Esmolol drug interactions: Difference between revisions

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==Drug Interactions==
==Drug Interactions==


Concomitant use of BREVIBLOC injection with other drugs that can lower blood pressure, reduce myocardial contractility, or interfere with sinus node function or electrical impulse propagation in the myocardium can exaggerate BREVIBLOC’s effects on blood pressure, contractility, and impulse propagation. Severe interactions with such drugs can result in, for example, severe hypotension, cardiac failure, severe bradycardia, sinus pause, sinoatrial block, atrioventricular block, and/or cardiac arrest. In addition, with some drugs, beta blockade may precipitate increased withdrawal effects. (See clonidine, guanfacine, and moxonidine below.) BREVIBLOC should therefore be used only after careful individual assessment of the risks and expected benefits in patients receiving drugs that can cause these types of pharmacodynamic interactions, including but not limited to:
Concomitant use of BREVIBLOC injection with other drugs that can lower blood pressure, reduce myocardial contractility, or interfere with sinus node function or electrical impulse propagation in the myocardium can exaggerate BREVIBLOC’s effects on [[blood pressure]], contractility, and impulse propagation. Severe interactions with such drugs can result in, for example, severe hypotension, cardiac failure, severe [[bradycardia]], [[sinus pause]], [[sinoatrial block]], [[atrioventricular block]], and/or [[cardiac arrest]]. In addition, with some drugs, beta blockade may precipitate increased withdrawal effects. (See[[ clonidine]], [[guanfacine]], and [[moxonidine]] below.) BREVIBLOC should therefore be used only after careful individual assessment of the risks and expected benefits in patients receiving drugs that can cause these types of pharmacodynamic interactions, including but not limited to:


<u>'''Digitalis glycosides'''</u>: Concomitant administration of digoxin and BREVIBLOC leads to an approximate 10% to 20% increase of digoxin blood levels at some time points. Digoxin does not affect BREVIBLOC pharmacokinetics. Both digoxin and beta blockers slow atrioventricular conduction and decrease heart rate. Concomitant use increases the risk of bradycardia.
<u>'''Digitalis glycosides'''</u>: Concomitant administration of digoxin and BREVIBLOC leads to an approximate 10% to 20% increase of [[digoxin]] blood levels at some time points. [[Digoxin]] does not affect BREVIBLOC pharmacokinetics. Both digoxin and beta [[blocker]]s slow [[atrioventricular conduction]] and decrease heart rate. Concomitant use increases the risk of[[ bradycardia]].


<u>'''Anticholinesterases'''</u>: BREVIBLOC prolonged the duration of succinylcholine-induced neuromuscular blockade and moderately prolonged clinical duration and recovery index of mivacurium.
<u>'''Anticholinesterases'''</u>: BREVIBLOC prolonged the duration of [[succinylcholine]]-induced neuromuscular blockade and moderately prolonged clinical duration and recovery index of[[ mivacurium]].


Antihypertensive agents clonidine, guanfacine, or moxonidine: Beta blockers also increase the risk of clonidine-, guanfacine-, or moxonidine-withdrawal rebound hypertension. If, during concomitant use of a beta blocker, antihypertensive therapy needs to be interrupted or discontinued, discontinue the beta blocker first, and the discontinuation should be gradual.
Antihypertensive agents [[clonidine]], [[guanfacine]], or [[moxonidine]]:[[ Beta blocker]]s also increase the risk of [[clonidine]]-, [[guanfacine]]-, or [[moxonidine]]-withdrawal [[rebound hypertension]]. If, during concomitant use of a beta blocker, antihypertensive therapy needs to be interrupted or discontinued, discontinue the beta blocker first, and the discontinuation should be gradual.


Calcium channel antagonists: In patients with depressed myocardial function, use of BREVIBLOC with cardiodepressant calcium channel antagonists (e.g., verapamil) can lead to fatal cardiac arrests.
[[Calcium channel antagonists]]: In patients with depressed myocardial function, use of BREVIBLOC with cardiodepressant calcium channel antagonists (e.g.,[[ verapamil]]) can lead to fatal cardiac arrests.


Sympathomimetic drugs: Sympathomimetic drugs having beta-adrenergic agonist activity will counteract effects of BREVIBLOC.
[[Sympathomimetic]] drugs: Sympathomimetic drugs having[[[[ beta-adrenergic agonist]] activity will counteract effects of BREVIBLOC.


Vasoconstrictive and positive inotropic agents: Because of the risk of reducing cardiac contractility in presence of high systemic vascular resistance, do not use BREVIBLOC to control tachycardia in patients receiving drugs that are vasoconstrictive and have positive inotropic effects, such as epinephrine, norepinephrine, and dopamine.<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = BREVIBLOC (ESMOLOL HYDROCHLORIDE) INJECTION [BAXTER HEALTHCARE CORPORATION] | url =http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=595cc3d5-1306-4828-aefa-5595219ffd62 | publisher =  | date =  | accessdate = }}</ref>
Vasoconstrictive and positive inotropic agents: Because of the risk of reducing cardiac contractility in presence of high systemic vascular resistance, do not use BREVIBLOC to control[[ tachycardia]] in patients receiving drugs that are vasoconstrictive and have positive inotropic effects, such as [[epinephrine]], [[norepinephrine]], and [[dopamine]].<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = BREVIBLOC (ESMOLOL HYDROCHLORIDE) INJECTION [BAXTER HEALTHCARE CORPORATION] | url =http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=595cc3d5-1306-4828-aefa-5595219ffd62 | publisher =  | date =  | accessdate = }}</ref>


== Major Interactions==
== Major Interactions==

Revision as of 00:12, 21 February 2014

Esmolol
BREVIBLOC® FDA Package Insert
Indications and Usage
Dosage and Administration
Dosage Forms and Strengths
Contraindications
Warnings and Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Overdosage
Description
Clinical Pharmacology
Nonclinical Toxicology
Clinical Studies
How Supplied/Storage and Handling
Patient Counseling Information
Labels and Packages

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]; Abdurahman Khalil, M.D. [3]

Drug Interactions

Concomitant use of BREVIBLOC injection with other drugs that can lower blood pressure, reduce myocardial contractility, or interfere with sinus node function or electrical impulse propagation in the myocardium can exaggerate BREVIBLOC’s effects on blood pressure, contractility, and impulse propagation. Severe interactions with such drugs can result in, for example, severe hypotension, cardiac failure, severe bradycardia, sinus pause, sinoatrial block, atrioventricular block, and/or cardiac arrest. In addition, with some drugs, beta blockade may precipitate increased withdrawal effects. (Seeclonidine, guanfacine, and moxonidine below.) BREVIBLOC should therefore be used only after careful individual assessment of the risks and expected benefits in patients receiving drugs that can cause these types of pharmacodynamic interactions, including but not limited to:

Digitalis glycosides: Concomitant administration of digoxin and BREVIBLOC leads to an approximate 10% to 20% increase of digoxin blood levels at some time points. Digoxin does not affect BREVIBLOC pharmacokinetics. Both digoxin and beta blockers slow atrioventricular conduction and decrease heart rate. Concomitant use increases the risk ofbradycardia.

Anticholinesterases: BREVIBLOC prolonged the duration of succinylcholine-induced neuromuscular blockade and moderately prolonged clinical duration and recovery index ofmivacurium.

Antihypertensive agents clonidine, guanfacine, or moxonidine:Beta blockers also increase the risk of clonidine-, guanfacine-, or moxonidine-withdrawal rebound hypertension. If, during concomitant use of a beta blocker, antihypertensive therapy needs to be interrupted or discontinued, discontinue the beta blocker first, and the discontinuation should be gradual.

Calcium channel antagonists: In patients with depressed myocardial function, use of BREVIBLOC with cardiodepressant calcium channel antagonists (e.g.,verapamil) can lead to fatal cardiac arrests.

Sympathomimetic drugs: Sympathomimetic drugs having[[beta-adrenergic agonist activity will counteract effects of BREVIBLOC.

Vasoconstrictive and positive inotropic agents: Because of the risk of reducing cardiac contractility in presence of high systemic vascular resistance, do not use BREVIBLOC to controltachycardia in patients receiving drugs that are vasoconstrictive and have positive inotropic effects, such as epinephrine, norepinephrine, and dopamine.[1]

Major Interactions

Moderate Interactions

Minor Interactions

References

  1. ↑ "BREVIBLOC (ESMOLOL HYDROCHLORIDE) INJECTION [BAXTER HEALTHCARE CORPORATION]".

Adapted from the FDA Package Insert.

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