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| Interactions: | 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 a nonselective Labetalol 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.
AmlodipineAdverse Effect hypotension and/or bradycardia
Clinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
BenidipineAdverse Effect hypotension and/or bradycardia Clinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
CelecoxibAdverse 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.
Chlorpropamide + Phenformin Comb.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 labetalol serum levels, bradycardia, and hypotension Clinical Management If concurrent therapy is required, monitor cardiac function carefully (ie, blood pressure, heart rate). A labetalol dosage adjustment may be required.
ClonidineAdverse 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.
Glibenclamide + Metformin Comb.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.
Gliclazide + Metformin Comb. 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.
GlipizideAdverse 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 + Metformin Comb.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.
Halothane Adverse Effect hypotension or decreased cardiac output Clinical Management If concurrent use of labetalol and an inhalation anesthetic is required, monitor cardiac function (ie, blood pressure, heart rate) carefully, particularly in patients with pre-existing cardiac dysfunction.
IbuprofenAdverse 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.
Ibuprofen Comb. 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.
Imipramine Adverse Effect Imipramine toxicity (dry mouth, urinary retention, sedation) Clinical Management Monitor for anticholinergic side effects of imipramine if labetalol is added to therapy; lower doses of imipramine may be appropriate. Conversely, if labetalol is discontinued, monitor continued clinical efficacy of imipramine and adjust dosage accordingly.
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.
LacidipineAdverse Effect hypotension and/or bradycardia Clinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
LidoflazineAdverse 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.
NabumetoneAdverse 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.
NifedipineAdverse 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.
ParacetamolAdverse 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 Comb.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.
RitodrineAdverse 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.
TolbutamideAdverse 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. |
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