Basic Information
ID DDInter1346 and DDInter305
Interaction Beta-blockers may antagonize the effects of beta-2 adrenergic bronchodilators and precipitate acute, life-threatening bronchospasm in patients with asthma or other obstructive airway diseases. The mechanism involves increased airway resistance and reduced bronchodilation due to blockade of beta-2 adrenergic receptors. The interaction may also occur with ophthalmically applied beta-blockers, which are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. Due to opposing effects on beta-2 adrenergic receptors, propranolol has been used in the treatment of albuterol overdose. Likewise, beta-2 adrenergic agonists may interfere with the pharmacologic effects of beta-blockers.
Management Concomitant use of beta-2 adrenergic bronchodilators with beta-blockers, including ophthalmic formulations, should generally be avoided. If coadministration is required, a cardioselective beta-blocker (e.g., acebutolol, atenolol, betaxolol, bisoprolol, metoprolol, nebivolol) is usually preferred. Nevertheless, caution is advised and respiratory status should be closely monitored, as cardioselectivity is not absolute and larger doses of beta-1 selective agents may pose some of the same risks as nonselective agents. In general, nonselective beta-blockers are considered contraindicated in patients with obstructive airways disease.
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Eur J Clin Pharmacol 8 (1975): 175-80 [20] Mooss AN, Hilleman DE, Mohiuddin SM, Hunter CB "Safety of esmolol in patients with acute myocardial infarction treated with thrombolytic therapy who had relative contraindications to beta-blocker therapy." Ann Pharmacother 28 (1994): 701-3 [21] Ashrafian H, Violaris AG "Beta-blocker therapy of cardiovascular diseases in patients with bronchial asthma or COPD: the pro viewpoint." Prim Care Respir J 14 (2005): 236-41 [22] Tafreshi MJ, Weinacker AB "Beta-adrenergic-blocking agents in broncospastic diseases: a therapeutic dilemma." Pharmacotherapy 19 (1999): 974-8 [23] "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ. [24] Hollenberg NK "The role of beta-blockers as a cornerstone of cardiovascular therapy." Am J Hypertens 18(12 Pt 2) (2005): 165S-168S [25] Herschman Z, Kaufman B "Complications arising from the use of ophthalmologic medications in an intensive care unit patient." 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Breo Ellipta (fluticasone-vilanterol)." GlaxoSmithKline, Research Triangle Park, NC. [34] Cazzola M, Noschese P, D'Amato G, Matera MG "The pharmacologic treatment of uncomplicated arterial hypertension in patients with airway dysfunction." Chest 121 (2002): 230-41 [35] De Bono G, Kaye CM, Roland E, Summers AJ "Acebutolol: ten years of experience." Am Heart J 109 (1985): 1211-3 [36] van der Woude HJ, Zaagsma J, Postma DS, Winter TH, van Hulst M, Aalbers R "Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers." Chest 127 (2005): 818-24 [37] Cazzola M, Noschese P, D'Amato M, D'Amato G "Comparison of the effects of single oral doses of nebivolol and celiprolol on airways in patients with mild asthma." Chest 118 (2000): 1322-6 [38] "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals, East Hanover, NJ. [39] Salpeter SR, Ormiston TM, Salpeter EE "Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis." Ann Intern Med 137 (2002): 715-25 [40] "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
Alternative for Orciprenaline R03A
Mometasone furoate Umeclidinium Beclomethasone dipropionate Ipratropium Cromoglicic acid Mometasone
Aclidinium

R03C
Alternative for Carvedilol C07A

C07F
Felodipine Acetylsalicylic acid Nifedipine Amlodipine
Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.