Beta blockers, non-selective(continued)
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure topropranolol.oStudy
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tobeta blockers, non-selective(carvedilol,
labetalol).oTheoretical
▶Antifungals, azoles(itraconazole, ketoconazole)are predicted to
increase the exposure tonadolol.oStudy
▶Antimalarials(mefloquine)are predicted to increase the risk of
bradycardia when given withbeta blockers, non-selective.
rTheoretical
▶Calcium channel blockers(diltiazem)are predicted to increase
the risk of cardiodepression when given withbeta blockers,
non-selective.rStudy→Also seeTABLE 6p. 848→Also see
TABLE 8p. 848
▶Intravenouscalcium channel blockers(verapamil)increase the
risk of cardiovascular side-effects when given withbeta
blockers, non-selective. Avoid.rStudy→Also seeTABLE 6
p. 848→Also seeTABLE 8p. 848
▶Oralcalcium channel blockers(verapamil)increase the risk of
cardiovascular side-effects when given withbeta blockers,
non-selective.rStudy→Also seeTABLE 6p. 848→Also see
TABLE 8p. 848
▶Ciclosporinis predicted to increase the exposure tonadolol.
oStudy
▶Eliglustatis predicted to increase the exposure topropranolol.
Adjust dose.oStudy
▶Beta blockers, non-selectiveare predicted to increase the risk
of peripheral vasoconstriction when given withergometrine.
rStudy
▶Beta blockers, non-selectiveare predicted to increase the risk
of peripheral vasoconstriction when given withergotamine.
rStudy
▶HIV-protease inhibitors(lopinavir, ritonavir, saquinavir)are
predicted to increase the exposure tonadolol.oStudy
▶Beta blockers, non-selectiveare predicted to increase the risk
of bradycardia when given withlanreotide.oTheoretical
▶Lapatinibis predicted to increase the exposure tonadolol.
oStudy
▶Macrolidesare predicted to increase the exposure tonadolol.
oStudy
▶Ranolazineis predicted to increase the exposure tonadolol.
oStudy
▶Rifampicinmoderately decreases the exposure tocarvedilol.
oStudy
▶Rifampicindecreases the exposure topropranolol. Monitor and
adjust dose.oStudy
▶Propranololslightly to moderately increases the exposure to
rizatriptan. Adjustrizatriptandose and separate
administration by at least 2 hours.oStudy
▶SSRIs(fluvoxamine)moderately increase the concentration of
propranolol.oStudy
▶Beta blockers, non-selectiveincrease the risk of hypertension
and bradycardia when given withsympathomimetics, inotropic
(dobutamine).rTheoretical
▶Beta blockers, non-selectiveare predicted to increase the risk
of hypertension and bradycardia when given with
sympathomimetics, vasoconstrictor(adrenaline/epinephrine,
noradrenaline/norepinephrine).rStudy
▶Beta blockers, non-selectiveare predicted to increase the risk
of bronchospasm when given withtheophylline. Avoid.r
Theoretical
▶Vemurafenibis predicted to increase the exposure tonadolol.
oStudy
Beta blockers, selective→seeTABLE 6p. 848 (bradycardia),TABLE 8
p. 848 (hypotension)
acebutolol.atenolol.betaxolol.bisoprolol.celiprolol.esmolol.
metoprolol.nebivolol..▶Since systemic absorption can follow topical application of
betaxolol, the possibility of interactions should be borne in
mind.
▶Orange juice greatly decreases the exposure toceliprolol.▶Abirateroneis predicted to increase the exposure to
metoprolol.oStudy▶Beta blockers, selectiveare predicted to increase the risk of
bronchospasm when given withaminophylline. Avoid.r
Theoretical
▶Antiarrhythmics(amiodarone, disopyramide, dronedarone,
flecainide, lidocaine)are predicted to increase the risk of
cardiovascular side-effects when given withbeta blockers,
selective. Use with caution or avoid.rStudy→Also see
TABLE 6p. 848
▶Antiarrhythmics(propafenone)are predicted to increase the
exposure tometoprolol.oStudy
▶Antiarrhythmics(propafenone)are predicted to increase the
exposure tonebivololandnebivololis predicted to increase the
risk of cardiodepression when given withantiarrhythmics
(propafenone). Avoid.rTheoretical
▶Antiarrhythmics(propafenone)are predicted to increase the risk
of cardiovascular side-effects when given withbeta blockers,
selective(acebutolol, atenolol, betaxolol, bisoprolol, celiprolol,
esmolol). Use with caution or avoid.rStudy
▶Anticholinesterases, centrally actingare predicted to increase
the risk of bradycardia when given withbeta blockers,
selective.oAnecdotal→Also seeTABLE 6p. 848
▶Antiepileptics(phenobarbital, primidone)are predicted to
decrease the exposure tobeta blockers, selective(acebutolol,
bisoprolol, metoprolol, nebivolol).oStudy
▶Antimalarials(mefloquine)are predicted to increase the risk of
bradycardia when given withbeta blockers, selective.r
Theoretical
▶Bupropionis predicted to increase the exposure tobeta
blockers, selective(metoprolol, nebivolol).oStudy
▶Calcium channel blockers(diltiazem)are predicted to increase
the risk of cardiodepression when given withbeta blockers,
selective.rStudy→Also seeTABLE 6p. 848→Also seeTABLE 8
p. 848
▶Intravenouscalcium channel blockers(verapamil)increase the
risk of cardiovascular side-effects when given withbeta
blockers, selective. Avoid.rStudy→Also seeTABLE 6
p. 848→Also seeTABLE 8p. 848
▶Oralcalcium channel blockers(verapamil)increase the risk of
cardiovascular side-effects when given withbeta blockers,
selective.rStudy→Also seeTABLE 6p. 848→Also seeTABLE 8
p. 848
▶Cinacalcetis predicted to increase the exposure tobeta
blockers, selective(metoprolol, nebivolol).oStudy
▶Duloxetineis predicted to increase the exposure tometoprolol.
oStudy
▶Eliglustatis predicted to increase the exposure tometoprolol.
Adjust dose.oStudy
▶Beta blockers, selectiveare predicted to increase the risk of
peripheral vasoconstriction when given withergometrine.
rStudy
▶Beta blockers, selectiveare predicted to increase the risk of
peripheral vasoconstriction when given withergotamine.
rStudy
▶Grapefruit juicegreatly decreases the exposure toceliprolol.
oStudy
▶HIV-protease inhibitors(ritonavir)are predicted to increase the
exposure tometoprolol.oStudy
▶Beta blockers, selectiveare predicted to increase the risk of
bradycardia when given withlanreotide.oTheoretical
▶Mirabegronis predicted to increase the exposure to
metoprolol.oStudy
▶Panobinostatis predicted to increase the exposure to
metoprolol. Monitor and adjust dose.oTheoretical
▶Panobinostatis predicted to increase the exposure to
nebivolol. Monitor and adjust dose.nTheoretical
▶Rifampicinslightly decreases the exposure tobeta blockers,
selective(bisoprolol, metoprolol).nStudy
▶Rifampicinmoderately decreases the exposure toceliprolol.
oStudy
▶Rolapitantis predicted to moderately increase the exposure to
metoprolol.rStudy
▶SSRIs(fluoxetine, paroxetine)are predicted to increase the
exposure tobeta blockers, selective(metoprolol, nebivolol).
oStudy884 Beta blockers, non-selective—Beta blockers, selective BNFC 2018 – 2019
Interactions|Appendix 1A1