When This Medicine Should Not Be Used:
You should not use this medicine if you have had an allergic reaction to bisoprolol, hydrochlorothiazide, sulfa drugs (such as sulfamethoxazole, sulfasalazine, sulfisoxazole, Azulfidine®, Bactrim®, Gantrisin®, or Septra®), or certain blood pressure medicines (such as atenolol, metoprolol, propranolol, Inderal®, Lopressor®, Tenormin®, or Toprol®). You should not use this medicine if you are not able to form urine (anuria) or if you have certain heart problems such as heart block, heart failure, or slow heartbeat.

How to Use This Medicine:
Tablet

• Take your medicine as directed. Your dose may need to be changed several times to find what works best for you.
• Carefully follow your doctor's instructions about any special diet. You may need to eat foods that are high in potassium (such as oranges or bananas) to prevent potassium loss while you are using this medicine.

Drugs and Foods to Avoid:
Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Make sure your doctor knows if you are also using cholestyramine (Questran®), clonidine (Catapres®, Combipres®), colestipol (Colestid®), digoxin (Lanoxin®), lithium (Eskalith®, Lithobid®), norepinephrine, reserpine (Ser-ap-es®), rifampin (Rifadin®, Rimactane®), tubocurarine, or diabetes medicine (such as glyburide, insulin, Avandia®, Glucophage®, or Glucotrol®). Tell your doctor if you are also using diuretics or "water pills" (such as furosemide, Hyzaar®, Lasix®, or Moduretic®), pain or arthritis medicine (such as aspirin, diclofenac, ibuprofen, Advil®, Aleve®, Motrin®, or Orudis®), steroids (such as cortisone, prednisone, Azmacort®, Flonase®, or Medrol®), medicines to treat abnormal heart rhythm (such as disopyramide, Norpace®), or other blood pressure medicine (such as atenolol, diltiazem, guanethidine, metoprolol, verapamil, Accupril®, Adalat®, Altace®, Calan®, Cardizem®, Ismelin®, Isoptin®, Lotensin®, Lotrel®, Procardia®, Tiazac®, Toprol®, Vasotec®, Verelan®, or Zestril®).
• Do not use medicines, supplements, or salt substitutes that contain potassium without checking first with your doctor.
• Tell your doctor if you use anything else that makes you sleepy. Some examples are allergy medicine, narcotic pain medicine, and alcohol.
• Do not drink alcohol while you are using this medicine.

Warnings While Using This Medicine:

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you have kidney disease, liver disease, heart or blood vessel disease, chest pain (angina), or a history of mineral imbalance (such as high calcium or low magnesium, potassium, or sodium in the blood). Tell your doctor if you have diabetes, gout, lung problems, lupus, an overactive thyroid, or a history of asthma.
• This medicine will not cure your high blood pressure, but it does help control it. You must continue to take it as directed if you expect to lower your blood pressure and keep it down. You may have to take high blood pressure medicine for the rest of your life.
• This medicine may cause serious allergic reactions including anaphylaxis. Anaphylaxis can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash; itching; hoarseness; trouble breathing; trouble swallowing; or any swelling of your hands, face, lips, tongue, or throat while you are using this medicine.
• This medicine may cause or worsen heart failure in some patients. Check with your doctor right away if you are having chest pain or discomfort; dilated neck veins; extreme fatigue; irregular breathing; an irregular heartbeat; shortness of breath; swelling of the face, fingers, feet, or lower legs; weight gain; or wheezing.
• Do not stop using this medicine suddenly. Your doctor will need to slowly decrease your dose before you stop it completely.
• Make sure any doctor or dentist who treats you knows that you are using this medicine. Your doctor will tell you if you are going to stop taking this medicine several days before having surgery or medical tests.
• This medicine may cause changes in your blood sugar levels. Also, this medicine may cover up signs of low blood sugar, such as a rapid pulse rate. Check with your doctor if you have these problems or if you notice a change in the results of your blood or urine sugar tests.
• Check with your doctor right away if you become sick while taking this medicine, especially with severe or continuing nausea, vomiting, or diarrhea. These conditions may cause you to lose too much water or salt.
• Check with your doctor right away if you experience dizziness, fainting, confusion, muscle pain, weakness, and/or a fast heartbeat. Use extra care if you exercise or if the weather is hot. Heavy sweating can cause dehydration (loss of too much water) or electrolyte imbalances (loss of sodium in the body).
• Stop using this medicine and check with your doctor immediately if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. This could be a sign of a serious eye problem. Your doctor will want you to have your eyes checked by an ophthalmologist (eye doctor).
• This medicine may make your skin more sensitive to sunlight. Wear sunscreen. Do not use sunlamps or tanning beds.
• Tell any doctor or dentist who treats you that you are using this medicine. This medicine may affect certain medical test results.
• This medicine may make you dizzy or drowsy. Avoid driving, using machines, or doing anything else that could be dangerous if you are not alert.
• If you stop using this medicine, your blood pressure may go up. High blood pressure usually has no symptoms. Even if you feel well, do not stop using the medicine without asking your doctor.
• Your doctor will check your progress and the effects of this medicine at regular visits. Keep all appointments. Blood and urine tests may be needed to check for unwanted effects.

Possible Side Effects While Using This Medicine:
Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing
• Blistering, peeling, or red skin rash.
• Blurred vision or changes in vision.
• Change in how much or how often you urinate.
• Chest pain (may be related to your disease and not a side effect).
• Confusion, weakness, nausea, or vomiting.
• Dry mouth, increased thirst, or muscle cramps.
• Fast, slow, pounding, or uneven heartbeat.
• Lightheadedness, dizziness, or fainting.
• Seizures.
• Shortness of breath, cold sweats, and bluish-colored skin, palms, or fingernails.
• Swelling in you feet, ankles, or legs.
• Unusual bleeding or bruising.
• Unusual tiredness or weakness.
• Wheezing or trouble breathing.
• Yellowing of your skin or the whites of your eyes.

If you notice these less serious side effects, talk with your doctor:

• Constipation, diarrhea, loss of appetite, or stomach upset.
• Joint or muscle pain.
• Mild skin rash.

If you notice other side effects that you think are caused by this medicine, tell your doctor.
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088