Adrenaline
Adverse Effect: Hypertension, bradycardia, resistance to Adrenaline in anaphylaxis Clinical Management: Concurrent use should be avoided if possible. However, if used concurrently, monitor blood pressure carefully. If Carvedilol causes resistance to Adrenaline in anaphylactic shock, glucagon may be effective in a dose of 1 mg or more intravenously every five minutes.
Amiodarone
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Amlodipine
Adverse Effect: hypotension and/or bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Benidipine
Adverse Effect: hypotension and/or bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Celecoxib
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Chlorpropamide
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Cimetidine
Adverse Effect: increased adverse effects of carvedilol (dizziness, insomnia, GI symptoms, postural hypotension) Clinical Management: Monitor patient response (blood pressure, pulse rate) to carvedilol when used concomitantly with cimetidine. Adjust carvedilol dosage as needed.
Clonidine
Adverse Effect: exaggerated clonidine withdrawal response (acute hypertension) Clinical Management: Patients to be withdrawn from clonidine who are concomitantly receiving a beta blocking agent should be monitored carefully for hypertension. Withdraw the beta blocker several days before a gradual lowering of clonidine doses. Alternatively, substitute labetalol (an alpha/beta blocker) for clonidine.
Digoxin
Adverse Effect: AV block and possible digoxin toxicity Clinical Management: When beta blockers and digoxin are to be given concomitantly, carefully monitor ECG and digoxin serum concentrations. Adjust doses accordingly.
Diltiazem
Adverse Effect: Hypotension, bradycardia, AV conduction disturbances Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure. A dosage adjustment for hepatically metabolized beta blockers may be required.
Felodipine
Adverse Effect: hypotension and/or bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Flunarizine
Adverse Effect: Hypotension, bradycardia, and AV conduction disturbances Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure or bradyarrhythmias.
Flurbiprofen
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Glibenclamide
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Gliclazide
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Glimepiride
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Glipizide
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Ibuprofen
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Indomethacin
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Ketoprofen
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Ketorolac
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Lacidipine
Adverse Effect: hypotension and/or bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Lidoflazine
Adverse Effect: Hypotension, bradycardia, and AV conduction disturbances Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure or bradyarrhythmias.
Mefenamic Acid
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Meloxicam
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Metformin
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Methyldopa
Adverse Effect: Exaggerated hypertensive response, tachycardia, or arrhythmias during physiologic stress or exposure to exogenous catecholamines Clinical Management: Monitor blood pressure carefully during concurrent therapy, especially during excessive physiologic stress or use of exogenous catecholamines such as phenylpropanolamine.
Nabumetone
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Naproxen
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Nifedipine
Adverse Effect: hypotension and/or bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Nimesulide
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Nitrendipine
Adverse Effect: hypotension and/or bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Oxyphenbutazone
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Paracetamol
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Phenacetin
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Phenformin
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Phenylbutazone
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Piroxicam
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Prazosin - BPH
Adverse Effect: an exaggerated hypotensive response to the first dose of the alpha blocker Clinical Management: When concurrent therapy with an alpha blocker and a beta blocker is required, initiate the alpha blocker with a smaller than usual dose, preferably at bedtime. Monitor the patient closely for hypotension
Rifampicin
Adverse Effect: Decreased therapeutic response to carvedilol Clinical Management: Monitor patient response (blood pressure, signs/symptoms of hepatic dysfunction) with concomitant use of carvedilol and rifampin. Adjust carvedilol dosage as needed.
Ritodrine
Adverse Effect: Potential interference with tocolytic action of ritodrine Clinical Management: It is possible to successfully treat a patient with both a beta blocker and a beta mimetic if an appropriate dosage is found and the clinical response is monitored.
Tenoxicam
Adverse Effect: Decreased antihypertensive effect Clinical Management: If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Terazosin - BPH
Adverse Effect: an exaggerated hypotensive response to the first dose of the alpha blocker Clinical Management: When concurrent therapy with an alpha blocker and a beta blocker is required, initiate the alpha blocker with a smaller than usual dose, preferably at bedtime. Monitor the patient closely for hypotension
Tolbutamide
Adverse Effect: Hypoglycemia, hyperglycemia, or hypertension Clinical Management: If the use of a beta blocker is required in a diabetic, watch for decreased diabetic control by monitoring the patients glucose carefully. Cardioselective beta blockers (atenolol, metoprolol) cause less disturbance of glucose metabolism and less masking of hypoglycemic effects. Propranolol accounts for the majority of positive reports of an interaction and should clearly be avoided.
Verapamil
Adverse Effect: Hypotension, bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure. |