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Drug Interactions between Darvon and Lopressor

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

metoprolol propoxyphene

Applies to: Lopressor (metoprolol) and Darvon (propoxyphene)

MONITOR: Propoxyphene may increase the serum levels of some oral beta-blockers. The proposed mechanism is inhibition of CYP450 2D6 first-pass metabolism and decreased hepatic clearance. Data are available for metoprolol and propranolol only; however, other hepatically metabolized beta-blockers may also be affected. Renally excreted beta-blockers such as atenolol, carteolol, nadolol, or sotalol are not expected to interact.

MANAGEMENT: Patients receiving this combination should be monitored for hypotension, heart failure, bradycardia, arrhythmias, and mental status changes when propoxyphene is added to the patient's medical regimen, and for decreased beta-blockade when propoxyphene is deleted from the regimen. A reduction in beta-blocker dosage may necessary.

References

  1. Stagni G, Davis PJ, Ludden TM (1991) "Human pharmacokinetics of betaxolol enantiomers." J Pharm Sci, 80, p. 321-4
  2. Janku I, Perlik F, Tkaczykova M, Brodanova M (1992) "Disposition kinetics and concentration-effect relationship of metipranolol in patients with cirrhosis and healthy subjects." Eur J Clin Pharmacol, 42, p. 337-40
  3. Lundborg P, Regard CG (1981) "The effect of propoxyphene pretreatment on the disposition of metoprolol and propranolol." Clin Pharmacol Ther, 29, p. 263-4
  4. Piquette-Miller M, Foster RT, Kappagoda CT, Jamali F (1992) "Effect of aging on the pharmacokinetics of acebutolol enantiomers." J Clin Pharmacol, 32, p. 148-56
  5. Smith RL (1985) "Polymorphic metabolism of the beta-adrenoreceptor blocking drugs and its clinical relevance." Eur J Clin Pharmacol, 28, p. 77-84
  6. McGourty JC, Silas JH, Fleming JJ, McBurney A, Ward JW (1985) "Pharmacokinetics and beta-blocking effects of timolol in poor and extensive metabolizers of debrisoquin." Clin Pharmacol Ther, 38, p. 409-13
  7. Le Coz F, Sauleman P, Poirier JM, Cuche JL, Midavaine M, Rames A, Lecocq B, Jaillon P (1991) "Oral pharmacokinetics of bisoprolol in resting and exercising healthy volunteers." J Cardiovasc Pharmacol, 18, p. 28-34
  8. Amemiya M, Tabei K, Furuya H, Sakairi Y, Asano Y (1992) "Pharmacokinetics of carteolol in patients with impaired renal function." Eur J Clin Pharmacol, 43, p. 417-21
  9. (2002) "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc
  10. (2002) "Product Information. Normodyne (labetalol)." Schering Corporation
  11. (2002) "Product Information. Corgard (nadolol)." Bristol-Myers Squibb
  12. (2001) "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories
  13. (2001) "Product Information. Blocadren (timolol)." Merck & Co., Inc
  14. (2001) "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals
  15. (2001) "Product Information. Betapace (sotalol)." Berlex Laboratories
  16. (2001) "Product Information. Levatol (penbutolol)." Reed and Carnrick
  17. Morgan T (1994) "Clinical pharmacokinetics and pharmacodynamics of carvedilol." Clin Pharmacokinet, 26, p. 335-46
  18. McTavish D, Campoli-Richards D, Sorkin EM (1993) "Carvedilol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy." Drugs, 45, p. 232-58
  19. Seffart G ed. (1991) "Drug Dosage in Renal Insufficiency." Dordrecht, South Holland, : Kluwer Academic Publishers
  20. Limbird LE eds., Gilman AG, Hardman JG (1995) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: McGraw-Hill
View all 20 references

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Drug and food interactions

Major

propoxyphene food

Applies to: Darvon (propoxyphene)

GENERALLY AVOID: Alcohol may have additive CNS- and/or respiratory-depressant effects with propoxyphene. Misuse of propoxyphene, either alone or in combination with other CNS depressants, has been a major cause of drug-related deaths, particularly in patients with a history of emotional disturbances, suicidal ideation, or alcohol and drug abuse.

MANAGEMENT: The use of alcohol during propoxyphene therapy should be avoided. Patients should be warned not to exceed the recommended dosage of propoxyphene and to avoid activities requiring mental alertness until they know how these agents affect them.

References

  1. (2001) "Product Information. Darvon (propoxyphene)." Lilly, Eli and Company

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Moderate

metoprolol food

Applies to: Lopressor (metoprolol)

ADJUST DOSING INTERVAL: The bioavailability of metoprolol may be enhanced by food.

MANAGEMENT: Patients may be instructed to take metoprolol at the same time each day, preferably with or immediately following meals.

References

  1. (2001) "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals
  2. Darcy PF (1995) "Nutrient-drug interactions." Adverse Drug React Toxicol Rev, 14, p. 233-54

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Moderate

metoprolol food

Applies to: Lopressor (metoprolol)

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 429-35

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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