Bivolol Drug Interactions

Pharmacodynamic interactions: The following interactions apply to beta-blockers in general: Combinations not recommended: Class I antiarrhythmics (quinidine, hydroquinidine, cibenzoline, flecainide, disopyramide, lidocaine, mexiletine, propafenone): effect on atrio-ventricular conduction time may be potentiated and negative inotropic effect increased.
Calcium channel antagonists of verapamil/diltiazem type: negative influence on contractility and atrio-ventricular conduction. Intravenous administration of verapamil in patients with β-blocker treatment may lead to profound hypotension and atrio-ventricular block.
Centrally-acting antihypertensives (clonidine, guanfacin, moxonidine, methyldopa, rilmenidine): concomitant use of centrally acting antihypertensive drugs may worsen heart failure by a decrease in the central sympathetic tonus (reduction of heart rate and cardiac output, vasodilation). Abrupt withdrawal, particularly if prior to beta-blocker discontinuation, may increase risk of "rebound hypertension".
Combinations to be used with caution: Class III antiarrhythmic drugs (Amiodarone): effect on atrio-ventricular conduction time may be potentiated.
Anaesthetics - volatile halogenated: concomitant use of beta-adrenergic antagonists and anaesthetics may attenuate reflex tachycardia and increase the risk of hypotension. As a general rule, avoid sudden withdrawal of beta-blocker treatment. The anaesthesiologist should be informed when the patient is receiving nebivolol.
Insulin and oral antidiabetic drugs: although nebivolol does not affect glucose level, concomitant use may mask certain symptoms of hypoglycemia (palpitations, tachycardia).
Baclofen (antispastic agent), amifostine (antineoplastic adjunct): concomitant use with antihypertensives is likely to increase the fall in blood pressure, therefore the dosage of the antihypertensive medication should be adjusted accordingly.
Combinations to be considered: The following concomitant use with Nebivolol should be considered.
Digitalis glycosides, Calcium antagonists of the dihydropyridine type (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nitrendipine), Antipsychotics, antidepressants (tricyclics, barbiturates and phenothiazines), Non steroidal anti-inflammatory drugs (NSAID), Sympathicomimetic agents.
Pharmacokinetic interactions: Co-administration of Nebivolol with bupropion, paroxetine, fluoxetine, thioridazine, quinidine, chloroquine, levomepromazin, terbinafine and cimetidine may lead to increased plasma levels of nebivolol.
Co-administration of ranitidine, alcohol, furosemide or hydrochlorothiazide did not affect the pharmacokinetics of nebivolol.
Combining Nebivolol with Nicardipine slightly increased the plasma levels of both drugs.
Nebivolol does not affect the pharmacokinetics and pharmacodynamics of warfarin.