Dorzolamide + Timolol 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

Conditions

Conditions in which Dorzolamide + Timolol needs care, as documented in this source.

• Asthma

  Major

  Some beta-adrenergic receptor blocking agents (i.e., non-cardioselective beta-blockers) are contraindicated in patients with bronchial asthma or with a history of bronchial asthma, or severe chronic obstructive pulmonary disease. In general, beta-adrenergic receptor blocking agents should not be used in patients with bronchospastic diseases. Beta blockade may adversely affect pulmonary function by counteracting the bronchodilation produced by catecholamine stimulation of beta-2 receptors. If beta-blocker therapy is necessary in these patients, an agent with beta-1 selectivity (e.g., atenolol, metoprolol, betaxolol) is considered safer, but should be used with caution nonetheless. Cardioselectivity is not absolute and can be lost with larger doses.

  23 sources

  1. van Zyl AI, Jennings AA, Bateman ED, Opie LH "Comparison of respiratory effects of two cardioselective beta-blockers, celiprolol and atenolol, in asthmatics with mild to moderate hypertension." Chest 95 (1989): 209-13
  2. Adam WR, Meagher EJ, Barter CE "Labetalol, beta blockers, and acute deterioration of chronic airway obstruction." Clin Exp Hypertens A A4 (1982): 1419-28
  3. Falliers CJ, Vincent ME, Medakovic M "Effect of single doses of labetalol, metoprolol, and placebo on ventilatory function in patients with bronchial asthma: interaction with isoproterenol." J Asthma 23 (1986): 251-60
  4. Durant PA, Joucken K "Bronchospasm and hypotension during cardiopulmonary bypass after preoperative cimetidine and labetalol therapy." Br J Anaesth 56 (1984): 917-20
  5. Raine JM, Palazzo MG, Kerr JH, Sleight P "Near-fatal bronchospasm after oral nadolol in a young asthmatic and response to ventilation with halothane." Br Med J 282 (1981): 548-9
  6. Stephen SA "Unwanted effects of propranolol." Am J Cardiol 18 (1966): 463-72
  7. Chodosh S, Tuck J, Blasucci DJ "The effects of dilevalol, metoprolol, and placebo on ventilatory function in asthmatics." J Cardiovasc Pharmacol 11 (1988): s18-24
  8. Morris R, Bulteau P "Respiratory arrest after beta-blocker in an asthmatic patient." Med J Aust 2 (1980): 576

  Show all 23 sourcesShow fewer sources

  9. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  10. Schoenberger JA, Croog SH, Sudilovsky A, et al. "Self-reported side effects from antihypertensive drugs: a clinical trial." Am J Hypertens 3 (1990): 123-32
  11. Horvath JS, Woolcock AJ, Tiller DJ, Donnelly P, Armstrong J, Caterson R "A comparison of metoprolol and propranolol on blood pressure and respiratory function in patients with hypertension." Aust N Z J Med 8 (1978): 1-6
  12. Benson MK, Berrill WT, Cruickshank JM, Sterling GS "A comparison of four B-adrenoceptor antagonists in patients with asthma." Br J Clin Pharmacol 5 (1978): 415-9
  13. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  14. "Product Information. Trandate (labetalol)." Glaxo Wellcome (2002):
  15. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  16. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  17. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  18. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  19. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  20. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  21. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):
  22. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):
  23. 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):

• 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):

• 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):

• Hematologic Diseases

  Major

  Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. The use of sulfonamides has been associated with hematologic toxicity, including methemoglobinemia, sulfhemoglobinemia, leukopenia, granulocytopenia, eosinophilia, hemolytic anemia, aplastic anemia, purpura, clotting disorder, thrombocytopenia, hypofibrinogenemia, and hypoprothrombinemia. Therapy with topical sulfonamides should be administered cautiously in patients with preexisting blood dyscrasias or bone marrow suppression. Complete blood counts should be obtained regularly during prolonged therapy (>2 weeks), and patients should be instructed to immediately report any signs or symptoms suggestive of blood dyscrasia such as fever, sore throat, local infection, bleeding, pallor, dizziness, or jaundice.

  23 sources

  1. Barak S, Shaked Y, Bar A, Samra Y "Drug-induced post-surgical hemorrhage resulting from trimethoprim-sulphamethoxazole." Int J Oral Maxillofac Surg 18 (1989): 206-7
  2. Chan M, Beale D, Moorhead J "Acute megaloblastosis due to cotrimoxazole." Br J Clin Pract 34 (1980): 87-8
  3. Damergis J, Stoker J, Abadie J "Methemoglobinemia after sulfamethoxazole and trimethoprim therapy." JAMA 249 (1983): 590-1
  4. Kuipers EJ, Vellenga E, de Wolf JT, Hazenberg BP "Sulfasalazine induced agranulocytosis treated with GM-CSF." J Rheumatol 19 (1992): 621-2
  5. Youssef PP, Bertouch JV "Sulphasalazine induced aplastic anaemia." Aust N Z J Med 22 (1992): 391-2
  6. Keisu M, Ekman E "Sulfasalazine associated agranulocytosis in sweden 1972-1989: clinical features, and estimation of its incidence." Eur J Clin Pharmacol 43 (1992): 215-8
  7. Jacobson IM, Kelsey PB, Blyden GT, Demirjian ZN, Isselbacher KJ "Sulfasalazine-induced agranulocytosis." Am J Gastroenterol 80 (1985): 118-21
  8. Wheelan KR, Cooper B, Stone MJ "Multiple haematologic abnormalities associated with sulfasalazine." Ann Intern Med 97 (1982): 726-7

  Show all 23 sourcesShow fewer sources

  9. Pena JM, Gonzalez-Garcia JJ, Garcia-Alegria J, Barbado FJ, Vazquez JJ "Thrombocytopenia and sulfasalazine." Ann Intern Med 102 (1985): 277-8
  10. Davies GE, Palek J "Selective erythroid and magakaryocytic aplasia after sulfasalazine administration." Arch Intern Med 140 (1980): 1122
  11. Guillemin F, Aussedat R, Guerci A, Lederlin P, Trechot P, Pourel J "Fatal agranulocytosis in sulfasalazine treated rheumatoid arthritis." J Rheumatol 16 (1989): 1166-7
  12. Mitrane MP, Singh A, Seibold JR "Cholestasis and fatal agranulocytosis complicating sulfasalazine therapy: case report and review of the literature." J Rheumatol 13 (1986): 969-72
  13. Mechanick JI "Coombs' positive hemolytic anemia following sulfasalazine therapy in ulcerative colitis: case reports, review, and discussion of pathogenesis." Mt Sinai J Med 52 (1985): 667-70
  14. Betkowski AS, Lubin A "Sulfamethoxazole-related antiplatelet antibody." Blood 82 (1993): 1683
  15. Gales BJ, Gales MA "Granulocyte-colony stimulating factor for sulfasalazine-induced agranulocytosis." Ann Pharmacother 27 (1993): 1052-4
  16. "Product Information. Gantrisin (sulfiSOXAZOLE)." Roche Laboratories (2022):
  17. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc (2001):
  18. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc (2001):
  19. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  20. "Product Information. Sodium Sulamyd (sulfacetamide sodium ophthalmic)." Schering Corporation
  21. "Product Information. Sultrin Triple Sulfa (triple sulfa topical)." Janssen Pharmaceuticals
  22. "Product Information. Sulfacet-R (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  23. "Product Information. AVC (sulfanilamide topical)." Aventis Pharmaceuticals (2022):

• 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):

• Hypersensitivity, Immediate

  Major

  Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. The use of sulfonamides is associated with large increases in the risk of Stevens-Johnson syndrome, toxic epidermal necrolysis and other serious dermatologic reactions, although these phenomena are rare as a whole. Hepatitis, pneumonitis, and interstitial nephritis have also occurred in association with sulfonamide hypersensitivity. Therapy with topical sulfonamides should be administered cautiously in patients with severe allergies, bronchial asthma or AIDS, since these patients may be at increased risk for potentially severe hypersensitivity reactions. Patients should be instructed to promptly report signs and symptoms that may precede the onset of cutaneous manifestations of the Stevens-Johnson syndrome, such as high fever, severe headache, stomatitis, conjunctivitis, rhinitis, urethritis, and balanitis. Sulfonamide therapy should be stopped at once if a rash develops.

  51 sources

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  2. Hofer T, Becker EW, Weigand K, Berg PA "Demonstration of sensititzed lymphocytes to trimethoprim/sulfamethoxazole and ofloxacin in a patient with cholestatic hepatitis." J Hepatol 15 (1992): 262-3
  3. Stevenson D, Christie D, Haas J "Hepatic injury in a child caused by trimethoprim-sulfamethoxazole." Pediatrics 61 (1978): 864-6
  4. Smith E, Light J, Filo R, Yum M "Interstitial nephritis caused by trimethoprim-sulfamethoxazole in renal transplant recipients." JAMA 244 (1980): 360-1
  5. Whittington R "Toxic epidermal necrolysis and co-trimoxazole." Lancet 2 (1989): 574
  6. Kelly W, Dooley D, Lattuada C, Smith C "A severe, unusual reaction to trimethoprim-sulfamethoxazole in patients infected with human immunodeficiency virus." Clin Infect Dis 14 (1992): 1034-9
  7. Horak J, Mertl L, Hrabal P "Severe liver injuries due to sulfamethoxazole-trimethoprim and sulfamethoxydiazine." Hepatogastroenterology 31 (1984): 199-200
  8. Gibson J "Recurrent trimethoprim-associated fixed skin eruption." Br Med J 284 (1982): 1529-30

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  9. Holdcroft C, Ellison R "Trimethoprim-sulfamethoxazole reaction simulating pneumocystis carinii pneumonia." AIDS 5 (1991): 1029-42
  10. Steinbrecher U, Mishkin S "Sulfamethoxazole-induced hepatic injury." Dig Dis Sci 26 (1981): 756-9
  11. Rudra T, Webb D, Evans A "Acute tubular necrosis following co-trimoxazole therapy." Nephron 53 (1989): 85-6
  12. Ulstad D, Ampel N, Shon B, Galgiani JN, Cutcher AB "Reaction after re-exposure to trimethoprim-sulfamethoxazole." Chest 95 (1989): 937-8
  13. Heer M, Altorfer J, Burger H, Walti M "Bullous esophageal lesions due to co-trimoxazole: an immune-mediated process?" Gastroenterology 88 (1985): 1954-7
  14. Pisanty S, Brayer L "Erythema multiforme-like eruption due to sulfadiazine." J Dent Med 20 (1965): 154-7
  15. Robson M, Levi J, Dolberg L, Rosenfeld J "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci 6 (1970): 561-6
  16. Goadsby P, Donaghy A, Lloyd A, Wakefield D "Acquired immunodeficiency syndrome (AIDS) and sulfadiazine-associated acute renal failure." Ann Intern Med 107 (1987): 783-4
  17. Carbone L, Bendixen B, Appel G "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis 12 (1988): 72-5
  18. Tenant-Flowers M, Boyle M, Carey D, et al. "Sulphadiazine desenitization in patients with AIDS and cerebral toxoplasmosis." AIDS 5 (1991): 311-5
  19. Leroux JL, Ghezail M, Chertok P, Blotman F "Hypersensitivity reactions to sulfasalazine: skin rash, fever, hepatitis and activated lymphocytes." Clin Exp Rheumatol 10 (1992): 427
  20. Kanner RS, Tedesco FJ, Kalser MH "Azulfidine- (sulfasalazine-) induced hepatic injury." Am J Dig Dis 23 (1978): 956-8
  21. Losek JD, Werlin SL "Sulfasalazine hepatotoxicity." Am J Dis Child 135 (1981): 1070-2
  22. Fich A, Schwartz J, Braverman D, Zifroni A, Rachmilewitz D "Sulfasalazine hepatotoxicity." Am J Gastroenterol 79 (1984): 401-2
  23. Yaffe BH, Korelitz BI "Sulfasalazine pneumonitis." Am J Gastroenterol 78 (1983): 493-4
  24. Ribe J, Benkov KJ, Thung SN, Shen SC, LeLeiko NS "Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulfasalazine." Am J Gastroenterol 81 (1986): 205-8
  25. Averbuch M, Halpern Z, Hallak A, Topilsky M, Levo Y "Sulfasalazine pneumonitis." Am J Gastroenterol 80 (1985): 343-5
  26. Gabazza EC, Taguchi O, Yamakami T, Machishi M, Ibata H, Suzuki S, Matsumoto K, Kitagawa T, Yamamoto J "Pulmonary infiltrates and skin pigmentation associated with sulfasalazine." Am J Gastroenterol 87 (1992): 1654-7
  27. Poland GA, Love KR "Marked atypical lymphocytosis, hepatitis, and skin rash in sulfasalazine drug allergy." Am J Med 81 (1986): 707-8
  28. Hamadeh MA, Atkinson J, Smith LJ "Sulfasalazine-induced pulmonary disease." Chest 101 (1992): 1033-7
  29. Williams T, Eidus L, Thomas P "Fibrosing alveolitis, bronchiolitis obliterans, and sulfasalazine therapy." Chest 81 (1982): 766-8
  30. Valcke Y, Pauwels R, Van der Straeten M "Bronchoalveolar lavage in acute hypersensitivity pneumonitis caused by sulfasalazine." Chest 92 (1987): 572-3
  31. Taffet SL, Das KM "Sulfasalazine. Adverse effects and desensitization." Dig Dis Sci 28 (1983): 833-42
  32. Pearl RK, Nelson RL, Prasad ML, Orsay CP, Abcarian H "Serious complications of sulfasalazine." Dis Colon Rectum 29 (1986): 201-2
  33. Sotolongo RP, Neefe LI, Rudzki C, Ishak KG "Hypersensitivity reaction to sulfasalazine with severe hepatotoxicity." Gastroenterology 75 (1978): 95-9
  34. Wang KK, Bowyer BA, Fleming CR, Schroeder KW "Pulmonary infiltrates and eosinophilia associated with sulfasalazine." Mayo Clin Proc 59 (1984): 343-6
  35. Haines JD, Jr "Hepatotoxicity after treatment with sulfasalazine." Postgrad Med 79 (1986): 193-4,
  36. Faintuch J, Mott CB, Machado MC "Pancreatitis and pancreatic necrosis during sulfasalazine therapy." Int Surg 70 (1985): 271-2
  37. Marinos G, Riley J, Painter DM, McCaughan GW "Sulfasalazine-induced fulminant hepatic failure." J Clin Gastroenterol 14 (1992): 132-5
  38. Namias A, Bhalotra R, Donowitz M "Reversible sulfasalazine-induced granulomatous hepatitis." J Clin Gastroenterol 3 (1981): 193-8
  39. Gremse DA, Bancroft J, Moyer MS "Sulfasalazine hypersensitivity with hepatotoxicity, thrombocytopenia, and erythroid hypoplasia." J Pediatr Gastroenterol Nutr 9 (1989): 261-3
  40. Marinac JS, Stanford JF "A severe hypersensitive reaction to trimethoprim-sulfamethoxazole in a patient infected with human immunodeficiency virus." Clin Infect Dis 16 (1993): 178-9
  41. Rubin R "Sulfasalazine-induced fulminant hepatic failure and necrotizing pancreatitis." Am J Gastroenterol 89 (1994): 789-91
  42. Roujeau JC, Kelly JP, Naldi L, et al. "Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis." N Engl J Med 333 (1995): 1600-7
  43. Kawada A, Kobayashi T, Noguchi H, Hiruma M, Ishibashi A, Marshall J "Fixed drug eruption induced by sulfasalazine." Contact Dermatitis 34 (1996): 155-6
  44. "Product Information. Gantrisin (sulfiSOXAZOLE)." Roche Laboratories (2022):
  45. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc (2001):
  46. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc (2001):
  47. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  48. "Product Information. Sodium Sulamyd (sulfacetamide sodium ophthalmic)." Schering Corporation
  49. "Product Information. Sultrin Triple Sulfa (triple sulfa topical)." Janssen Pharmaceuticals
  50. "Product Information. Sulfacet-R (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  51. "Product Information. AVC (sulfanilamide topical)." Aventis Pharmaceuticals (2022):

• Liver Diseases

  Major

  Timolol is partially metabolized by the liver, and both parent drug and metabolites are eliminated by the kidney. Patients with renal and/or liver disease may be at greater risk for adverse effects from timolol due to decreased drug clearance. Therapy with timolol should be administered cautiously in patients with renal and/or liver dysfunction. Dosage adjustments may be necessary.

  4 sources

  1. Lowenthal DT, Pitone JM, Affrime MB, et al. "Timolol kinetics in chronic renal insufficiency." Clin Pharmacol Ther 23 (1978): 606-15
  2. McGourty JC, Silas JH, Fleming JJ, McBurney A, Ward JW "Pharmacokinetics and beta-blocking effects of timolol in poor and extensive metabolizers of debrisoquin." Clin Pharmacol Ther 38 (1985): 409-13
  3. Dunn FG, Frohlich ED "Pharmacokinetics, mechanisms of action, indications, and adverse effects of timolol maleate, a nonselective beta-adrenoreceptor blocking agent." Pharmacotherapy 1 (1981): 188-200
  4. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):

• 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):

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  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):

• Porphyrias

  Major

  Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. Therapy with topical sulfonamides should be administered cautiously in patients with porphyria, since these drugs can precipitate an acute attack. The use of oral sulfonamides is considered contraindicated in patients with porphyria.

  8 sources

  1. "Product Information. Gantrisin (sulfiSOXAZOLE)." Roche Laboratories (2022):
  2. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc (2001):
  3. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc (2001):
  4. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  5. "Product Information. Sodium Sulamyd (sulfacetamide sodium ophthalmic)." Schering Corporation
  6. "Product Information. Sultrin Triple Sulfa (triple sulfa topical)." Janssen Pharmaceuticals
  7. "Product Information. Sulfacet-R (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  8. "Product Information. AVC (sulfanilamide topical)." Aventis Pharmaceuticals (2022):

• 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):

• 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):

• Crystalluria

  Moderate

  Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. The use of sulfonamides has been associated with crystalluria due to precipitation of the sulfonamide and/or its N4-acetyl metabolite in the urinary tract. Renal toxicity such as uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine has been reported. Hydration and adequate urinary output (> 1.5 L/day) should be maintained during sulfonamide administration. Patients who are dehydrated (e.g., due to severe diarrhea or vomiting) may be at increased risk for the development of crystalluria and lithiasis and should be encouraged to consume additional amounts of liquid. Renal function tests and urinalysis should be performed regularly during prolonged therapy (> 2 weeks).

  15 sources

  1. Robson M, Levi J, Dolberg L, Rosenfeld J "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci 6 (1970): 561-6
  2. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med 84 (1988): 791-2
  3. Simon D, Brosius F, Rothstein D "Sulfadiazine crystalluria revisited." Arch Intern Med 150 (1990): 2379-84
  4. Molina J, Belenfant X, Doco-Lecompte T, et al. "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS 5 (1991): 587-9
  5. Sasson JP, Dratch PL, Shortsleeve MJ "Renal US findings in sulfadiazine-induced crystalluria." Radiology 185 (1992): 739-40
  6. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol 39 (1993): 254-6
  7. Erturk E, Casemento JB, Guertin KR, Kende AS "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol 151 (1994): 1605-6
  8. "Product Information. Gantrisin (sulfiSOXAZOLE)." Roche Laboratories (2022):

  Show all 15 sourcesShow fewer sources

  9. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc (2001):
  10. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc (2001):
  11. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  12. "Product Information. Sodium Sulamyd (sulfacetamide sodium ophthalmic)." Schering Corporation
  13. "Product Information. Sultrin Triple Sulfa (triple sulfa topical)." Janssen Pharmaceuticals
  14. "Product Information. Sulfacet-R (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  15. "Product Information. AVC (sulfanilamide topical)." Aventis Pharmaceuticals (2022):

• 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):

• 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

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  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):

• Kidney Diseases

  Moderate

  Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. Once absorbed, sulfonamides and their metabolites are eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from sulfonamides due to decreased drug clearance. Additionally, sulfonamides may cause renal toxicity secondary to crystalluria, including uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine. Hydration and adequate urinary output (> 1.5 L/day) should be maintained during sulfonamide administration. Renal function tests and urinalysis should be performed regularly during prolonged therapy (> 2 weeks). Some manufacturers of topical sulfonamide products do not recommend their use in patients with impaired renal function.

  44 sources

  1. Smith E, Light J, Filo R, Yum M "Interstitial nephritis caused by trimethoprim-sulfamethoxazole in renal transplant recipients." JAMA 244 (1980): 360-1
  2. Rudra T, Webb D, Evans A "Acute tubular necrosis following co-trimoxazole therapy." Nephron 53 (1989): 85-6
  3. Cryst C, Hammar S "Acute granulomatous interstitial nephritis due to co-trimoxazole." Am J Nephrol 8 (1988): 483-8
  4. Robson M, Levi J, Dolberg L, Rosenfeld J "Acute tubulo-interstitial nephritis following sulfadiazine therapy." Isr J Med Sci 6 (1970): 561-6
  5. Goadsby P, Donaghy A, Lloyd A, Wakefield D "Acquired immunodeficiency syndrome (AIDS) and sulfadiazine-associated acute renal failure." Ann Intern Med 107 (1987): 783-4
  6. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med 84 (1988): 791-2
  7. Carbone L, Bendixen B, Appel G "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis 12 (1988): 72-5
  8. Christin S, Baumelou A, Bahri S, Ben Hmida M, Deray G, Jacobs C "Acute renal failure due to sulfadiazine in patients with AIDS." Nephron 55 (1990): 233-4

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  9. Simon D, Brosius F, Rothstein D "Sulfadiazine crystalluria revisited." Arch Intern Med 150 (1990): 2379-84
  10. Molina J, Belenfant X, Doco-Lecompte T, et al. "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS 5 (1991): 587-9
  11. Marques L, Silva M, Madeira E, Santos O "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron 62 (1992): 361
  12. Hekster C, Vree T "Clinical pharmacokinetics of sulphonamides and their N4-acetyl derivatives." Antibiot Chemother 31 (1982): 22-118
  13. Adam W, Dawborn J "Urinary excretion and plasma levels of sulphonamides in patients with renal impairment." Australas Ann Med 19 (1970): 250-4
  14. Madsen S "A comparative study of the excretion of sulfonamide-metabolites in cases of renal failure and hepatitis." Chemotherapy 11 (1966): 1-9
  15. Andreasen F, Elsborg L, Husted S, Thomsen O "Pharmacokinetics of sulfadiazine and trimethoprim in man." Eur J Clin Pharmacol 14 (1978): 57-67
  16. Bergan T, Brodwall E, Vik-Mo H, Anstad U "Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function." Infection 7 (1979): s382-7
  17. Ortengren B, Fellner H, Bergan T "Development of sulphonamide-trimethoprim combinations for urinary tract infections. Part 2: Comparative pharmacokinetics of five sulphonamides." Infection 7 Suppl 4 (1979): s367-70
  18. Stachowska B, Senczuk W "Studies on kinetics of sulfadiazine and trimethoprim excretion in man." Int J Clin Pharmacol Ther Toxicol 25 (1987): 81-5
  19. Ohnhaus EE, Spring P "Elimination kinetics of sulfadiazine in patients with normal and impaired renal function." J Pharmacokinet Biopharm 3 (1975): 171-9
  20. Ortengren B, Magni L, Bergan T "Development of sulphonamide-trimethoprim combinations for urinary tract infections. part 3: pharmacokinetic characterization of sulphadiazine and sulphamethoxazole." Infection 7 (1979): s371-81
  21. Bergan T, Brodwall EK "Human pharmacokinetics of a sulfamethoxazole-trimethoprim combination." Acta Med Scand 192 (1972): 483-92
  22. Adam WR, Henning M, Dawborn JK "Excretion of trimethoprim and sulphamethoxazole in patients with renal failure." Aust N Z J Med 3 (1973): 383-7
  23. Kremers P, Duvivier J, Heusghem C "Pharmacokinetic studies of co-trimoxazole in man after single and repeated doses." J Clin Pharmacol 14 (1974): 112-7
  24. Rieder J, Schwartz DE, Fernex M, et al. "Pharmacokinetics of the antibacterial combination sulfamethoxazole plus trimethoprim in patients with normal or impaired kidney function." Antibiot Chemother 18 (1974): 148-98
  25. Bergan T, Brodwall EK, Vik-Mo H, Anstad U "Pharmacokinetics of sulphadiazine, sulphamethoxazole and trimethoprim in patients with varying renal function." Infection 7 (1979): s382-7
  26. Patel RB, Welling PG "Clinical pharmacokinetics of co-trimoxazole (trimethoprim-sulphamethoxazole)." Clin Pharmacokinet 5 (1980): 405-23
  27. Vergin H, Ferber H, Zimmermann I, Neurath GB "Single and multiple dose kinetics of co-tetroxazine and co-trimoxazole in patients." Int J Clin Pharmacol Ther Toxicol 19 (1981): 350-7
  28. Cohen M, Pocelinko R "Renal transport mechanisms for the excretion of sulfisoxazole." J Pharmacol Exp Ther 185 (1973): 703-12
  29. Shermantine M, Gambertoglio J, Amend W, Vincenti F, Oie S "Pharmacokinetics of sulfisoxazole in renal transplant patients." Antimicrob Agents Chemother 28 (1985): 535-9
  30. Dwarakanath AD, Michael J, Allan RN "Sulphasalazine-induced renal failure." Gut 33 (1992): 1006-7
  31. Marques LP, Silva MT, Madeira EP, Santos OR "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron 62 (1992): 361
  32. Sasson JP, Dratch PL, Shortsleeve MJ "Renal US findings in sulfadiazine-induced crystalluria." Radiology 185 (1992): 739-40
  33. Farinas MC, Echevarria S, Sampedro I, Gonzalez A, Perez del Molino A, Gonzalez-Macias J "Renal failure due to sulphadiazine in AIDS patients with cerebral toxoplasmosis." J Intern Med 233 (1993): 365-7
  34. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol 39 (1993): 254-6
  35. Erturk E, Casemento JB, Guertin KR, Kende AS "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol 151 (1994): 1605-6
  36. Becker K, Jablonowski H, Haussinger D "Sulfadiazine-associated nephrotoxicity in patients with the acquired immunodeficiency syndrome." Medicine 75 (1996): 185-94
  37. "Product Information. Gantrisin (sulfiSOXAZOLE)." Roche Laboratories (2022):
  38. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc (2001):
  39. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc (2001):
  40. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  41. "Product Information. Sodium Sulamyd (sulfacetamide sodium ophthalmic)." Schering Corporation
  42. "Product Information. Sultrin Triple Sulfa (triple sulfa topical)." Janssen Pharmaceuticals
  43. "Product Information. Sulfacet-R (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  44. "Product Information. AVC (sulfanilamide topical)." Aventis Pharmaceuticals (2022):

• Liver Diseases

  Moderate

  Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. Hepatotoxicity, including jaundice, diffuse hepatocellular necrosis, hypersensitivity hepatitis and hepatic failure, has rarely been reported in patients receiving sulfonamides. In addition, sulfonamides are partially metabolized by the liver and may accumulate in patients with hepatic impairment. Therapy with topical sulfonamides should be administered cautiously in patients with liver disease.

  40 sources

  1. Kowdley K, Keeffe E, Fawaz K "Prolonged cholestasis due to trimethoprim-sulfamethoxazole." Gastroenterology 102 (1992): 2148-50
  2. Hofer T, Becker EW, Weigand K, Berg PA "Demonstration of sensititzed lymphocytes to trimethoprim/sulfamethoxazole and ofloxacin in a patient with cholestatic hepatitis." J Hepatol 15 (1992): 262-3
  3. Stevenson D, Christie D, Haas J "Hepatic injury in a child caused by trimethoprim-sulfamethoxazole." Pediatrics 61 (1978): 864-6
  4. Horak J, Mertl L, Hrabal P "Severe liver injuries due to sulfamethoxazole-trimethoprim and sulfamethoxydiazine." Hepatogastroenterology 31 (1984): 199-200
  5. Steinbrecher U, Mishkin S "Sulfamethoxazole-induced hepatic injury." Dig Dis Sci 26 (1981): 756-9
  6. Alberti-Flor JJ, Hernandez ME, Ferrer JP, Howell S, Jeffers L "Fulminant liver failure and pancreatitis associated with the use of sulfamethoxazole-trimethoprim." Am J Gastroenterol 84 (1989): 1577-9
  7. Ransohoff D, Jacobs G "Terminal hepatic failure following a small dose of sulfamethoxazole-trimethoprim." Gastroenterology 80 (1981): 816-9
  8. Hekster C, Vree T "Clinical pharmacokinetics of sulphonamides and their N4-acetyl derivatives." Antibiot Chemother 31 (1982): 22-118

  Show all 40 sourcesShow fewer sources

  9. Madsen S "A comparative study of the excretion of sulfonamide-metabolites in cases of renal failure and hepatitis." Chemotherapy 11 (1966): 1-9
  10. Andreasen F, Elsborg L, Husted S, Thomsen O "Pharmacokinetics of sulfadiazine and trimethoprim in man." Eur J Clin Pharmacol 14 (1978): 57-67
  11. Ortengren B, Fellner H, Bergan T "Development of sulphonamide-trimethoprim combinations for urinary tract infections. Part 2: Comparative pharmacokinetics of five sulphonamides." Infection 7 Suppl 4 (1979): s367-70
  12. Stachowska B, Senczuk W "Studies on kinetics of sulfadiazine and trimethoprim excretion in man." Int J Clin Pharmacol Ther Toxicol 25 (1987): 81-5
  13. Ortengren B, Magni L, Bergan T "Development of sulphonamide-trimethoprim combinations for urinary tract infections. part 3: pharmacokinetic characterization of sulphadiazine and sulphamethoxazole." Infection 7 (1979): s371-81
  14. Bergan T, Brodwall EK "Human pharmacokinetics of a sulfamethoxazole-trimethoprim combination." Acta Med Scand 192 (1972): 483-92
  15. Kremers P, Duvivier J, Heusghem C "Pharmacokinetic studies of co-trimoxazole in man after single and repeated doses." J Clin Pharmacol 14 (1974): 112-7
  16. Patel RB, Welling PG "Clinical pharmacokinetics of co-trimoxazole (trimethoprim-sulphamethoxazole)." Clin Pharmacokinet 5 (1980): 405-23
  17. Khan AK, Truelove SC, Aronson JK "The disposition and metabolism of sulphasalazine (salicylazosulphapyridine) in man." Br J Clin Pharmacol 13 (1982): 523-8
  18. Klotz U "Clinical pharmacokinetics of sulphasalazine, its metabolites and other prodrugs of 5-aminosalicylic acid." Clin Pharmacokinet 10 (1985): 285-302
  19. Leroux JL, Ghezail M, Chertok P, Blotman F "Hypersensitivity reactions to sulfasalazine: skin rash, fever, hepatitis and activated lymphocytes." Clin Exp Rheumatol 10 (1992): 427
  20. Kanner RS, Tedesco FJ, Kalser MH "Azulfidine- (sulfasalazine-) induced hepatic injury." Am J Dig Dis 23 (1978): 956-8
  21. Losek JD, Werlin SL "Sulfasalazine hepatotoxicity." Am J Dis Child 135 (1981): 1070-2
  22. Fich A, Schwartz J, Braverman D, Zifroni A, Rachmilewitz D "Sulfasalazine hepatotoxicity." Am J Gastroenterol 79 (1984): 401-2
  23. Ribe J, Benkov KJ, Thung SN, Shen SC, LeLeiko NS "Fatal massive hepatic necrosis: a probable hypersensitivity reaction to sulfasalazine." Am J Gastroenterol 81 (1986): 205-8
  24. Poland GA, Love KR "Marked atypical lymphocytosis, hepatitis, and skin rash in sulfasalazine drug allergy." Am J Med 81 (1986): 707-8
  25. Sotolongo RP, Neefe LI, Rudzki C, Ishak KG "Hypersensitivity reaction to sulfasalazine with severe hepatotoxicity." Gastroenterology 75 (1978): 95-9
  26. Haines JD, Jr "Hepatotoxicity after treatment with sulfasalazine." Postgrad Med 79 (1986): 193-4,
  27. Marinos G, Riley J, Painter DM, McCaughan GW "Sulfasalazine-induced fulminant hepatic failure." J Clin Gastroenterol 14 (1992): 132-5
  28. Namias A, Bhalotra R, Donowitz M "Reversible sulfasalazine-induced granulomatous hepatitis." J Clin Gastroenterol 3 (1981): 193-8
  29. Gremse DA, Bancroft J, Moyer MS "Sulfasalazine hypersensitivity with hepatotoxicity, thrombocytopenia, and erythroid hypoplasia." J Pediatr Gastroenterol Nutr 9 (1989): 261-3
  30. Rubin R "Sulfasalazine-induced fulminant hepatic failure and necrotizing pancreatitis." Am J Gastroenterol 89 (1994): 789-91
  31. Schroder H, Campbell DE "Absorption, metabolism, and excretion of salicylazosulfapyridine in man." Clin Pharmacol Ther 13 (1972): 539-51
  32. Simma B, Meister B, Deutsch J, Sperl W, Fend F, Ofner D, Margreiter R, Vogel W "Fulminant hepatic failure in a child as a potential adverse effect of trimethoprim-sulphamethoxazole." Eur J Pediatr 154 (1995): 530-3
  33. "Product Information. Gantrisin (sulfiSOXAZOLE)." Roche Laboratories (2022):
  34. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc (2001):
  35. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc (2001):
  36. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  37. "Product Information. Sodium Sulamyd (sulfacetamide sodium ophthalmic)." Schering Corporation
  38. "Product Information. Sultrin Triple Sulfa (triple sulfa topical)." Janssen Pharmaceuticals
  39. "Product Information. Sulfacet-R (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  40. "Product Information. AVC (sulfanilamide topical)." Aventis Pharmaceuticals (2022):

• 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):

• Prinzmetal's variant angina

  Moderate

  Agents with non-selective beta-blocking activity may provoke chest pain in patients with Prinzmetal's variant angina. the use of non-selective beta blockers is not recommended in these patients. Caution should be taken in the administration of these agents to patients suspected of having Prinzmetal's variant angina.

  9 sources

  1. "Product Information. Normodyne (labetalol)." Schering Corporation (2002):
  2. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb (2002):
  3. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories (2001):
  4. "Product Information. Blocadren (timolol)." Merck & Co., Inc (2001):
  5. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical (2001):
  6. "Product Information. Betapace (sotalol)." Berlex Laboratories (2001):
  7. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation (2001):
  8. "Product Information. Levatol (penbutolol)." Reed and Carnrick (2001):

  Show all 9 sourcesShow fewer sources

  9. "Product Information. Coreg (carvedilol)." SmithKline Beecham (2001):

• 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):

• Urethral Obstruction

  Moderate

  Sulfonamides may be systemically absorbed when applied to the skin, eye, or mucosal membranes. Once absorbed, sulfonamides are excreted and concentrated in the urine. Therapy with topical sulfonamides should be administered cautiously in patients with urinary obstruction or retention, since excessive drug accumulation may occur. These patients may also be at increased risk for sulfonamide crystalluria, which may be associated with renal toxicity such as uro- and nephrolithiasis, nephritis, toxic nephrosis, hematuria, proteinuria, and elevated BUN and creatinine. A urinary output of at least 1.5 L/day should be maintained during sulfonamide administration. Renal function tests and urinalysis should be performed regularly during prolonged therapy (> 2 weeks).

  17 sources

  1. Sahai J, Heimberger R, Collins K, Kaplowitz L, Polk R "Sulfadiazine-induced crystalluria in a patient with the acquired immunodeficiency syndrome: a reminder." Am J Med 84 (1988): 791-2
  2. Carbone L, Bendixen B, Appel G "Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome." Am J Kidney Dis 12 (1988): 72-5
  3. Simon D, Brosius F, Rothstein D "Sulfadiazine crystalluria revisited." Arch Intern Med 150 (1990): 2379-84
  4. Molina J, Belenfant X, Doco-Lecompte T, et al. "Sulfadiazine-induced crystalluria in AIDS patients with toxoplasma encephalitis." AIDS 5 (1991): 587-9
  5. Marques L, Silva M, Madeira E, Santos O "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron 62 (1992): 361
  6. Marques LP, Silva MT, Madeira EP, Santos OR "Obstructive renal failure due to therapy with sulfadiazine in an AIDS patient." Nephron 62 (1992): 361
  7. Sasson JP, Dratch PL, Shortsleeve MJ "Renal US findings in sulfadiazine-induced crystalluria." Radiology 185 (1992): 739-40
  8. Hein R, Brunkhorst R, Thon WF, Schedel I, Schmidt RE "Symptomatic sulfadiazine crystalluria in AIDS patients: a report of two cases." Clin Nephrol 39 (1993): 254-6

  Show all 17 sourcesShow fewer sources

  9. Erturk E, Casemento JB, Guertin KR, Kende AS "Bilateral acetylsulfapyridine nephrolithiasis associated with chronic sulfasalazine therapy." J Urol 151 (1994): 1605-6
  10. "Product Information. Gantrisin (sulfiSOXAZOLE)." Roche Laboratories (2022):
  11. "Product Information. Azopt (brinzolamide ophthalmic)." Alcon Laboratories Inc (2001):
  12. "Product Information. Trusopt (dorzolamide ophthalmic)." Merck & Co., Inc (2001):
  13. "Product Information. Klaron (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  14. "Product Information. Sodium Sulamyd (sulfacetamide sodium ophthalmic)." Schering Corporation
  15. "Product Information. Sultrin Triple Sulfa (triple sulfa topical)." Janssen Pharmaceuticals
  16. "Product Information. Sulfacet-R (sulfacetamide sodium topical)." Dermik Laboratories/Aventis (2001):
  17. "Product Information. AVC (sulfanilamide topical)." Aventis Pharmaceuticals (2022):

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