Lopressor injection/drug interactions: Difference between revisions
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====Catecholamine-depleting drugs==== | ====Catecholamine-depleting drugs==== | ||
: Catecholamine-depleting drugs (e.g., reserpine) may have an additive effect when given with beta-blocking | : [[Catecholamine]]-depleting drugs (e.g., [[reserpine]]) may have an additive effect when given with [[beta-blocking agent]]s or [[MAO inhibitor|monoamine oxidase (MAO) inhibitors]]. Observe patients treated with [[Lopressor]] plus a [[catecholamine]] depletor for evidence of [[hypotension]] or marked [[bradycardia]], which may produce [[vertigo]], [[syncope]], or [[postural hypotension]]. In addition, possibly significant [[hypertension]] may theoretically occur up to 14 days following discontinuation of the concomitant administration with an irreversible [[MAO inhibitor]]. | ||
====Digitalis glycosides and beta blockers==== | ====Digitalis glycosides and beta blockers==== | ||
: Both digitalis glycosides and beta blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia. Monitor heart rate and PR interval. | : Both [[digitalis]] glycosides and [[beta blockers]] slow atrioventricular conduction and decrease [[heart rate]]. Concomitant use can increase the risk of [[bradycardia]]. Monitor [[heart rate]] and [[PR interval]]. | ||
====Calcium channel blockers==== | ====Calcium channel blockers==== | ||
: Concomitant administration of a beta-adrenergic antagonist with a calcium channel blocker may produce an additive reduction in myocardial contractility because of negative chronotropic and inotropic effects. | : Concomitant administration of a [[beta-adrenergic antagonist]] with a [[calcium channel blocker]] may produce an additive reduction in myocardial [[contractility]] because of negative [[chronotropic]] and [[inotropic]] effects. | ||
====General Anesthetics==== | ====General Anesthetics==== | ||
: Some inhalation | : Some inhalation [[anesthetic]]s may enhance the cardiodepressant effect of [[beta blockers]] (see ''[[Lopressor injection/warnings|Warnings]]''). | ||
====CYP2D6 Inhibitors==== | ====CYP2D6 Inhibitors==== | ||
: Potent inhibitors of the CYP2D6 enzyme may increase the plasma concentration of Lopressor which would mimic the pharmacokinetics of CYP2D6 poor metabolizer (see Pharmacokinetics section). Increase in plasma concentrations of metoprolol would decrease the cardioselectivity of metoprolol. Known clinically significant potent inhibitors of CYP2D6 are | : Potent inhibitors of the [[CYP2D6]] enzyme may increase the plasma concentration of [[Lopressor]] which would mimic the [[pharmacokinetics]] of [[CYP2D6]] poor metabolizer (see ''[[Lopressor injection/pharmacology#Pharmacokinetics|Pharmacokinetics]]'' section). Increase in plasma concentrations of [[metoprolol]] would decrease the cardioselectivity of [[metoprolol]]. Known clinically significant potent inhibitors of [[CYP2D6]] are [[antidepressant]]s such as [[fluvoxamine]], [[fluoxetine]], [[paroxetine]], [[sertraline]], [[bupropion]], [[clomipramine]], and [[desipramine]]; [[antipsychotic]]s such as [[chlorpromazine]], [[fluphenazine]], [[haloperidol]], and [[thioridazine]]; [[antiarrhythmic]]s such as [[quinidine]] or [[propafenone]]; [[antiretroviral]]s such as [[ritonavir]]; [[antihistamine]]s such as [[diphenhydramine]]; [[antimalarial]]s such as [[hydroxychloroquine]] or [[quinidine]]; [[antifungal]]s such as [[terbinafine]]. | ||
====Hydralazine==== | ====Hydralazine==== | ||
: Concomitant administration of hydralazine may inhibit presystemic metabolism of metoprolol leading to increased concentrations of metoprolol. | : Concomitant administration of [[hydralazine]] may inhibit presystemic metabolism of [[metoprolol]] leading to increased concentrations of [[metoprolol]]. | ||
====Alpha-adrenergic agents==== | ====Alpha-adrenergic agents==== | ||
: Antihypertensive effect of alpha-adrenergic | : ]]Antihypertensive]] effect of [[alpha-adrenergic blocker]]s such as [[guanethidine]], [[betanidine]], [[reserpine]], [[alpha-methyldopa]] or [[clonidine]] may be potentiated by [[beta-blocker]]s including [[Lopressor]]. [[Beta-adrenergic blocker]]s may also potentiate the postural [[hypotensive]] effect of the first dose of [[prazosin]], probably by preventing [[reflex tachycardia]]. On the contrary, [[beta-adrenergic blocker]]s may also potentiate the [[hypertensive]] response to withdrawal of [[clonidine]] in patients receiving concomitant [[clonidine]] and [[beta-adrenergic blocker]]. If a patient is treated with [[clonidine]] and [[Lopressor]] concurrently, and [[clonidine]] treatment is to be discontinued, stop Lopressor several days before [[clonidine]] is withdrawn. [[Rebound hypertension]] that can follow withdrawal of [[clonidine]] may be increased in patients receiving concurrent [[beta-blocker]] treatment. | ||
====Ergot alkaloid==== | ====Ergot alkaloid==== | ||
: Concomitant administration with beta-blockers may enhance the vasoconstrictive action of ergot | : Concomitant administration with [[beta-blockers]] may enhance the [[vasoconstrictive]] action of [[ergot alkaloid]]s. | ||
====Dipyridamole==== | ====Dipyridamole==== | ||
: In general, administration of a beta-blocker should be withheld before dipyridamole testing, with careful monitoring of heart rate following the dipyridamole injection.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = LOPRESSOR (METOPROLOL TARTRATE) INJECTION, SOLUTION [NOVARTIS PHARMACEUTICALS CORPORATION] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6640cc61-edee-4808-a26f-cbc2c0b7af86#nlm34067-9 | publisher = | date = | accessdate = }}</ref> | : In general, administration of a [[beta-blocker]] should be withheld before [[dipyridamole]] testing, with careful monitoring of heart rate following the [[dipyridamole]] injection.<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = LOPRESSOR (METOPROLOL TARTRATE) INJECTION, SOLUTION [NOVARTIS PHARMACEUTICALS CORPORATION] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=6640cc61-edee-4808-a26f-cbc2c0b7af86#nlm34067-9 | publisher = | date = | accessdate = }}</ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Latest revision as of 14:19, 21 March 2014
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
- Catecholamine-depleting drugs
- Digitalis glycosides
- Calcium channel blockers
- General anesthetics
- CYP2D6 inhibitors
- Hydralazine
- Alpha-adrenergic agents
- Ergot alkaloids
- Dipyridamole
Catecholamine-depleting drugs
- Catecholamine-depleting drugs (e.g., reserpine) may have an additive effect when given with beta-blocking agents or monoamine oxidase (MAO) inhibitors. Observe patients treated with Lopressor plus a catecholamine depletor for evidence of hypotension or marked bradycardia, which may produce vertigo, syncope, or postural hypotension. In addition, possibly significant hypertension may theoretically occur up to 14 days following discontinuation of the concomitant administration with an irreversible MAO inhibitor.
Digitalis glycosides and beta blockers
- Both digitalis glycosides and beta blockers slow atrioventricular conduction and decrease heart rate. Concomitant use can increase the risk of bradycardia. Monitor heart rate and PR interval.
Calcium channel blockers
- Concomitant administration of a beta-adrenergic antagonist with a calcium channel blocker may produce an additive reduction in myocardial contractility because of negative chronotropic and inotropic effects.
General Anesthetics
- Some inhalation anesthetics may enhance the cardiodepressant effect of beta blockers (see Warnings).
CYP2D6 Inhibitors
- Potent inhibitors of the CYP2D6 enzyme may increase the plasma concentration of Lopressor which would mimic the pharmacokinetics of CYP2D6 poor metabolizer (see Pharmacokinetics section). Increase in plasma concentrations of metoprolol would decrease the cardioselectivity of metoprolol. Known clinically significant potent inhibitors of CYP2D6 are antidepressants such as fluvoxamine, fluoxetine, paroxetine, sertraline, bupropion, clomipramine, and desipramine; antipsychotics such as chlorpromazine, fluphenazine, haloperidol, and thioridazine; antiarrhythmics such as quinidine or propafenone; antiretrovirals such as ritonavir; antihistamines such as diphenhydramine; antimalarials such as hydroxychloroquine or quinidine; antifungals such as terbinafine.
Hydralazine
- Concomitant administration of hydralazine may inhibit presystemic metabolism of metoprolol leading to increased concentrations of metoprolol.
Alpha-adrenergic agents
- ]]Antihypertensive]] effect of alpha-adrenergic blockers such as guanethidine, betanidine, reserpine, alpha-methyldopa or clonidine may be potentiated by beta-blockers including Lopressor. Beta-adrenergic blockers may also potentiate the postural hypotensive effect of the first dose of prazosin, probably by preventing reflex tachycardia. On the contrary, beta-adrenergic blockers may also potentiate the hypertensive response to withdrawal of clonidine in patients receiving concomitant clonidine and beta-adrenergic blocker. If a patient is treated with clonidine and Lopressor concurrently, and clonidine treatment is to be discontinued, stop Lopressor several days before clonidine is withdrawn. Rebound hypertension that can follow withdrawal of clonidine may be increased in patients receiving concurrent beta-blocker treatment.
Ergot alkaloid
- Concomitant administration with beta-blockers may enhance the vasoconstrictive action of ergot alkaloids.
Dipyridamole
- In general, administration of a beta-blocker should be withheld before dipyridamole testing, with careful monitoring of heart rate following the dipyridamole injection.[1]