 03/16/2000]
Question: I am currently taking 5 mg of Ziac once a dya due to hypertension. I cannot imagine being much healthier than I am now, therefore I am realizing that I may be on medication for a long time-without medication.I I hope to get pregnant soon, and I haven't found any research on Ziac specifically. What are the risks with pregnancy and breastfeeding?

Answer: Both pretty low. Ziac is a combination of a diuretic(hydrochlorthiazide) and a beta blocker(bisoprolol). It is a Class C drug for pregnancy due to the teratogenic potential at high doses. Most would use it since the dose is very, very small. But, there are other options and Class B drugs which are theorectically of lower risk.

[posted 03/8/2000]
Question: Does Ziac cause liver damage or any other body damage?

Answer: The thiazide part of Ziac theorectically can but practically almost never does. It is so low a risk that we do not follow liver functions for those on the medication. Also, the diurectic component of Ziac is very small compared to other diuretic doses. The beta blocker part of ziac should not cause a problem.

[posted 03/2/2000]
Question: I have been taking 2 Ziac 2.5mg daily since November and was recently changed to 1 Ziac 10mg daily. I have been having stomach cramps, bloating and gas(belching & heartburn). Could this be related to the inreased dosage or is this just a coincidence?

Answer: Beta blockers(one of the two ingredients in ziac) can cause nausea. It is often dosage related, so potentially the answer is yes. Belching and heartburn would be uncommon compared to nausea. I'd seek another answer, but it might be the source.

[posted 03/2/2000]
Question: I have been taking Ziac 10mg for high blood pressure and am also on Ortho Tri-Cyclen for birth control. Is it safe to be taking these 2 drugs together. I am also a worry wart that even though I take my pill every day as directed that I will still become pregnant. If someone were to get pregnant while taking the pill, would they stop getting their period like if they weren't on the pill? I got a very heavy period last month and have taken every pill as directed. I am getting married and am trying to find a worry free method of birth control.

Answer: There is no problem with this combination. Has anyone determined why you are having elevated blood pressure? As to the pregnancy, you would stop your period with pregnancy. The risk of this is very small unless you miss a pill. Using a secondary method with the pill(like spermicidal jelly) would increase the safety even further. However, pregnancies on bcps are very, very uncommon.

[posted 01/23/2000]
Question: I am currently taking 10mg Ziac per day. I work for Searle Pharmaceuticals, and
would like to switch to a drug that they make because it would be free.
Is Kerlone a comparable drug to Ziac?

Answer: Ziac is a combination of a small dose of a selective beta blocker and a small dose of a diuretic. The goal is to achieve blood pressure improvement while minimizing side effects using small dosing. Kerlone is a selective beta blocker,but there is no diuretic component. It is also dosed higher than Ziac, although that could be compensated. You could combine the Kerlone with a diuretic(12.5 of hydrochlorthiazide for example). This would involve two pills (see if Searle has a diuretic).

[posted 11/29/1999]
Question: I take Ziac every day along with Serzone and Altace plus various herbs. I notice that about 1-2 hours after taking Ziac I get tremendous heartburn and have a constant urge to move bowels. I also have some burning and itching discharge in the rectum. Could this be Ziac and what else can I use to get the BP down with the Serzone and Altace?

Answer: Beta blockers(part of the Ziac) often cause gi problems. Usually, nausea and not the bowel urgency. But, you can find out by stopping the pill for a day or three. Calcium channel blockers would be ok or maybe a higher dosage of the Altace depending on your current dosage. A diuretic works well with the Altace(the other 1/2 of the Ziac) and maybe just use the diuretic with the Altace and avoid the beta blocker aspect for awhile.

[posted 11/7/1999]
Question: I take ziac for high blood pressure, and the following other prescription drugs for rheumatoid and osteoarthritis: methotrexate, plaquenil, prempro, prednisone, and prozac for depression. Every 6 weeks I get bloodwork done because of the methotrexate. The last few labs have shown a low potassium level. My rheumatoligist suggested that I might need a potassium supplement, but would not prescribe one, as he is not the MD who prescribed the ziac (a diuretic?) Can a potassium supplement be purchased in a health food store, and is it safe to take with all the other drugs I'm already taking?

Answer: It cannot be bought without a prescription. But, increasing the vegtables in your diet would usually work. Try taking fruit juice a couple of glasses a day and recheck it in two weeks. If still low, you need a proscribed supplement.

[posted 08/30/1999]
Question: Lately, I have had problems with obtaining and maintaining
a "good" erection. More often than not, I can get to a "80%
erection but seldom do I now get to where it is enough for
penetration. When I do get to where penetration is possible,
I have a problem maintaining the erection. As my profile indicates, I
take the following medications: ziac, lotrel and zocor for
hypertension. 16 months ago I had a successful quad bypass
however, I do feel tired much of the time. Even though I will
be seeing my cardiologist shortly for a checkup, I decided to
seek another opinion. Therefore, 2 questions: will this combination of medication affect
erections and will they cause a general "tiredness".

Answer: Soft erections can be from several sources. The first to check are endocrine sources. Too much or too little of several hormones can cause dysfunction and changing the imbalance will improve it. Your doctor should check thyroid function(TSH), testerone and prolactin levels. Secondly, is whether one or more of the medications is the culprit. The ziac and the lotrel would be the first to try. Also, I have had a couple of patients who have had trouble with erections with the HMG Co A drugs, so worth a holiday on zocor for a couple of weeks. The ziac is a great cardiac drug but often causes fatigue due to the beta blocker component(the other is a small diuretic). Depending on your cardiac status, a calcium channel blocker may help this. Lastly, viagra is an excellent option if you do not need nitroglycerin and the above does not correct the problem.

[posted 08/29/1999]
Question: I'm taking Ziac, 5mg aday. I am having trouble with a
erection. Is this a side effect of Ziac?

Answer: Any of the blood pressure treatments can cause erectile dysfunction. Stop if for a day or two and see if the problem goes away, but probably the medication.

[posted 08/26/1999]
Question: I have been taking 300mg of normodyne (150mg 2x daily)for several yrs. My questions is is this supposed to keep the blood pressure "normal" consistantly because my pressure still goes up when im upset or sometimes it just goes up for some unknown reason-i know as soon as it's high as i feel very tense and "wrapped tight". sure enough when i take the pressure with an electronic cuff, it can be anywhere from 140/90 to 160/105. These high readings seem to occur about 2 or 3 times a month. During other home monitoring, it can be 100/69 or 125/85. my new doctor wants me on ziac and i'm nervous about the side effects. can you tell me if this up and down on pressure with medication is normal on a day to day basis and do you think this ziac would be better

Answer: Blood pressure has variation in everyone and swings are common. The question is whether another medication would reduce these swings. You truly can't tell without trying it. Ziac is a combination of a beta blocker and a diuretic to get the advantages of each without the side effects but, like most medications there is a lot of individual variation.

[posted 10/9/1999]
Question: I am taking atenolol for hypertension, 50 mg perday. Pressure readings with a home digital device area almost always normal, but occasionally about 128/87. I understand it is best of diastolic is 80 or less. Is it ok to take an occasional extra 50mg tablet if I get some of the higher readings as I mentioned?

Answer: Sure, but watch your pulse rate, if below 50-55 would be an indication that you can't tolerate much more. Also, the fatigue and difficulty sleeping would be expected to increase. Adding a small dosage of a diuretic or ACE inhibitor might get the advantages of both with less side effects. Ziac is an example of this approach.

[posted 08/5/1999]
Question: I've experienced a weight gain of about 15 lbs. since I started taking ziac 9 months ago. Is this normal? My diet and exercise have not changed. As a matter of fact, I increased my exercise program to try to lose the weight. Could the medicine be the cause of the weight gain?

Answer: Probably not.

Ziac [posted 1/8/99]
Question: Hi my mother has high blood pressure and has been put on different kinds of medicines to control it. At times it is under control, but the side effects are insane. The most bothersome is fatigue. She is now on Hyzaar, and she feels very tried also. Next week the doctor was going to try putting her on Ziac. We were told it's a drug with the least amount of side effects. Is this true or false. Is there a blood pressure medicine out there with every few side effects?

Answer: Well, it has less side effects due to small doses of its beta blocker and diuretic. However, fatigue is the usual one. I would try an ACE inhibitor and push the doses. Also, ensure she is checking her bp at home so that she is not over-treating herself (very common since bp rises generally in a doctor's office).

Breathlessness & Ziac [posted 11/10/98]
Question: I am a 40 year old white male, I've been taking Ziac for about 1 year and it has caused breathlessness for most of the time however I thought it might be daily stress of running my own business.I have sold the business and moved to the virgin islands trying to remove some stress in my life and I have. After 2 months in my new life I'm still short of breath alot and more if I done simple chores. I am not over weight and heart desease is not in family history, I appear in better than average physical shape and do not smoke.I'm currently taking 100Mgs. daily and I do not feel well for about 1-2 hours after taking in morning.

Answer: Ziac is a combination of a beta blocker and a diuretic. Beta blockers are known to produce asthma in some patients and this is a relatively contraindication. If it persists after stopping the Ziac you should have a stress test to rule out an angina equivalent. This should be discussed with your md and you should be on some other antianginal -calcium channel blocker probably when you discontinue the ziac.

Tremors & Ziac [posted 10/15/98]
Question: I am currently taking Ziac 10mg. I am experiencing a tremor-like sensation between my shoulder blades and up my neck. This happens intermittently.Sometimes it ceases for a few days, and then it starts up again. I consulted my Dr. about this and he changed my medication with disasterous results. I am finally back on Ziac, but the trembling still continues. Could this possibly be from the blood pressure medicine? No one can seem to find a reason for this.I'm border line high blood pressure 140/90.

Answer: Did it go away off the Ziac? This could be referred pain from your stomach, but, I can't figure any reason for this drug to cause any GI problems which would feel like a tremor. Occasional patients do have nausea on beta blockers.

Ziac with OJ & Grapefruit Juice [posted 10/9/98]
Question: I have recently been given a beta blocker Ziac but I was recently told by a friend who works at our local hospital that I should not drink orange or grapefruit juice because of a drug interaction I have been drinking a 10 ounce glass of grapefruit juice after every meal to speed up my metabolism for weight loss should I continue to do this my MD is not aware of this claim

Answer: There are drugs which have trouble with grapefruit juice, they generally are the calcium channel blockers and some antifungal drugs. Beta blockers are not affected. By the way, Ziac is a combination of beta blocker and a diuretic-not a pure beta blocker.

Ziac Withdrawal Symptoms [posted 7/23/98]
Question: I was taking Ziac for 3 years and recently stopped taking it 3 months ago. I am currently experiencing nervousness, shakiness and loss of sleep with an increased heart rate that last about 5 minutes (primarily at night when sleeping). Is this something that will go away or should I be back on the medication?

Answer: The rapid heart rate is clearly Ziac withdrawal since this is a drug that tends to slow the heart rate due to the beta blocker in the medication. Nervousness, shakiness, sleeplessness are less common. These may represent a panic attack or anxiety. Beta blockers can be used to treat these conditions, so stopping the Ziac may have brought out an underlying anxiety being treated by the beta blocker part of Ziac. Why did you need to stop? Possibly restarting a small dose of a beta blocker would alleviate these problems.

Ziac - Allergic Reactions to
Question: I have just started taking Ziac. Can it cause an allergic reaction such as rash and some swelling on the face?

Answer: Yes, usually through allergies to the diuretic part of the Ziac (part beta blocker and part diuretic). The diuretic commonly produces a rash, skin sensitivity etc., as a manifestation of its allergy.

Ziac and Diovan
Question: What are the known side effects of these two medications? I have been experiencing headaches, memory loss, loss of energy and fatigue. I was wondering if these are side effects of ziac or diovan.

Answer: Ziac is a combination of a small dose of a beta blocker and a small dose of a diuretic. This is to avoid the side effects of either while lowering Blood Pressure. However, some patients will experience the side effects anyway, especially the beta blocker. These are fatigue, nausea, sleep disturbances and slow pulse. Diuretics can produce low potassium, muscle cramps, impotence, etc. I'm not sure what Diovan is.

Question: I am taking 5 mg of ziac everyday. Will I have to continue this medication indefinitely? I am 65 years old.

Answer: Ziac is a combination drug combining a small amount of a beta-blocker and a small amount of a diuretic. This is an attempt to get effectiveness of the two drugs while minimizing the side effects. This seems to work fairly well. You will need to be on this drug unless your blood pressure improves (weight loss) or you have trouble with the side effects of either. For the beta-blocker the side effects tend to be fatigue, depression, and slow pulse. For the diuretic, usually a low potassium or sodium level.

Side Effects
Question: What are the side effects of ZIAC?

Answer: Ziac is a combination of a small amount of a beta-blocker and a small amount of a diuretic. This is in an attempt to achieve the benefits of both while minimizing the side effects. However, some patients will still experience side effects. Side effects of beta-blockers are fatigue, slow pulse, dyspnea(shortness of breath), nightmares and general sleep disturbance. Side effects of diuretics are usually low potassium leading to muscle cramps, rash and allergic side effects, elevated glucose and/or cholesterol.

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