Acarbose Adverse Effect hypoglycemia, hyperglycemia, or hypertensionClinical 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.
AdrenalineAdverse Effect Hypertension, bradycardia, resistance to Adrenaline in anaphylaxisClinical Management Concurrent use should be avoided if possible. However, if used concurrently, monitor blood pressure carefully. If a nonselective Metoprolol 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 arrestClinical 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 bradycardiaClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Benidipine Adverse Effect hypotension and/or bradycardiaClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Celecoxib Adverse Effect Decreased antihypertensive effectClinical Management If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
ChlorpropamideAdverse Effect Hypoglycemia, hyperglycemia, or hypertensionClinical 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.
CimetidineAdverse Effect Increased adverse effects of metoprolol (dizziness, insomnia, GI symptoms, postural hypotension)Clinical Management Monitor patient response (blood pressure, pulse rate) to metoprolol when used concomitantly with cimetidine. Adjust metoprolol dosage as needed.
Ciprofloxacin Adverse Effect Bradycardia, hypotensionClinical Management Monitor blood pressure and cardiac function with concurrent use. A metoprolol dosage adjustment may be required during ciprofloxacin therapy.
Clonidine Adverse Effect exaggerated clonidine withdrawal response (acute hypertension)Clinical Management When clonidine is to be withdrawn from concomitant therapy with a beta blocker, discontinue the beta blocker first, and monitor blood pressure carefully. Labetalol (alph/beta blocker) or alpha blockers (eg, prazosin, doxazosin) may prevent rebound hypertension.
DextropropoxypheneAdverse Effect an increased risk of hypotension and bradycardiaClinical Management Monitor patients for an increased response to metoprolol.
Diclofenac PrepsAdverse Effect Decreased antihypertensive effectClinical Management If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Digoxin Adverse Effect AV block and possible digoxin toxicityClinical Management When beta blockers and digoxin are to be given concomitantly, carefully monitor ECG and digoxin serum concentrations. Adjust doses accordingly.
DiltiazemAdverse Effect hypotension, bradycardia, AV conduction disturbancesClinical 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.
DiphenhydramineAdverse Effect An increased risk of metoprolol toxicity (bradycardia, fatigue, bronchospasm)Clinical Management Monitor patients for signs of metoprolol toxicity if diphenhydramine is added to the therapeutic regimen. The metoprolol dose may need to be adjusted when diphenhydramine is initiated or discontinued. This potential interaction should be noted especially since diphenhydramine is often self-administered without a physicians consent.
Doxazosin Adverse Effect an exaggerated hypotensive response to the first dose of the alpha blockerClinical 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.
Felodipine Adverse Effect hypotension and/or bradycardiaClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
FlunarizineAdverse Effect hypotension, bradycardia, and AV conduction disturbancesClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure or bradyarrhythmias.
Fluoxetine Adverse Effect An increased risk of metoprolol adverse effects (shortness of breath, bradycardia, hypotension, acute heart failure)Clinical Management A water soluble beta blocker, such as atenolol, should be considered for fluoxetine-treated patients who require a beta blocker. If metoprolol and fluoxetine are coadministered, monitor patients for metoprolol adverse effects. A reduction in the metoprolol dose may be necessary.
Flurbiprofen Adverse Effect Decreased antihypertensive effectClinical 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 hypertensionClinical 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.
GliclazideAdverse Effect hypoglycemia, hyperglycemia, or hypertensionClinical 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 hypertensionClinical 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 hypertensionClinical 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.
Guar Gum Adverse Effect hypoglycemia, hyperglycemia, or hypertensionClinical 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.
Hydralazine Adverse Effect an increased risk of metoprolol adverse effects (bradycardia, fatigue, bronchospasm)Clinical Management If concurrent therapy is required, take with food or switch to a sustained release beta blocker. Monitor blood pressure carefully.
IbuprofenAdverse Effect Decreased antihypertensive effectClinical 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 effectClinical Management If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Insulin LisproAdverse Effect hypoglycemia, hyperglycemia, or hypertensionClinical 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.
KetoprofenAdverse Effect Decreased antihypertensive effectClinical 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 effectClinical 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 bradycardiaClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
LidoflazineAdverse Effect hypotension, bradycardia, and AV conduction disturbancesClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure or bradyarrhythmias.
Lignocaine Adverse Effect lidocaine toxicity (anxiety, myocardial depression, cardiac arrest)Clinical Management With concurrent Metoprolol therapy, monitor lidocaine levels more closely (at least every 24 hours) and adjust lidocaine infusion rates appropriately.
Mefenamic Acid Adverse Effect Decreased antihypertensive effectClinical Management If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
MeloxicamAdverse Effect Decreased antihypertensive effectClinical 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.
MethyldopaAdverse Effect exaggerated hypertensive response, tachycardia, or arrhythmias during physiologic stress or exposure to exogenous catecholaminesClinical 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 effectClinical 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 effectClinical 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 bradycardiaClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
NimesulideAdverse Effect Decreased antihypertensive effectClinical Management If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Nimodipine Adverse Effect hypotension and/or bradycardiaClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Nitrendipine Adverse Effect hypotension and/or bradycardiaClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
Oxyphenbutazone Adverse Effect Decreased antihypertensive effectClinical 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 effectClinical 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 effectClinical Management If concurrent therapy is required, monitor the patients blood pressure carefully and assess the need for a dosage adjustment for the beta blocker.
Phenobarbitone Adverse Effect Decreased metoprolol effectivenessClinical Management If concurrent therapy is required, monitor for a reduction in the effectiveness of metoprolol. A dosage adjustment may be required. Timolol or atenolol may be an alternative beta-blocker choice because they are not dependent on first-pass hepatic metabolism.
Phenylbutazone Adverse Effect Decreased antihypertensive effectClinical 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 effectClinical 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 Adverse Effect an exaggerated hypotensive response to the first dose of the alpha blockerClinical 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.
Prazosin - BPH Adverse Effect An exaggerated hypotensive response to the first dose of the alpha blockerClinical 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.
ProcainamideAdverse Effect an increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest)Clinical Management The concurrent administration of Procainamide is not recommended. The Procainamide should be withheld for at least three half-lives prior to dosing.
Propafenone Adverse Effect metoprolol toxicity (bradycardia, fatigue, shortness of breath)Clinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly blood pressure. A dosage adjustment for the Propafenone may be required.
QuinidineAdverse Effect Bradycardia, fatigue, shortness of breathClinical Management If concurrent therapy is required, monitor cardiac function carefully (ie, blood pressure, heart rate). A dosage adjustment may be required for both drugs.
Rifampicin Adverse Effect Decreased metoprolol effectivenessClinical Management If concurrent therapy is required, monitor blood pressure carefully. A dosage increase for metoprolol may be required.
RitodrineAdverse Effect potential interference with tocolytic action of ritodrineClinical 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 effectClinical 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 Adverse Effect an exaggerated hypotensive response to the first dose of the alpha blockerClinical 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.
Terazosin - BPHAdverse Effect An exaggerated hypotensive response to the first dose of the alpha blockerClinical 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 hypertensionClinical 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.
VerapamilAdverse Effect hypotension, bradycardiaClinical Management If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure. |