Lodoz Drug Interactions

Bisoprolol: Volatile Halogenated Anesthetics: Reduction of the compensating cardiovascular reactions by β-blockers. (β-adrenergic inhibition can be lifted during the intervention by β-stimulants.) As a general rule, do not interrupt treatment with β-blockers, and in any event do not interrupt it suddenly. Inform the anesthetist of this treatment. The concurrent use of rifampicin can reduce the elimination half-life of bisoprolol, although an increase in dose is generally not necessary.
Theophylline: β-Blockers should be avoided on pharmacological grounds (bronchospasm).
Corticosteroids, NSAIDs: Antagonism of hypotensive effect.
Calcium-Channel Blockers (Bepridil, Diltiazem, Verapamil): Automatism disorders (excessive bradycardia, sinus arrest), sinoatrial and atrioventricular conduction disturbances and heart failure (synergistic effects). Such combinations should only be used with close clinical monitoring including ECGs, especially in the elderly or at the beginning of treatment.
Dihydropyridines (Combination to be Taken into Account): Hypotension, heart failure in patients with latent or uncontrolled heart failure (negative inotropic effect of dihydropyridines in vitro, possibly acting additively with the negative inotropic effect of β-blockers). The presence of the β-blocker treatment can furthermore reduce the reflex sympathetic reaction occurring in case of excessive hemodynamic repercussion.
Antiarrhythmics (Propafenone and Class 1A Drugs: Quinidine, Hydroquinidine, Disopyramide and Amiodarone): Contractility, automatism and conduction disorders (reduction of compensating sympathetic mechanisms), increased risk of myocardial depression and bradycardia.
Insulin and Sulfonamide Hypoglycemics: All β-blockers may enhance hypoglycemic effect and mask certain symptoms of hypoglycemia: Palpitations and tachycardia. Warn the patient and increase self-monitoring of blood glucose, especially at the beginning of treatment.
Lidocaine (Described for Propranolol, Metoprolol and Nadolol): Elevation of plasma lidocaine levels, with a possible increase in undesirable neurological and cardiac effects (reduction of the liver metabolism of lidocaine). Adjust the dosage of lidocaine. Clinical monitoring, ECG and possibly, monitoring of plasma lidocaine levels during and after interruption of treatment with β-blockers.
Connected with Hydrochlorothiazide: Lithium: Increased serum lithium levels with signs of overdosage, as in low-sodium regimes (reduced urinary excretion of lithium). If this combination cannot be avoided, strict surveillance of serum lithium and adaptation of the dosage are necessary.
High Doses of Salicylates: See NSAIDs.
Hyperkalemic Diuretics (Amiloride, Potassium canreonate, Spironolactone, Triamterene): Rational combination, used for certain patients, does not exclude the occurrence of hypokalemia, or particularly in cases of renal failure and in diabetics, hyperkalemia. Monitor the serum potassium possibly record an electrocardiogram (ECG) and if necessary, re-assess the treatment.
Angiotensin-Converting Enzyme (ACE) Inhibitors: Risk of a sudden fall in blood pressure and/or of acute renal failure while establishing treatment with an ACE inhibitor in cases of existing sodium depletion (particularly in patients with renal artery stenosis).
NSAIDs: Reduced antihypertensive effect (inhibition of vasodilating prostaglandins by NSAIDs and water and sodium retention in case of pyrazole NSAIDs). Acute renal failure in dehydrated patients (reduced glomerular filtration). Hydration of the patient: Monitoring of renal function at the beginning of treatment.
Imipramine Antidepressants (Tricyclic Antidepressants): Antihypertensive effect and increased risk of orthostatic hypotension (additive effect).