Bisoprolol Fumarate + Amlodipine Besilate interactions

Food & lifestyle

• alcohol

  Moderate

  Synergy

  Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

  What to do: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

  8 sources

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595

• alcohol

  Moderate

  Synergy

  Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

  What to do: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

  8 sources

  1. Sternbach H "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595

• grapefruit juice

  Minor

  Metabolism

  The consumption of grapefruit juice may slightly increase plasma concentrations of amlodipine. The mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

  What to do: Concomitant use of Amlodipine with grapefruit or grapefruit juice should generally be avoided.

  6 sources

  1. Bailey DG, Arnold JMO, Spence JD "Grapefruit juice and drugs - how significant is the interaction." Clin Pharmacokinet 26 (1994): 91-8
  2. Josefsson M, Zackrisson AL, Ahlner J "Effect of grapefruit juice on the pharmacokinetics of amlodipine in healthy volunteers." Eur J Clin Pharmacol 51 (1996): 189-93
  3. Bailey DG, Malcolm J, Arnold O, Spence JD "Grapefruit juice-drug interactions." Br J Clin Pharmacol 46 (1998): 101-10
  4. Vincent J, Harris SI, Foulds G, Dogolo LC, Willavize S, Friedman HL "Lack of effect of grapefruit juice on the pharmacokinetics and pharmacodynamics of amlodipine." Br J Clin Pharmacol 50 (2000): 455-63
  5. Josefsson M, Ahlner J "Amlodipine and grapefruit juice." Br J Clin Pharmacol 53 (2002): 405; discussion 406
  6. Kane GC, Lipsky JJ "Drug-grapefruit juice interactions." Mayo Clin Proc 75 (2000): 933-42

Conditions

Conditions in which Bisoprolol Fumarate + Amlodipine Besilate needs care, as documented in this source.

• Atrioventricular Block

  Major

  The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

  22 sources

  1. Crean PA, Williams DO "Effect of intravenous and oral acebutolol in patients with bundle branch block." Int J Cardiol 10 (1986): 119-26
  2. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  3. Treseder AS, Thomas TP "Sinus arrest due to timolol eye drops." Br J Clin Pract 40 (1986): 256-8
  4. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  5. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  6. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  7. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  8. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):

  Show all 22 sourcesShow fewer sources

  9. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  10. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  11. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  12. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  13. "Product Information. Kerlone (betaxolol)." Searle (2001):
  14. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  15. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  16. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  17. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  18. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  19. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  20. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  21. Braunwald E, Hauser SL, Kasper DL, Fauci AS, Isselbacher KJ, Longo DL, Martin JB, eds., Wilson JD "Harrison's Principles of Internal Medicine." New York, NY: McGraw-Hill Health Professionals Division (1998):
  22. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Coronary Artery Disease

  Major

  Increased frequency, duration, and/or severity of angina, as well as acute myocardial infarction, have rarely developed during initiation or dosage increase of calcium channel blockers (CCBs), particularly in patients with severe obstructive coronary artery disease and those treated with immediate-release formulations. The mechanism of this effect is not established. Therapy with CCBs should be administered cautiously in patients with significant coronary artery disease.

  15 sources

  1. Schanzenbacher P, Deeg P, Liebau G, Kochsiek K "Paradoxical angina after nifedipine: angiographic documentation." Am J Cardiol 53 (1984): 345-6
  2. Manga P, Vythilingum "Unstable angina precipitated by nifedipine." S Afr Med J 66 (1984): 144
  3. Sia STB, MacDonald PS, Triester B, et al. "Aggravation of myocardial ischaemia by nifedipine." Med J Aust 142 (1985): 48-50
  4. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  5. Lambert CR, Hill JA, Feldman RL, Pepine CJ "Myocardial ischemia during intravenous nicardipine administration." Am J Cardiol 55 (1985): 844-5
  6. Thomassen AR, Bagger JP, Nielsen TT "Hemodynamic and cardiac metabolic changes during nicardipine-induced myocardial ischemia." Cathet Cardiovasc Diagn 14 (1988): 41-3
  7. "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals (2002):
  8. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc (2002):

  Show all 15 sourcesShow fewer sources

  9. "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals (2002):
  10. Furberg CD, Psaty BM, Meyer JV "Nifedipine: dose-related increase in mortality in patients with coronary heart disease." Circulation 92 (1995): 1326-31
  11. Kloner RA "Nifedipine in ischemic heart disease." Circulation 92 (1995): 1074-8
  12. Yusuf S "Calcium antagonists in coronary artery disease and hypertension: time for reevaluation?" Circulation 92 (1995): 1079-82
  13. "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals (2001):
  14. Oei SG, Oei SK, Brolmann HAM "Myocardial infarction during nifedipine therapy for preterm labor." N Engl J Med 340 (1999): 154
  15. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57

• Diabetes Mellitus

  Major

  Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.

  21 sources

  1. Darga LL, Hakim MJ, Lucas CP, Franklin BA "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  2. Uusitupa M, Aro A, Pietikainen M "Severe hypoglycaemia caused by physical strain and pindolol therapy." Ann Clin Res 12 (1980): 25-7
  3. Velde TM, Kaiser FE "Ophthalmic timolol treatment causing altered hypoglycemic response in a diabetic patient." Arch Intern Med 143 (1983): 1627
  4. Grimaldi A, Bennett P, Delas B, et al. "Beta-blockers and hypoglycaemia: assessment of cardioselective and intrinsic sympathomimetic properties in relation to severity of hypoglycaemia." Curr Ther Res Clin Exp 36 (1984): 361-73
  5. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  6. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  7. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  8. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):

  Show all 21 sourcesShow fewer sources

  9. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  10. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  12. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  13. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  14. "Product Information. Kerlone (betaxolol)." Searle (2001):
  15. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  16. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  17. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  18. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  19. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  20. Giugliano D, Acampora R, Marfella R, DeRosa N, Ziccardi P, Ragone R, DeAngelis L, DOnofrio F "Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension - A randomized, controlled trial." Ann Intern Med 126 (1997): 955-9
  21. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Diseases requiring hemodialysis

  Major

  Therapy with beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in patients requiring hemodialysis. When given after dialysis, hemodynamic stability should be established prior to drug administration to avoid marked falls in blood pressure. The hemodynamic status should be closely monitored before and after the dose.

  15 sources

  1. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  2. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  3. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  4. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  5. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  6. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  7. "Product Information. Kerlone (betaxolol)." Searle (2001):
  8. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):

  Show all 15 sourcesShow fewer sources

  9. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  10. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  11. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  12. Deetjen A, Heidland A, Pangerl A, Meyer-Sabellek W, Schaefer RM "Antihypertensive treatment with a vasodilating beta-blocker, carvedilol, in chronic hemodialysis patients." Clin Nephrol 43 (1995): 47-52
  13. Miki S, Masumura H, Kaifu Y, Yuasa S "Pharmacokinetics and efficacy of carvedilol in chronic hemodialysis patients with hypertension." J Cardiovasc Pharmacol 18 Suppl 4 (1991): s62-8
  14. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  15. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Heart Failure

  Major

  Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Sympathetic stimulation may be important in maintaining the hemodynamic function in these patients, thus beta-blockade can worsen the heart failure. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Carvedilol, specifically, is indicated for use with these agents in the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.

  48 sources

  1. Michelson EL, Frishman WH, Lewis JE, et al. "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." Am J Med Oct 17 (1983): 68-80
  2. Myers J, Morgan T, Waga S, et al. "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  3. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  4. Altus P "Timolol-induced congestive heart failure." South Med J 74 (1981): 88
  5. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  6. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  7. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  8. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):

  Show all 48 sourcesShow fewer sources

  9. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  10. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  11. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  12. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  13. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  14. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  15. "Product Information. Kerlone (betaxolol)." Searle (2001):
  16. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  17. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  18. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  19. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  20. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  21. Lechat P, Jaillon P, Fontaine ML, Chanton E, Mesenge C, Gagey S, Guillardeau A, Dussous V "A randomized trial of beta-blockade in heart failure - the cardiac insufficiency bisoprolol study (CIBIS)." Circulation 90 (1994): 1765-73
  22. Maisel AS "Beneficial effects of metoprolol treatment in congestive heart failure - reversal of sympathetic-induced alterations of immunologic function." Circulation 90 (1994): 1774-80
  23. Persson H, Rythenalder E, Melcher A, Erhardt L "Effects of beta receptor antagonists in patients with clinical evidence of heart failure after myocardial infarction: double blind comparison of metoprolol and xamoterol." Br Heart J 74 (1995): 140-8
  24. Kelly DT "Carvedilol in heart failure." Cardiology 82 Suppl 3 (1993): 45-9
  25. Olsen SL, Gilbert EM, Renlund DG, Taylor DO, Yanowitz FD, Bristow MR "Carvedilol improves left ventricular function and symptoms in chronic heart failure: a double-blind randomized study." J Am Coll Cardiol 25 (1995): 1225-31
  26. Krum H, Sackner-Bernstein JD, Goldsmith RL, et al. "Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure." Circulation 92 (1995): 1499-506
  27. Australia-New Zealand Heart Failure Research Collaborative Group. "Effects of carvedilol, a vasodilator-B-blocker, in patients with congestive heart failure due to ischemic heart disease." Circulation 92 (1995): 212-8
  28. Kalman J, Buchholz C, Steinmetz M, Courtney M, Gass A, Lansman S, Kukin ML "Safety and efficacy of beta blockade in patients with chronic congestive heart failure awaiting transplantation." J Heart Lung Transplant 14 (1995): 1212-7
  29. Adams KF Jr "Current perspectives on B-receptor antagonists in the treatment of symptomatic ventricular dysfunction." Pharmacotherapy 16(2 Pt 2) (1996): 69-77
  30. Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH "The effect of carvedilol on morbidity and mortality in patients with chronic heart failure." N Engl J Med 334 (1996): 1349-55
  31. Persson SV, Erhardt L "Effects of beta receptor antagonists on left ventricular function in patients with clinical evidence of heart failure after myocardial infarction. A double-blind comparison of metoprolol and xamoterol: echocardiographic results from the Metoprolol and..." Eur Heart J 17 (1996): 741-9
  32. Cleland JGF, Swedberg K "Carvedilol for heart failure, with care." Lancet 347 (1996): 1199-201
  33. Moye LA, Abernethy D "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318
  34. Von Olshausen K, Pop T, Berger J "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318-20
  35. Packer M, Cohn JN, Colucci WS "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1310-20
  36. Colucci WS, Packer M, Bristow MR, Gilbert EM, Cohn JN, Fowler MB, Krueger SK, Hershberger R, Uretsky BF, Bowers JA, Sackne "Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure." Circulation 94 (1996): 2800-6
  37. Macmahon S, Sharpe N, Doughty R, Krum H, Tonkin A, Trotter A, Burton R, Garrett J, Lane G, Owensby D, Ryan J, Shepherd J, Sing "Randomised, placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease." Lancet 349 (1997): 375-80
  38. Bristow MR, Gilbert EM, Abraham WT, et al. "Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators." Circulation 94 (1996): 2807-16
  39. Packer M, Colucci WS, Sackner-Bernstein JD, Liang CS, Goldscher DA, Freeman I, Kukin ML, Kinhal V, Udelson JE, Klapholz M, Gottlieb SS, Pearle D "Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure. The PRECISE Trial Prospective Randomized Evaluation of Carvedilol on Symptoms an Exercise." Circulation 94 (1996): 2793-9
  40. Doughty RN, Whalley GA, Gamble G, MacMahon S, Sharpe N "Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia-Ne Zealand Heart Failure Research Collaborative Group." J Am Coll Cardiol 29 (1997): 1060-6
  41. Lechat P, Packer M, Chalon S, Cucherat M, Arab T, Boissel JP "Clinical effects of beta-adrenergic blockade in chronic heart failure: A meta-analysis of double-blind, placebo-controlled, randomized trials." Circulation 98 (1998): 1184-91
  42. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  43. CIBIS-II Investigators and Committees. "The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial." Lancet 353 (1999): 9-13
  44. Macdonald PS, Keogh AM, Aboyoun CL, Lund M, Amor R, McCaffrey DJ "Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure." J Am Coll Cardiol 33 (1999): 924-31
  45. Hjalmarson A, Goldstein S, Fagerberg B, et al. "Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF)." JAMA 283 (2000): 1295-302
  46. Phillips KA, Shlipak MG, Coxson P, et al. "Health and economic benefits of increased B-blocker use following myocardial infarction." JAMA 284 (2000): 2748-54
  47. Hart SM "Influence of B-blockers on mortality in chronic heart failure." Ann Pharmacother 34 (2000): 1440-51
  48. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Hypersensitivity

  Major

  The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.

  17 sources

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  8. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):

  Show all 17 sourcesShow fewer sources

  9. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  10. "Product Information. Kerlone (betaxolol)." Searle (2001):
  11. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  12. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  13. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  14. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  15. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  16. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  17. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Liver Diseases

  Major

  Bisoprolol is eliminated by both the kidney and liver. Patients with renal and/or liver disease may be at greater risk for adverse effects from bisoprolol due to decreased drug clearance. Initial dosage adjustments and cautious titration are recommended in patients with a creatinine clearance below 40 mL/min and/or liver disease.

  4 sources

  1. Kirch W, Rose I, Demers HG, Leopold G, Pabst J, Ohnhaus EE "Pharmacokinetics of bisoprolol during repeated oral administration to healthy volunteers and patients with kidney or liver disease." Clin Pharmacokinet 13 (1987): 110-7
  2. Hayes PC, Jenkins D, Vavianos P, Dagap K, Johnston A, Ioannides C, Thomas P, Williams R "Single oral dose pharmacokinetics of bisoprolol 10 mg in liver disease." Eur Heart J 8 (1987): 23-9
  3. Payton CD, Fox JG, Pauleau NF, Boulton-Jones JM, Ioannides C, Johnston A, Thomas P "The single dose pharmacokinetics of bisoprolol (10 mg) in renal insufficiency: the clinical significance of balanced clearance." Eur Heart J 8 (1987): 15-22
  4. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):

• Liver Diseases

  Major

  Calcium channel blockers (CCBs) are extensively metabolized by the liver. The half-lives of CCBs may be prolonged substantially in patients with severe hepatic impairment, with the potential for significant drug accumulation. In addition, the use of some CCBs has been associated with elevations in serum transaminases, both with and without concomitant elevations in alkaline phosphatase and bilirubin. While these effects may be transient and reversible, some patients have developed cholestasis or hepatocellular injury. Therapy with CCBs should be administered cautiously and often at reduced dosages in patients with significantly impaired hepatic function. Periodic monitoring of liver function is advised.

  54 sources

  1. Echizen H, Eichelbaum M "Clinical pharmacokinetics of verapamil, nifedipine and diltiazem." Clin Pharmacokinet 11 (1986): 425-49
  2. Saracheck NS, London RL, Matulewicz TJ, et al. "Diltiazem and granulomatous hepatitis." Gastroenterology 88 (1985): 1260-2
  3. Shallcross H, Padley SP, Glynn MJ, Gibbs DD "Fatal renal and hepatic toxicity after treatment with diltiazem." Br Med J 295 (1987): 1256-7
  4. Colombo G, Zucchella G, Planca E, Grieco A "Intravenous diltiazem in the treatment of unstable angina: a study of efficacy and tolerance." Clin Ther 9 (1987): 536-47
  5. Toft E, Vyberg M, Therkelsen K "Diltiazem-induced granulomatous hepatitis." Histopathology 18 (1991): 474-5
  6. Abramson M, Littlejohn GO "Hepatic reactions to nifedipine." Med J Aust 142 (1985): 47-8
  7. Toner M, White A, Moriarty J, Clancy L "Allergic urticarial eruption, leukocytosis and abnormal liver function tests following nifedipine administration." Chest 93 (1988): 1320-1
  8. Babany G, Uzzan F, Larrey D, et al. "Alcoholic-like liver lesions induced by nifedipine." J Hepatol 9 (1989): 252-5

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  9. Brodsky SJ, Cutler SS, Weiner DA, Klein MD "Hepatotoxicity due to treatment with verapamil." Ann Intern Med 94 (1981): 490-1
  10. Somogyi A, Albrecht M, Kliems G, et al. "Pharmacokinetics, bioavailability and ECG response of verapamil in patients with liver cirrhosis." Br J Clin Pharmacol 12 (1981): 51-60
  11. Woodcock BG, Rietbrock I, Vohringer HF, Rietbrock N "Verapamil disposition in liver disease and intensive-care patients: kinetics, clearance, and apparent blood flow relationships." Clin Pharmacol Ther 29 (1981): 27-34
  12. Woodcock BG, Rietbrock N "Verapamil bioavailability and dosage in liver disease." Br J Clin Pharmacol 13 (1982): 240-1
  13. Stern EH, Pitchon R, King BD, Wiener I "Possible hepatitis from verapamil." N Engl J Med 306 (1982): 612-3
  14. Stehle G, Buss J, Eibach J, et al. "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  15. Hare DL, Horowitz JD "Verapamil hepatotoxicity: a hypersensitivity reaction." Am Heart J 111 (1986): 610-11
  16. Guarascio P, D'Amato C, Sette P, et al. "Liver damage from verapamil." Br Med J 288 (1984): 362-3
  17. Dow RJ, Graham DJM "A reveiw of the human metabolism and pharmacokinetics of nicardipine hydrochloride." Br J Clin Pharmacol 22 (1986): s195-202
  18. McAllister RG Jr, Hamann SR, Blouin RA "Pharmacokinetics of calcium-entry blockers." Am J Cardiol 55 (1985): b30-40
  19. Kates RE "Calcium antagonists: pharmacokinetic properties." Drugs 25 (1983): 113-24
  20. Finucci GF, Padrini R, Piovan D, et al. "Verapamil pharmacokinetics and liver function in patients with cirrhosis." Int J Clin Pharmacol Res 8 (1988): 123-6
  21. Giacomini KM, Massoud N, Wong FM, Giacomini JC "Decreased binding of verapamil to plasma proteins in patients with liver disease." J Cardiovasc Pharmacol 6 (1984): 924-8
  22. Razak TA, McNeil JJ, Sewell RB, Drummer OH, Smallwood RA, Conway EL, Louis WJ "The effect of hepatic cirrhosis on the pharmacokinetics and blood pressure response to nicardipine." Clin Pharmacol Ther 47 (1990): 463-9
  23. Rush WR, Alexander O, Hall DJ, Cairncross L, Dow RJ, Graham DJ "The metabolism of nicardipine hydrochloride in healthy male volunteers." Xenobiotica 16 (1986): 341-9
  24. Benet LZ "Pharmacokinetics and metabolism of bepridil." Am J Cardiol 55 (1985): c8-13
  25. Kurosawa S, Kurosawa N, Owada E, et al. "Pharmacokinetics of diltiazem in patients with liver cirrhosis." Int J Clin Pharmacol Res 10 (1990): 311-8
  26. Elliott HL, Meredith PA "The clinical consequences of the absorption, distribution, metabolism and excretion of amlodipine." Postgrad Med J 67 (1991): s20-3
  27. Stopher DA, Beresford AP, Macrae PV, Humphrey MJ "The metabolism and pharmacokinetics of amlodipine in humans and animals." J Cardiovasc Pharmacol 12 (1988): s55-9
  28. Kleinbloesem CH, van Harten J, Wilson JP, et al. "Nifedipine: kinetics and hemodynamic effects in patients with liver cirrhosis after intravenous and oral administration." Clin Pharmacol Ther 40 (1986): 21-8
  29. Raemsch KD, Sommer J "Pharmacokinetics and metabolism of nifedipine." Hypertension 5 (1983): 18-24
  30. Ramsch KD, Graefe KH, Scherling D, et al. "Pharmacokinetics and metabolism of calcium-blocking agents nifedipine, nitrendipine, and nimodipine." Am J Nephrol 6 (1986): 73-80
  31. Challenor VF, Waller DG, Renwick AG, et al. "The trans-hepatic extraction of nifedipine." Br J Clin Pharmacol 24 (1987): 473-7
  32. Dunselman PH, Edgar B "Felodipine clinical pharmacokinetics." Clin Pharmacokinet 21 (1991): 418-30
  33. Regardh CG, Edgar B, Olsson R, Kendall M, Collste P, Shansky C "Pharmacokinetics of felodipine in patients with liver disease." Eur J Clin Pharmacol 36 (1989): 473-9
  34. Cotting J, Reichen J, Kutz K, Laplanche R, Nuesch E "Pharmacokinetics of isradipine in patients with chronic liver disease." Eur J Clin Pharmacol 38 (1990): 599-603
  35. Tse FL, Jaffe JM "Pharmacokinetics of PN 200-110 (isradipine), a new calcium antagonist, after oral administration in man." Eur J Clin Pharmacol 32 (1987): 361-5
  36. Graham D, Dow R, Hall D, Alexander O, Mroszczak E, Freedman A "The metabolism and pharmacokinetics of nicardipine hydrochloride in man." Br J Clin Pharmacol 20 (1985): s23-8
  37. Gengo FM, Fagan SC, Krol G, Bernhard H "Nimodipine disposition and haemodynamic effects in patients with cirrhosis and age-matched controls." Br J Clin Pharmacol 23 (1987): 47-53
  38. Meredith P, Elliott H "Clinical pharmacokinetics of amlodipine." Clin Pharmacokinet 22 (1992): 22-31
  39. "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals (2002):
  40. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical (2002):
  41. "Product Information. Cardizem (diltiazem)." Hoechst Marion Roussel (2002):
  42. "Product Information. Plendil (felodipine)." Merck & Co., Inc (2002):
  43. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc (2002):
  44. "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals (2002):
  45. "Product Information. Nimotop (nimodipine)." Bayer (2002):
  46. "Product Information. Calan (verapamil)." Searle (2001):
  47. Johnson KE, Balderston SM, Pieper JA, Mann DE, Reiter MJ "Electrophysiologic effects of verapamil metabolites in the isolated heart." J Cardiovasc Pharmacol 17 (1991): 830-7
  48. "Product Information. Dynacirc (isradipine)." Sandoz Pharmaceuticals Corporation
  49. Kumar KL, Colley CA "Verapamil-induced hepatotoxicity." West J Med 160 (1994): 485-6
  50. Traverse JH, Swenson LJ, Mcbride JW "Acute hepatic injury after treatment with diltiazem." Am Heart J 127 (1994): 1636-9
  51. Scherling D, Karl W, Ahr G, Ahr HJ, Wehinger E "Pharmacokinetics of nisoldipine. III. Biotransformation of nisoldipine in rat, dog, monkey, and man." Arzneimittelforschung 38 (1988): 1105-10
  52. "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals (2001):
  53. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57
  54. "Product Information. Conjupri (levamlodipine)." CSPC Ouyi Pharmaceutical Co, Ltd (2020):

• Myocardial Ischemia

  Major

  Heightened sensitivity to catecholamines may occur after prolonged use of beta-adrenergic receptor blocking agents (aka beta-blockers). Exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt withdrawal of therapy. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Patients should be advised not to discontinue treatment without first consulting with the physician. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures.

  20 sources

  1. Miller RR, Olson HG, Amsterdam EA, Mason DT "Propranolol-withdrawal rebound phenomenon: exacerbation of coronary events after abrupt cessation of antianginal therapy." N Engl J Med 293 (1975): 416-8
  2. Rangno RE, Langlois S "Comparison of withdrawal phenomena after propranolol, metoprolol, and pindolol." Am Heart J 104 (1982): 473-8
  3. Szecsi E, Kohlschutter S, Schiess W, Lang E "Abrupt withdrawal of pindolol or metoprolol after chronic therapy." Br J Clin Pharmacol 13 (1982): s353-7
  4. Walden RJ, Hernandez J, Yu Y, et al. "Withdrawal of beta-blocking drugs." Am Heart J 104 (1982): 515-20
  5. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  6. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  7. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  8. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):

  Show all 20 sourcesShow fewer sources

  9. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  10. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  11. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  12. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  13. "Product Information. Kerlone (betaxolol)." Searle (2001):
  14. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  15. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  16. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  17. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  18. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  19. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  20. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Peripheral Vascular Diseases

  Major

  Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Therapy with beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.

  27 sources

  1. Michelson EL, Frishman WH, Lewis JE, et al. "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." Am J Med Oct 17 (1983): 68-80
  2. Eliasson K, Danielson M, Hylander B, Lindblad LE "Raynaud's phenomenon caused by beta-receptor blocking drugs." Acta Med Scand 215 (1984): 333-9
  3. Myers J, Morgan T, Waga S, et al. "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  4. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  5. Eliasson K, Lins L-E, Sundqvist K "Peripheral vasospasm during beta-receptor blockade: a comparison between metoprolol and pindolol." Acta Med Scand 665 (1982): 109-12
  6. Lepantalo M "Beta blockade and intermittent claudication." Acta Med Scand 700 (1985): 1-48
  7. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  8. Coppeto JR "Transient ischemic attacks and amaurosis fugax from timolol." Ann Ophthalmol 17 (1985): 64-5

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  9. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  10. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  11. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  12. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  13. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  14. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  15. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  16. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  17. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  18. "Product Information. Kerlone (betaxolol)." Searle (2001):
  19. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  20. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  21. Broeder CE, Thomas EL, Martin NB, Hofman Z, Jesek JK, Scruggs KD, Wambsgans KC, Wilmore JH "Effects of propranolol and pindolol on cardiac output during extended periods of low-intensity physical activity." Am J Cardiol 72 (1993): 1188-95
  22. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  23. Holti G "A double-blind study of the peripheral vasoconstrictor effects of the beta-blocking drug penbutolol in patients with Raynaud's phenomenon." Curr Med Res Opin 6 (1979): 267-70
  24. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  25. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  26. Breckenridge A, Roberts DH "Antihypertensive treatment in concomitant peripheral vascular disease: current experience and the potential of carvedilol." J Cardiovasc Pharmacol 18 Suppl 4 (1991): s78-81
  27. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Shock, Cardiogenic

  Major

  The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

  24 sources

  1. Kholeif M, Isles C "Profound hypotension after atenolol in severe hypertension." Br Med J 298 (1989): 161-2
  2. Tirlapur VG, Evans PJ, Jones MK "Shock syndrome after acebutolol." Br J Clin Pract 40 (1986): 33-4
  3. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  4. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  5. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  6. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  7. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  8. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):

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  9. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  10. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  11. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  12. "Product Information. Kerlone (betaxolol)." Searle (2001):
  13. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  14. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  15. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  16. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  17. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  18. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  19. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  20. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  21. "Product Information. Acupress (carteolol ophthalmic)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
  22. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc (2001):
  23. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  24. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Shock, Cardiogenic

  Major

  In general, calcium channel blockers (CCBs) should not be used in patients with hypotension (systolic pressure < 90 mm Hg) or cardiogenic shock. Due to potential negative inotropic and peripheral vasodilating effects, the use of CCBs may further depress cardiac output and blood pressure, which can be detrimental in these patients. The use of verapamil and diltiazem is specifically contraindicated under these circumstances.

  6 sources

  1. Stehle G, Buss J, Eibach J, et al. "Cardiogenic shock associated with verapamil in a patient with liver cirrhosis." Lancet 336 (1990): 1079
  2. "Product Information. Vascor (bepridil)." McNeil Pharmaceutical (2002):
  3. "Product Information. Cardizem (diltiazem)." Hoechst Marion Roussel (2002):
  4. "Product Information. Calan (verapamil)." Searle (2001):
  5. Kubota K, Pearce GL, Inman WHW "Vasodilation-related adverse events in diltiazem and dihydropyridine calcium antagonists studied by prescription-event monitoring." Eur J Clin Pharmacol 48 (1995): 1-7
  6. Pahor M, Manto A, Pedone C, Carosella L, Guralnik JM, Carbonin P "Age and severe adverse drug reactions caused by nifedipine and verapamil." J Clin Epidemiol 49 (1996): 921-8

• Asthma

  Moderate

  Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.

  7 sources

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  4. "Product Information. Kerlone (betaxolol)." Searle (2001):
  5. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  6. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  7. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Cerebrovascular Disorders

  Moderate

  Beta-adrenergic blocking agents (beta-blockers), should be used with caution in patients with cerebrovascular insufficiency because of their potential effects relative to blood pressure and pulse. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.

  16 sources

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  4. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  5. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  7. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Kerlone (betaxolol)." Searle (2001):
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  11. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Glaucoma

  Moderate

  Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.

  16 sources

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Kerlone (betaxolol)." Searle (2001):
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  11. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Heart Failure

  Moderate

  Calcium channel blockers (CCBs) may have varying degrees of negative inotropic effect. Congestive heart failure (CHF), worsening of CHF, and pulmonary edema have occurred in some patients treated with a CCB, primarily verapamil. Some CCBs have also caused mild to moderate peripheral edema due to localized vasodilation of dependent arterioles and small blood vessels, which can be confused with the effects of increasing left ventricular dysfunction. Although some CCBs have been used in the treatment of CHF, therapy with CCBs should be administered cautiously in patients with severe left ventricular dysfunction (e.g., ejection fraction < 30%) or moderate to severe symptoms of cardiac failure and in patients with any degree of ventricular dysfunction if they are receiving a beta-adrenergic blocker. Likewise, caution is advised in patients with acute myocardial infarction and pulmonary congestion documented by X-ray on admission, since associated heart failure may be acutely worsened by administration of a CCB.

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  1. Gillmer DJ, Kark P "Pulmonary oedema precipitated by nifedipine." Br Med J 280 (1980): 1420-1
  2. Batra AK, Segall PH, Ahmed T "Pulmonary edema with nifedipine in primary pulmonary hypertension." Respiration 47 (1985): 161-3
  3. Myrhed M, Wiholm B-E "Nifedipine: a survey of adverse effects." Acta Pharmacol Toxicol (Copenh) 58 (1986): 133-6
  4. Prigogine T, Waterlot Y, Gottignies P, et al. "Acute nonhemodynamic pulmonary edema with nifedipine in primary pulmonary hypertension." Chest 100 (1991): 563-4
  5. Batlouni M, Armaganijan D, Ghorayeb N, Magliano MF "Clinical efficacy and tolerability of isradipine in the treatment of mild-to-moderate hypertension in young and elderly patients." J Cardiovasc Pharmacol 19 (1992): s53-7
  6. Scheidt S, LeWinter MM, Hermanovich J, Venkataraman K, Freedman D "Efficacy and safety of nicardipine for chronic, stable angina pectoris: a multicenter randomized trial." Am J Cardiol 58 (1986): 715-21
  7. Taylor SH, Frais MA, Lee P, Verma SP, Jackson N, Reynolds G, Silke B "A study of the long-term efficacy and tolerability of oral nicardipine in hypertensive patients." Br J Clin Pharmacol 20 (1985): s139-42
  8. Dubois C, Blanchard D "Efficacy and safety of nicardipine in 29,104 patients with hypertension." Clin Ther 11 (1989): 452-60

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  9. Yedinak KC, Lopez LM "Felodipine: a new dihydropyridine calcium-channel antagonist." DICP 25 (1991): 1193-206
  10. Lorimer AR, Pringle SD "The safety of felodipine." J Cardiovasc Pharmacol 15 (1990): s85-9
  11. Sundstedt CD, Ruegg PC, Keller A, Waite R "A multicenter evaluation of the safety, tolerability, and efficacy of isradipine in the treatment of essential hypertension." Am J Med 86 (1989): 98-102
  12. Ruegg PC, Nelson DJ "Safety and efficacy of isradipine, alone and in combination, in the treatment of angina pectoris." Am J Med 86 (1989): 70-4
  13. "Product Information. Norvasc (amlodipine)." Pfizer U.S. Pharmaceuticals (2002):
  14. "Product Information. Plendil (felodipine)." Merck & Co., Inc (2002):
  15. "Product Information. Cardene (nicardipine)." Syntex Laboratories Inc (2002):
  16. "Product Information. Procardia (nifedipine)." Pfizer U.S. Pharmaceuticals (2002):
  17. "Product Information. Nimotop (nimodipine)." Bayer (2002):
  18. "Product Information. Dynacirc (isradipine)." Sandoz Pharmaceuticals Corporation
  19. Walton T, Symes LR "Felodipine and isradipine: new calcium-channel-blocking agents for the treatment of hypertension." Clin Pharm 12 (1993): 261-75
  20. Fagan TC, Haggert BE, Liss C "Efficacy and tolerability of extended-release felodipine and extended-release nifedipine in patients with mild-to-moderate essential hypertension." Clin Ther 16 (1994): 634-46
  21. Blecker D "Antihypertensive therapy with isradipine in patients with special safety concerns." Angiology 45 (1994): 997-1008
  22. Brogden RN, Sorkin EM "Isradipine: an update of its pharmacodynamic and pharmacokinetic properties and therapeutic efficacy in the treatment of mild to moderate hypertension." Drugs 49 (1995): 618-49
  23. Kubota K, Pearce GL, Inman WHW "Vasodilation-related adverse events in diltiazem and dihydropyridine calcium antagonists studied by prescription-event monitoring." Eur J Clin Pharmacol 48 (1995): 1-7
  24. Johnson BF, Eisner GM, Mcmahon FG, Jain AK, Rudd P, Sowers JR "A multicenter comparison of adverse reaction profiles of isradipine and enalapril at equipotent doses in patients with essential hypertension." J Clin Pharmacol 35 (1995): 484-92
  25. "Product Information. Sular (nisoldipine)." Astra-Zeneca Pharmaceuticals (2001):
  26. Sleight P "Calcium antagonists during and after myocardial infarction." Drugs 51 (1996): 216-25
  27. Elkayam U "Calcium channel blockers in heart failure." Cardiology 89 (1998): 38-46
  28. Schaefer RM, Aldons PM, Burgess ED, Tilvis R, Singh GP, Rehn L, Morgan TO "Improved tolerability of felodipine compared with amlodipine in elderly hypertensives: A randomised, double-blind study in 535 patients, focusing on vasodilatory adverse events." Int J Clin Pract 52 (1998): 381
  29. Abernathy DR, Schwrtz JB "Calcium-antagonist drugs." N Engl J Med 341 (1999): 1447-57

• Hyperlipidemias

  Moderate

  Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles. Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Patients with preexisting hyperlipidemia may require closer monitoring during beta-blocker therapy, and adjustments made accordingly in their lipid-lowering regimen.

  40 sources

  1. Rossner S, Weiner L "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7
  2. Valimaki M, Maass L, Harno K, Nikkila EA "Lipoprotein lipids and apoproteins during beta-blocker administration: comparison of penbutolol and atenolol." Eur J Clin Pharmacol 30 (1986): 17-20
  3. Disler LJ, Joffe BI, Seftel HC "Massive hypertriglyceridemia associated with atenolol." Am J Med 85 (1988): 586-7
  4. Harvengt C, Heller FR, Martiat P, Nieuwenhuyze YV "Short-term effects of beta blockers atenolol, nadolol, pindolol, and propranolol on lipoprotein metabolism in normolipemic subjects." J Clin Pharmacol 27 (1987): 475-80
  5. Darga LL, Hakim MJ, Lucas CP, Franklin BA "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  6. Rossner S, Weiner L "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7
  7. Weiner L, Rossner S "Atenolol 50 mg or metoprolol 200 mg: a comparison of antihypertensive efficacy, side effects and lipoprotein changes." Acta Med Scand 677 (1983): 153-7
  8. Ferrara LA, Marotta T, Scilla A, et al. "Effect of oxprenolol and metoprolol on serum lipid concentration." Eur J Clin Pharmacol 26 (1984): 331-4

  Show all 40 sourcesShow fewer sources

  9. Pasotti C, Capra A, Fiorella G, et al. "Effects of pindolol and metoprolol on plasma lipids and lipoproteins." Br J Clin Pharmacol 13 (1982): s435-9
  10. Carlson LA, Ribacke M, Terent A "A long-term study on the effect of pindolol on serum lipoproteins: a preliminary report." Br J Clin Pharmacol 24 (1987): s61-2
  11. Samuel P, Chin B, Schoenfeld BH, et al. "Comparison of the effect of pindolol versus propranolol on the lipid profile in patients treated for hypertension." Br J Clin Pharmacol 24 (1987): s63-4
  12. Terent A, Ribacke M, Carlson LA "Long-term effect of pindolol on lipids and lipoproteins in men with newly diagnosed hypertension." Eur J Clin Pharmacol 36 (1989): 347-50
  13. Sasaki J, Saku K, Ideishi M, et al. "Effects of pindolol on serum lipids, apolipoproteins, and lipoproteins in patients with mild to moderate essential hypertension." Clin Ther 11 (1989): 219-24
  14. Szollar LG, Meszaros I, Tornoci L, et al. "Effect of metoprolol and pindolol monotherapy on plasma lipid- and lipoprotein-cholesterol levels (including the HDL subclasses) in mild hypertensive males and females." J Cardiovasc Pharmacol 15 (1990): 911-7
  15. Leren P, Foss PO, Nordvik B, Fossbakk B "The effect of enalapril and timolol on blood lipids." Acta Med Scand 223 (1988): 321-6
  16. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  17. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  18. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  19. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  20. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  21. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  22. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  23. Northcote RJ, Packard CJ, Ballantyne D "The effect of sotalol on plasma lipoproteins and apolipoproteins." Clin Chim Acta 158 (1986): 187-91
  24. Lehtonen A, Hietanen E, Marniemi J, Peltonen P, Nikkila EA "Effect of sotalol withdrawal on serum lipids and lipoprotein lipase activity." Int J Clin Pharmacol Ther Toxicol 21 (1983): 73-6
  25. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  26. "Product Information. Kerlone (betaxolol)." Searle (2001):
  27. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  28. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  29. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  30. Safran AB, Simona F, Sansonetti A, Pometta D, James R "Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level." Am J Ophthalmol 117 (1994): 683
  31. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  32. Clucas A, Miller N "Effects of acebutolol on the serum lipid profile." Drugs 36 Suppl 2 (1988): 41-50
  33. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  34. Kasiske BL, Ma JZ, Kalil RS, Louis TA "Effects of antihypertensive therapy on serum lipids." Ann Intern Med 122 (1995): 133-41
  35. Lind L, Pollare T, Berne C, Lithell H "Long-term metabolic effects of antihypertensive drugs." Am Heart J 128 (1994): 1177-83
  36. Sasaki J, Kajiyama G, Kusukawa R, Mori H, Koga S, Takagi R, Tanaka N, Ogawa N, Arakawa K "Effect of bevantolol and propranolol on serum lipids in patients with essential hypertension." Int J Clin Pharmacol Ther 32 (1994): 660-4
  37. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  38. Lithell H, Andersson PE "Metabolic effects of carvedilol in hypertensive patients." Eur J Clin Pharmacol 52 (1997): 13-7
  39. Gordon NF, Scott CB, Duncan JJ "Effects of atenolol versus enalapril on cardiovascular fitness and serum lipids in physically active hypertensive men." Am J Cardiol 79 (1997): 1065-9
  40. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Hyperthyroidism

  Moderate

  When beta-adrenergic receptor blocking agents (aka beta-blockers) are used to alleviate symptoms of hyperthyroidism such as tachycardia, anxiety, tremor and heat intolerance, abrupt withdrawal can exacerbate thyrotoxicosis or precipitate a thyroid storm. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.

  16 sources

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Kerlone (betaxolol)." Searle (2001):
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  11. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Myasthenia Gravis

  Moderate

  Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.

  7 sources

  1. Confavreux C, Charles N, Aimard G "Fulminant myasthenia gravis soon after initiation of acebutolol therapy." Eur Neurol 30 (1990): 279-81
  2. Berstein LP, Henkind P "Additional information on adverse reactions to timolol." Am J Ophthalmol 92 (1981): 295-6
  3. Coppeto JR "Timolol-associated myasthenia gravis." Am J Ophthalmol 98 (1984): 244-5
  4. Verkijk A "Worsening of myasthenia gravis with timolol maleate eyedrops." Ann Neurol 17 (1985): 211-2
  5. Herishanu Y, Rosenberg P "Beta-blockers and myasthenia gravis." Ann Intern Med 83 (1975): 834-5
  6. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  7. Choi KL, Wat MS, Ip TP, Kung AWC, Lam KSL "Phaeochromocytoma associated with myasthenia gravis precipitated by propranolol treatment." Aust N Z J Med 25 (1995): 257

• Pheochromocytoma

  Moderate

  Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.

  16 sources

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  4. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  5. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  6. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  7. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Kerlone (betaxolol)." Searle (2001):
  10. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  11. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Psoriasis

  Moderate

  The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.

  16 sources

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  8. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  10. "Product Information. Kerlone (betaxolol)." Searle (2001):
  11. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  12. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  13. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  14. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  15. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

• Tachycardia

  Moderate

  Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol. The use of beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in these patients.

  16 sources

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories (2002):
  2. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc (2002):
  3. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  5. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  7. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  8. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals (2001):

  Show all 16 sourcesShow fewer sources

  9. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  10. "Product Information. Kerlone (betaxolol)." Searle (2001):
  11. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals (2001):
  12. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  13. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories (2001):
  14. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  15. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  16. "Product Information. Bystolic (nebivolol)." Forest Pharmaceuticals (2007):

Therapeutic duplication

Drug classes that overlap with Bisoprolol Fumarate + Amlodipine Besilate, so taking both doubles up the same effect. This source publishes no per-row citations for duplication.

• beta blockers

  The recommended maximum number of medicines in the 'beta blockers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'beta blockers' category.

  Example product in the source data (US market): Hydrochlorothiazide/metoprolol

• beta blockers

  The recommended maximum number of medicines in the 'beta blockers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'beta blockers' category.

  Example product in the source data (US market): Hydrochlorothiazide/propranolol

• beta blockers

  The recommended maximum number of medicines in the 'beta blockers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'beta blockers' category.

  Example product in the source data (US market): Hydrochlorothiazide/timolol

• beta blockers

  The recommended maximum number of medicines in the 'beta blockers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'beta blockers' category.

  Example product in the source data (US market): Tenoretic 50

• beta blockers

  The recommended maximum number of medicines in the 'beta blockers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'beta blockers' category.

  Example product in the source data (US market): Bendroflumethiazide/nadolol

• beta blockers

  The recommended maximum number of medicines in the 'beta blockers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'beta blockers' category.

  Example product in the source data (US market): Nebivolol/valsartan

• calcium channel blockers

  The recommended maximum number of medicines in the 'calcium channel blockers' category to be taken concurrently is usually one.Your list includes two medicines belonging to the 'calcium channel blockers' category.

  Example product in the source data (US market): Trandolapril/verapamil