Acarbose
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.
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 Propranolol 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.
Antacids Comb
Adverse Effect: Decreased propranolol bioavailability Clinical Management: The administration of propranolol and antacids should be spaced apart as far as possible. Monitor the patient for propranolol efficacy.
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.
Chlorpromazine
Adverse Effect: Increased plasma levels of both the drugs # Clinical Management: Monitor for the therapeutic effects and adjust dose accordingly.
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 propranolol (dizziness, insomnia, GI symptoms, postural hypotension) Clinical Management: Monitor patient response (blood pressure, pulse rate) to propranolol when used concomitantly with cimetidine. Adjust propranolol dosage as needed.
Ciprofloxacin
Adverse Effect: Bradycardia, hypotension Clinical Management: Monitor blood pressure and cardiac function with concurrent use. A propranolol 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.
Dextropropoxyphene
Adverse Effect: an increased risk of hypotension and bradycardia Clinical Management: Monitor patients for an increased response to propranolol.
Diclofenac Preps.
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.
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.
Dihydroergotoxine
Adverse Effect: Peripheral ischemia or a hypertensive episode Clinical Management: If used together, monitor for peripheral ischemic effects (eg, cold extremities), and choose a selective beta blocker (eg, atenolol) if ischemia occurs. Also monitor blood pressure carefully.
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.
Disopyramide
Adverse Effect: Bradycardia, decreased cardiac output Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients with pre-existing heart disease.
Doxazosin
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.
Ergotamine
Adverse Effect: peripheral ischemia Clinical Management: If used together, monitor for peripheral ischemic effects (eg, cold extremities), and choose a selective beta blocker (eg, atenolol) if ischemia occurs.
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.
Fluoxetine
Adverse Effect: An increased risk of complete heart block Clinical Management: Fluoxetine should be prescribed cautiously to patients on propranolol therapy. A baseline electrocardiogram should be considered prior to the initiation of fluoxetine.
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.
Frusemide
Adverse Effect: hypotension, bradycardia Clinical Management: Monitor for a possible increased incidence of hypotension and/or bradycardia.
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.
Guar Gum
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.
Hydralazine
Adverse Effect: an increased risk of propranolol 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.
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.
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: Increased imipramine concentrations Clinical Management: Monitor for an enhanced effect of imipramine. A dosage adjustment may be required.
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.
Insulin Lispro
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.
Ketoprofen
vAdverse 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.
Lignocaine
Adverse Effect: lidocaine toxicity (anxiety, myocardial depression, cardiac arrest) Clinical Management: With concurrent beta blocker therapy, monitor lidocaine levels more closely (at least every 24 hours) and adjust lidocaine infusion rates appropriately.
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.
Mefloquine
Adverse Effect: an increased risk of ECG abnormalities and cardiac arrest Clinical Management: Caution should be used if mefloquine is to be administered to patients receiving concurrent propranolol, especially in patients with known cardiac disease. Carefully monitor ECG when this combination is given.
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.
Nimodipine
Adverse Effect: hypotension and/or bradycardia Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly in patients predisposed to heart failure.
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.
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.
Phenobarbitone
Adverse Effect: Decreased propranolol effectiveness Clinical Management: If concurrent therapy is required, monitor for a reduction in the effectiveness of propranolol. A dosage adjustment may be required. Timolol or atenolol may be an alternative choice for a beta blocker because they are not dependent on hepatic metabolism.
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.
Phenylephrine
Adverse Effect: Increased blood pressure Clinical Management: If concurrent therapy is required, monitor blood pressure carefully. A dosage reduction for phenylephrine may be required.
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
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.
Procainamide
Adverse 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.
Promethazine
Adverse Effect: Increased plasma levels of both the drugs # Clinical Management: Monitor for therapeutic effects and adjust the dose.
Propafenone
Adverse Effect: an increased risk of propranolol toxicity (fatigue, bradycardia, hypotension) Clinical Management: If concurrent therapy is required, monitor cardiac function carefully, particularly blood pressure. A dosage adjustment for the Propranolol may be required.
Quinidine
Adverse Effect: Hypotension, bradycardia, arrhythmias, and heart failure Clinical Management: Use caution when administering propranolol and quinidine concomitantly. Monitor patients for hypotension, bradycardia, arrhythmias, and heart failure.
Rifampicin
Adverse Effect: Decreased propranolol effectiveness Clinical Management: If concurrent therapy is required, monitor blood pressure carefully. A higher dose of propranolol may be required in patients receiving rifampin for longer than one to two weeks. Beta blockers which are less likely to be affected include atenolol, nadolol, and timolol.
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.
Sertraline
Adverse Effect: Increased risk of chest pain Clinical Management: Monitor patients receiving propranolol and sertraline cotherapy for an increased incidence of chest pain. This effect may be more pronounced in patients with pre-existing coronary artery disease.
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
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.
Theophylline
Adverse Effect: Decreased theophylline clearance and pharmacological antagonism Clinical Management: Theophylline serum concentrations should be monitored when propranolol is added, discontinued, or when dosing changes occur. Monitor propranolol for adverse effects on the respiratory system. Dosing adjustments of theophylline may be necessary. In general, patients should not be maintained on chronic combination therapy with theophylline and propranolol.
Thioridazine
Adverse Effect: Thioridazine toxicity (sedation, extrapyramidal symptoms, delirium) Clinical Management: Until more is known about the potential toxic effects of concomitant therapy, it is suggested that caution be used when thioridazine and propranolol are administered concurrently. A dosage adjustment of thioridazine may be necessary.
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.
Warfarin
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving oral anticoagulant therapy with warfarin, the prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of treatment with propranolol, and should be reassessed periodically during concurrent therapy. Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation |