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Symptoms: The most common signs expected with overdose of a betablocker are slow heart rate (bradycardia), marked drop in blood pressure (hypotension), bronchospasm, acute cardiac insufficiency and hypoglycemia. There is a wide interindividual variation in sensitivity to one single high dose of bisoprolol and patients with heart failure are probably very sensitive.
The clinical picture in acute or chronic overdose of hydrochlorothiazide is characterized by the extent of fluid and electrolyte loss. Most common signs are dizziness, nausea, somnolence, hypovolemia, hypotension, hypokalemia.
Management: In general, if overdose occurs, discontinuation of bisoprolol + hydrochlorothiazide (Ziac) and supportive and symptomatic treatment is recommended.
Limited data suggest that bisoprolol is hardly dialyzable. The degree to which hydrochlorothiazide is removed by hemodialysis has not been established.
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