A combination is graded by its riskiest ingredient: each part of the score is the lowest of the ingredients' scores. This grade answers one narrow question: how strong is the public evidence and safety record behind this drug, and how clean is its money trail and court record? It is not a verdict on whether the drug is right for you.
Each ingredient has its own full page with the FDA label, side-effect reports, recalls, evidence, and payments. Open them for the detail behind this grade.
Score breakdown (78/100)
Safety ×35%
B
Evidence ×25%
F
Regulatory ×15%
B
Money & lawsuits ×15%
A
Options ×10%
A
Safety: 83
Graded by its riskiest ingredient, bisoprolol (83)
18,635 FDA reports naming it as the suspect drug per million Medicare fills, 6.7x the median drug on this site (-15)
Death share in reports is near or below the FAERS average (1.2x)
Serious outcomes are 1.7x the FAERS average share (-2)
Evidence: 45
Graded by its riskiest ingredient, bisoprolol (45)
214 randomized trials and 7 systematic reviews/meta-analyses indexed in PubMed
On the WHO Model List of Essential Medicines (shown for context; no score effect)
No Cochrane review found (-5)
Only 31% of completed registered trials posted results (-15)
Regulatory history: 85
Graded by its riskiest ingredient, hydrochlorothiazide (85)
Recalls since 2016: 1 Class I, 0 Class II, 0 Class III across 32 generic makers (-15)
Money & lawsuits: 100
Graded by its riskiest ingredient, bisoprolol (100)
Pharma paid doctors $0 tied to this drug last year: negligible
Not named in any pending federal MDL
Options: 100
Graded by its riskiest ingredient, bisoprolol (100)
Generic versions approved (13 applications)
10 same-class alternatives exist
Money and lawsuits
In 2024, drug companies reported $0 in payments to US physicians and hospitals tied to this combination's brands across 0 transactions.
No pending federal MDL names this combination or its brands.
The ingredients' own payments and lawsuits are on their pages and already count toward this grade.
Who takes it and what it costs
142,073Medicare Part D patients (2024)
568,303prescriptions filled
$29average cost per fill
$17Mtotal Medicare spend
Product
Fills
$/fill
Bisoprolol-Hydrochlorothiazide
568,266
$29
Ziac
37
$1,031
Questions to ask your prescriber
This is a fixed combination of bisoprolol and hydrochlorothiazide. Why both together, instead of only the one I need?
The most-reported problems in FDA's adverse event data are dyspnoea, acute kidney injury, fatigue, diarrhoea. How would we recognize and handle those?
Why this one over acebutolol, atenolol, betaxolol? What would make you pick one of those instead?
What result are we expecting, by when, and what is the plan if it does not happen?
If 100 people like me took this drug, how many would actually get better because of it, and how many would be harmed by it? (Doctors call these the number needed to treat and the number needed to harm.)
The most-reported problems in FDA's adverse event data are fatigue, nausea, diarrhoea. How would we recognize and handle those?
Why this one over bendroflumethiazide, chlorothiazide, cyclopenthiazide? What would make you pick one of those instead?