Nitroxel Drug Interactions

The following interactions apply to beta-adrenergic antagonists 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 medicinal products 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 substances (Amiodarone): Effect on atrio-ventricular conduction time may be potentiated.
Anesthetics - volatile halogenated: Concomitant use of beta-adrenergic antagonists and anesthetics may attenuate reflex tachycardia and increase the risk of hypotension. As a general rule, avoid sudden withdrawal of beta-blocker treatment. The anesthesiologist should be informed when the patient is receiving nebivolol tablet.
Insulin and oral antidiabetic substances: 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 high blood pressure, therefore, the dosage of the antihypertensive medicinal products should be adjusted accordingly.
Combinations to be considered: Digitalis glycosides: Concomitant use may increase atrio-ventricular conduction time. Clinical trials with nebivolol have not shown any clinical evidence of an interaction. Nebivolol does not influence the kinetics of digoxin.
Calcium antagonists of dihydropyridine type (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nitrendipine): Concomitant use may increase the risk of hypotension, and an increase in the risk of a further deterioration of the ventricular pump function in patients with heart failure cannot be excluded.
Antipsychotics, antidepressants (tricyclics, barbiturates, and phenothiazines): Concomitant use may enhance the hypotensive effect of the beta-blockers (additive effect).
Non-steroidal anti-inflammatory drugs (NSAID): No effect on the blood pressure lowering effect of nebivolol.
Sympathomimetic agents: Concomitant use may counteract the effect of beta-adrenergic antagonists. Beta-adrenergic agents may lead to unopposed alpha-adrenergic activity of sympathicomimetic agents with both alpha- and beta-adrenergic effects (risk of hypertension, severe bradycardia and heart block).
Pharmacokinetic interactions: As nebivolol metabolism involves the CYP2D6 isoenzyme, co-administration with substances inhibiting this enzyme, especially paroxetine, fluoxetine, thioridazine and quinidine may lead to increased plasma levels of nebivolol associated with an increased risk of excessive bradycardia and adverse events.
Co-administration of cimetidine increased the plasma levels of nebivolol, without changing the clinical effect. Co-administration of ranitidine did not affect the pharmacokinetic of nebivolol. Provided nebivolol tablets are taken with the meal, the two treatments can be co-prescribed.
Combining nebivolol with nicardipine slightly increased the plasma levels of both active substances, without changing the clinical effect.
Co-administration of alcohol, furosemide and hydrochlorothiazide did not affect the pharmacokinetics of nebivolol.
Nebivolol does not affect the pharmacokinetics and pharmacodynamics of warfarin.