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Nebivolol / valsartan Disease Interactions

There are 26 disease interactions with nebivolol / valsartan:

Major

AR antagonist (applies to nebivolol/valsartan) diabetes

Major Potential Hazard, Moderate plausibility. Applicable conditions: Diabetes Mellitus

The coadministration of some angiotensin II receptor blocker agents with aliskiren is contraindicated in patients with diabetes.

Major

AR antagonists (applies to nebivolol/valsartan) angioedema

Major Potential Hazard, Moderate plausibility.

The use of these agents is contraindicated in patients with a history of angioedema related to previous angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) therapy or in patients with hereditary angioedema. Patients with a history of angioedema unrelated to these agents may be at increased risk of angioedema while receiving angiotensin II receptor (AR) antagonists. Patients should be advised to immediately report any signs or symptoms suggestive of angioedema (swelling of face, extremities, eyes, lips, or tongue, or difficulty swallowing or breathing) and to stop taking the medication until otherwise directed by their physician. Emergency therapy and/or measures to prevent airway obstruction are required for angioedema involving the tongue, glottis, or larynx. Treatment with angiotensin II receptor (AR) antagonists should be discontinued permanently if angioedema develops in association with therapy.

Major

AR antagonists (applies to nebivolol/valsartan) hypotension

Major Potential Hazard, High plausibility. Applicable conditions: Dehydration, hemodialysis, Hyponatremia

Angiotensin II receptor (AR) antagonists can cause symptomatic hypotension in patients with an activated renin-angiotensin system, such as volume- and/or sodium-depleted patients. Therapy with AR antagonists should be administered cautiously in such patients and in those predisposed to hypovolemic or hyponatremic states (e.g., patients on diuretic therapy, especially if high doses were used or if recently instituted; those on dietary salt restriction; renal dialysis patients). Volume and/or sodium depletion should be corrected prior to initiating therapy with AR antagonists, and the patient should be hemodynamically stable. Ideally, patients at risk for excessive hypotension should initiate AR antagonist therapy under close medical supervision, preferably with a lower dose, and followed closely for the first 2 weeks of treatment and whenever the dosage of AR antagonist or diuretic is increased.

References

  1. "Product Information. Cozaar (losartan)." Merck & Co, Inc, West Point, PA.
  2. Goldberg AI, Dunlay MC, Sweet CS "Safety and tolerability of losartan potassium, and angiotensin II receptor antagonist, compared with hydrochlorothiazide, atenolol, felodipine ER, and angiotensin-converting enzyme inhibitors for the treatment of systemic hypertension." Am J Cardiol 75 (1995): 793-5
  3. Goldberg MR, Bradstreet TE, McWilliams EJ, Tanaka WK, Lipert S, Bjornsson TD, Waldman SA, Osborne B, Pivadori L, Lewis G, et al "Biochemical effects of losartan, a nonpeptide angiotensin II receptor antagonist, on the renin-angiotensin-aldosterone system in hypertensive patients." Hypertension 25 (1995): 37-46
  4. Weir MR, Elkins M, Liss C, Vrecenak AJ, Barr E, Edelman JM "Efficacy, tolerability, and quality of life of losartan, alone or with hydrochlorothiazide, versus nifedipine GITS in patients with essential hypertension." Clin Ther 18 (1996): 411-28
  5. Waeber B, Burnier M, Nussberger J, Brunner HR "Experience with angiotensin II antagonists in hypertensive patients." Clin Exp Pharmacol Physiol 23 ( Suppl (1996): s142-6
  6. van den Meiracker AH, Admiraal PJ, Janssen JA, Kroodsma JM, de Ronde WA, Boomsma F, Sissmann J, Blankestijn PJ, Mulder PG, Man In 't Veld AJ "Hemodynamic and biochemical effects of the AT1 receptor antagonist irbesartan in hypertension." Hypertension 25 (1995): 22-9
  7. Gibbs CR, Ferner RE, Beevers DG "Angiotensin receptor antagonists - a new class of antihypertensive drug." J Clin Pharm Ther 21 (1996): 127-30
  8. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals, East Hanover, NJ.
  9. Ellis ML, Patterson H "A new class of antihypertensive therapy: angiotensin II receptor antagonists." Pharmacotherapy 16 (1996): 849-60
  10. Weber MA, Bryyny RL, Pratt JH, et al. "Blood pressure effects of the angiotensin II receptor blocker, losartan." Arch Intern Med 155 (1995): 405-11
  11. Goldberg AI, Dunlay MC, Sweet CS "Safety and tolerability of losartan compared with atenolol, felodipine and angiotensin converting enzyme inhibitors." J Hypertens 13 Suppl (1995): s77-80
  12. Waeber B, Brunner HR "Angiotensin II antagonists: a new class of antihypertensive agent." Br J Clin Pract 50 (1996): 265-8
  13. Mcintyre M, Macfadyen RJ, Meredith PA, Menard J, Brunner HR, Insuasty J, Reid JL "Comparison of the oral angiotensin II receptor antagonist UP 269-6 or enalapril 20 mg on blood pressure and neurohormonal effects in salt-deplete man." J Cardiovasc Pharmacol 25 (1995): 994-1000
  14. "Product Information. Benicar (olmesartan)." Sankyo Parke Davis, Parsippany, NJ.
  15. Schaefer KL, Porter JA "Angiotensin II receptor antagonists: the prototype losartan." Ann Pharmacother 30 (1996): 625-36
  16. McClellan KJ, Markham A "Telmisartan." Drugs 56 (1998): 1039-44
  17. Doig JK, MacFadyen RJ, Sweet CS, Lees KR, Reid JL "Dose-ranging study of the angiotensin type I receptor antagonist losartan (DuP753/MK954), in salt-deplete normal man." J Cardiovasc Pharmacol 21 (1993): 732-8
  18. Karlberg BE, Lins LE, Hermansson K "Efficacy and safety of telmisartan, a selective AT(1) receptor antagonist, compared with enalapril in elderly patients with primary hypertension." J Hypertens 17 (1999): 293-302
  19. McIntyre M, MacFadyen RJ, Meredith PA, Brouard R, Reid JL "Dose-ranging study of the angiotensin II receptor antagonist irbesartan (SR 47436/BMS-186295) on blood pressure and neurohormona effects in salt-deplete men." J Cardiovasc Pharmacol 28 (1996): 101-6
  20. Tikkanen I, Omvik P, Jensen HA "Comparison of the angiotensin II antagonist losartan with the angiotensin converting enzyme inhibitor enalapril in patients with essential hypertension." J Hypertens 13 (1995): 1343-51
  21. Oparil S, Barr E, Elkins M, Liss C, Vrecenak A, Edelman J "Efficacy, tolerability, and effects on quality of life of losartan, alone or with hydrochlorothiazide, versus amlodipine, alone or with hydrochlorothiazide, in patients with essential hypertension." Clin Ther 18 (1996): 608-25
  22. Holwerda NJ, Fogari R, Angeli P, et al. "Valsartan, a new angiotensin II antagonist for the treatment of essential hypertension: efficacy and safety compared with placebo and enalapril." J Hypertens 14 (1996): 1147-115
View all 22 references
Major

Beta-blockers (applies to nebivolol/valsartan) bradyarrhythmia/AV block

Major Potential Hazard, High plausibility. Applicable conditions: Heart Block, Sinus Node Dysfunction

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

References

  1. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  2. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  3. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  4. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. Fauci AS, Braunwald E, Isselbacher KJ, Wilson JD, Martin JB, Kasper DL, Hauser SL, Longo DL, eds. "Harrison's Principles of Internal Medicine. 14th ed." New York, NY: McGraw-Hill Health Professionals Division (1998):
  6. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  7. Treseder AS, Thomas TP "Sinus arrest due to timolol eye drops." Br J Clin Pract 40 (1986): 256-8
  8. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  9. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  10. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  11. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  12. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  15. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  16. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  17. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  18. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  19. Crean PA, Williams DO "Effect of intravenous and oral acebutolol in patients with bundle branch block." Int J Cardiol 10 (1986): 119-26
  20. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  21. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
View all 21 references
Major

Beta-blockers (applies to nebivolol/valsartan) cardiogenic shock/hypotension

Major Potential Hazard, High plausibility.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

References

  1. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  2. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  3. "Product Information. Betagan Liquifilm (levobunolol)." Allergan Inc, Irvine, CA.
  4. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  5. "Product Information. Acupress (carteolol ophthalmic)." Otsuka American Pharmaceuticals Inc, Rockville, MD.
  6. Kholeif M, Isles C "Profound hypotension after atenolol in severe hypertension." Br Med J 298 (1989): 161-2
  7. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  9. Tirlapur VG, Evans PJ, Jones MK "Shock syndrome after acebutolol." Br J Clin Pract 40 (1986): 33-4
  10. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  11. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  13. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  14. "Product Information. Betoptic (betaxolol ophthalmic)." Alcon Laboratories Inc, Fort Worth, TX.
  15. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  16. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  17. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  18. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  19. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  20. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  21. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  22. "Product Information. OptiPranolol (metipranolol)." Bausch and Lomb, Tampa, FL.
  23. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
View all 23 references
Major

Beta-blockers (applies to nebivolol/valsartan) CHF

Major Potential Hazard, High plausibility. Applicable conditions: Congestive Heart Failure

Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Sympathetic stimulation may be important in maintaining the hemodynamic function in these patients, thus beta-blockade can worsen the heart failure. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Carvedilol, specifically, is indicated for use with these agents in the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.

References

  1. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  2. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  3. Kalman J, Buchholz C, Steinmetz M, Courtney M, Gass A, Lansman S, Kukin ML "Safety and efficacy of beta blockade in patients with chronic congestive heart failure awaiting transplantation." J Heart Lung Transplant 14 (1995): 1212-7
  4. Australia-New Zealand Heart Failure Research Collaborative Group. "Effects of carvedilol, a vasodilator-B-blocker, in patients with congestive heart failure due to ischemic heart disease." Circulation 92 (1995): 212-8
  5. Olsen SL, Gilbert EM, Renlund DG, Taylor DO, Yanowitz FD, Bristow MR "Carvedilol improves left ventricular function and symptoms in chronic heart failure: a double-blind randomized study." J Am Coll Cardiol 25 (1995): 1225-31
  6. Cleland JGF, Swedberg K "Carvedilol for heart failure, with care." Lancet 347 (1996): 1199-201
  7. Altus P "Timolol-induced congestive heart failure." South Med J 74 (1981): 88
  8. Myers J, Morgan T, Waga S, et al "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  9. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  10. Packer M, Bristow MR, Cohn JN, Colucci WS, Fowler MB, Gilbert EM, Shusterman NH "The effect of carvedilol on morbidity and mortality in patients with chronic heart failure." N Engl J Med 334 (1996): 1349-55
  11. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  12. Moye LA, Abernethy D "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318
  13. Michelson EL, Frishman WH, Lewis JE, et al "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." Am J Med Oct 17 (1983): 68-80
  14. Bristow MR, Gilbert EM, Abraham WT, et al. "Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. MOCHA Investigators." Circulation 94 (1996): 2807-16
  15. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  16. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  17. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  18. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  19. Adams KF Jr "Current perspectives on B-receptor antagonists in the treatment of symptomatic ventricular dysfunction." Pharmacotherapy 16(2 Pt 2) (1996): 69-77
  20. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  21. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  22. Krum H, Sackner-Bernstein JD, Goldsmith RL, et al. "Double-blind, placebo-controlled study of the long-term efficacy of carvedilol in patients with severe chronic heart failure." Circulation 92 (1995): 1499-506
  23. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  24. Packer M, Colucci WS, Sackner-Bernstein JD, Liang CS, Goldscher DA, Freeman I, Kukin ML, Kinhal V, Udelson JE, Klapholz M, Gottlieb SS, Pearle D "Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure. The PRECISE Trial Prospective Randomized Evaluation of Carvedilol on Symptoms an Exercise." Circulation 94 (1996): 2793-9
  25. Phillips KA, Shlipak MG, Coxson P, et al. "Health and economic benefits of increased B-blocker use following myocardial infarction." JAMA 284 (2000): 2748-54
  26. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  27. Macmahon S, Sharpe N, Doughty R, Krum H, Tonkin A, Trotter A, Burton R, Garrett J, Lane G, Owensby D, Ryan J, Shepherd J, Sing "Randomised, placebo-controlled trial of carvedilol in patients with congestive heart failure due to ischaemic heart disease." Lancet 349 (1997): 375-80
  28. Kelly DT "Carvedilol in heart failure." Cardiology 82 Suppl 3 (1993): 45-9
  29. Macdonald PS, Keogh AM, Aboyoun CL, Lund M, Amor R, McCaffrey DJ "Tolerability and efficacy of carvedilol in patients with New York Heart Association class IV heart failure." J Am Coll Cardiol 33 (1999): 924-31
  30. CIBIS-II Investigators and Committees. "The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial." Lancet 353 (1999): 9-13
  31. Packer M, Cohn JN, Colucci WS "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1310-20
  32. Lechat P, Packer M, Chalon S, Cucherat M, Arab T, Boissel JP "Clinical effects of beta-adrenergic blockade in chronic heart failure: A meta-analysis of double-blind, placebo-controlled, randomized trials." Circulation 98 (1998): 1184-91
  33. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  34. Persson H, Rythenalder E, Melcher A, Erhardt L "Effects of beta receptor antagonists in patients with clinical evidence of heart failure after myocardial infarction: double blind comparison of metoprolol and xamoterol." Br Heart J 74 (1995): 140-8
  35. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  36. Lechat P, Jaillon P, Fontaine ML, Chanton E, Mesenge C, Gagey S, Guillardeau A, Dussous V "A randomized trial of beta-blockade in heart failure - the cardiac insufficiency bisoprolol study (CIBIS)." Circulation 90 (1994): 1765-73
  37. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  38. Doughty RN, Whalley GA, Gamble G, MacMahon S, Sharpe N "Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia-Ne Zealand Heart Failure Research Collaborative Group." J Am Coll Cardiol 29 (1997): 1060-6
  39. Colucci WS, Packer M, Bristow MR, Gilbert EM, Cohn JN, Fowler MB, Krueger SK, Hershberger R, Uretsky BF, Bowers JA, Sackne "Carvedilol inhibits clinical progression in patients with mild symptoms of heart failure." Circulation 94 (1996): 2800-6
  40. Hjalmarson A, Goldstein S, Fagerberg B, et al. "Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF)." JAMA 283 (2000): 1295-302
  41. Persson SV, Erhardt L "Effects of beta receptor antagonists on left ventricular function in patients with clinical evidence of heart failure after myocardial infarction. A double-blind comparison of metoprolol and xamoterol: echocardiographic results from the Metoprolol and..." Eur Heart J 17 (1996): 741-9
  42. Maisel AS "Beneficial effects of metoprolol treatment in congestive heart failure - reversal of sympathetic-induced alterations of immunologic function." Circulation 90 (1994): 1774-80
  43. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  44. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  45. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  46. Von Olshausen K, Pop T, Berger J "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318-20
  47. Hart SM "Influence of B-blockers on mortality in chronic heart failure." Ann Pharmacother 34 (2000): 1440-51
View all 47 references
Major

Beta-blockers (applies to nebivolol/valsartan) diabetes

Major Potential Hazard, High plausibility. Applicable conditions: Diabetes Mellitus

Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.

References

  1. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  2. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  3. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  5. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  6. Grimaldi A, Bennett P, Delas B, et al "Beta-blockers and hypoglycaemia: assessment of cardioselective and intrinsic sympathomimetic properties in relation to severity of hypoglycaemia." Curr Ther Res Clin Exp 36 (1984): 361-73
  7. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  9. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  10. Velde TM, Kaiser FE "Ophthalmic timolol treatment causing altered hypoglycemic response in a diabetic patient." Arch Intern Med 143 (1983): 1627
  11. Giugliano D, Acampora R, Marfella R, DeRosa N, Ziccardi P, Ragone R, DeAngelis L, DOnofrio F "Metabolic and cardiovascular effects of carvedilol and atenolol in non-insulin-dependent diabetes mellitus and hypertension - A randomized, controlled trial." Ann Intern Med 126 (1997): 955-9
  12. Darga LL, Hakim MJ, Lucas CP, Franklin BA "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  15. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  16. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  17. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  18. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  19. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  20. Uusitupa M, Aro A, Pietikainen M "Severe hypoglycaemia caused by physical strain and pindolol therapy." Ann Clin Res 12 (1980): 25-7
  21. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
View all 21 references
Major

Beta-blockers (applies to nebivolol/valsartan) hypersensitivity

Major Potential Hazard, High plausibility. Applicable conditions: Allergies

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.

References

  1. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  5. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  6. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  7. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  11. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  12. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  13. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  14. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  15. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  16. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
View all 16 references
Major

Beta-blockers (applies to nebivolol/valsartan) ischemic heart disease

Major Potential Hazard, High plausibility.

Heightened sensitivity to catecholamines may occur after prolonged use of beta-adrenergic receptor blocking agents (aka beta-blockers). Exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt withdrawal of therapy. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Patients should be advised not to discontinue treatment without first consulting with the physician. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures.

References

  1. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  2. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  3. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  4. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  5. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  9. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  10. Rangno RE, Langlois S "Comparison of withdrawal phenomena after propranolol, metoprolol, and pindolol." Am Heart J 104 (1982): 473-8
  11. Szecsi E, Kohlschutter S, Schiess W, Lang E "Abrupt withdrawal of pindolol or metoprolol after chronic therapy." Br J Clin Pharmacol 13 (1982): s353-7
  12. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  13. Miller RR, Olson HG, Amsterdam EA, Mason DT "Propranolol-withdrawal rebound phenomenon: exacerbation of coronary events after abrupt cessation of antianginal therapy." N Engl J Med 293 (1975): 416-8
  14. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  15. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  16. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  17. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  18. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  19. Walden RJ, Hernandez J, Yu Y, et al "Withdrawal of beta-blocking drugs." Am Heart J 104 (1982): 515-20
View all 19 references
Major

Beta-blockers (applies to nebivolol/valsartan) PVD

Major Potential Hazard, High plausibility. Applicable conditions: Peripheral Arterial Disease

Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Therapy with beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.

References

  1. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  2. Coppeto JR "Transient ischemic attacks and amaurosis fugax from timolol." Ann Ophthalmol 17 (1985): 64-5
  3. Michelson EL, Frishman WH, Lewis JE, et al "Multicenter clinical evaluation of long-term efficacy and safety of labetalol in treatment of hypertension." Am J Med Oct 17 (1983): 68-80
  4. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  5. Broeder CE, Thomas EL, Martin NB, Hofman Z, Jesek JK, Scruggs KD, Wambsgans KC, Wilmore JH "Effects of propranolol and pindolol on cardiac output during extended periods of low-intensity physical activity." Am J Cardiol 72 (1993): 1188-95
  6. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. Breckenridge A, Roberts DH "Antihypertensive treatment in concomitant peripheral vascular disease: current experience and the potential of carvedilol." J Cardiovasc Pharmacol 18 Suppl 4 (1991): s78-81
  8. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  9. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  10. Lepantalo M "Beta blockade and intermittent claudication." Acta Med Scand 700 (1985): 1-48
  11. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  13. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  14. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  15. Eliasson K, Danielson M, Hylander B, Lindblad LE "Raynaud's phenomenon caused by beta-receptor blocking drugs." Acta Med Scand 215 (1984): 333-9
  16. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  17. Eliasson K, Lins L-E, Sundqvist K "Peripheral vasospasm during beta-receptor blockade: a comparison between metoprolol and pindolol." Acta Med Scand 665 (1982): 109-12
  18. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  19. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  20. Holti G "A double-blind study of the peripheral vasoconstrictor effects of the beta-blocking drug penbutolol in patients with Raynaud's phenomenon." Curr Med Res Opin 6 (1979): 267-70
  21. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  22. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  23. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  24. Myers J, Morgan T, Waga S, et al "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  25. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
View all 25 references
Major

Nebivolol (applies to nebivolol/valsartan) hepatic impairment

Major Potential Hazard, Moderate plausibility. Applicable conditions: Liver Disease

Metabolism of nebivolol is decreased in patients with moderate hepatic impairment. d-Nebivolol peak plasma concentration increased 3-fold, exposure (AUC) increased 10-fold, and the apparent clearance decreased by 86% in patients with moderate hepatic impairment (Child-Pugh Class B). Patients with liver disease may be at greater risk for adverse effects from nebivolol due to decreased drug clearance. Therapy with nebivolol should be administered cautiously in patients with liver disease. Dosage adjustments may be necessary. No formal studies have been performed in patients with severe hepatic impairment and nebivolol should be contraindicated for these patients.

Moderate

AR antagonists (applies to nebivolol/valsartan) CHF

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Congestive Heart Failure

Angiotensin II receptor (AR) antagonists can cause renal impairment in patients whose renal function depends on the activity of the renin-angiotensin-aldosterone system. In addition, symptomatic hypotension can occur in susceptible individuals, which may compromise renal and myocardial perfusion. In patients with severe congestive heart failure (CHF), treatment with AR antagonists has been associated with oliguria and/or progressive azotemia and, rarely, renal failure, myocardial ischemia, and death. Therapy with AR antagonists should be initiated cautiously in patients with severe CHF, especially when accompanied by volume and/or sodium depletion. In patients who experience a decline in renal function, discontinuation of AR antagonist therapy is usually not required provided there is symptomatic improvement of the heart failure and renal deterioration is well-tolerated. Transient hypotension is also not a contraindication to further treatment with AR antagonists, since therapy can usually be reinstated without difficulty after blood pressure stabilizes.

References

  1. Saine DR, Ahrens ER "Renal impairment associated with losartan." Ann Intern Med 124 (1996): 775
  2. Doig JK, MacFadyen RJ, Sweet CS, Lees KR, Reid JL "Dose-ranging study of the angiotensin type I receptor antagonist losartan (DuP753/MK954), in salt-deplete normal man." J Cardiovasc Pharmacol 21 (1993): 732-8
  3. McIntyre M, MacFadyen RJ, Meredith PA, Brouard R, Reid JL "Dose-ranging study of the angiotensin II receptor antagonist irbesartan (SR 47436/BMS-186295) on blood pressure and neurohormona effects in salt-deplete men." J Cardiovasc Pharmacol 28 (1996): 101-6
  4. Holwerda NJ, Fogari R, Angeli P, et al. "Valsartan, a new angiotensin II antagonist for the treatment of essential hypertension: efficacy and safety compared with placebo and enalapril." J Hypertens 14 (1996): 1147-115
  5. Crozier I, Ikram H "The acute and chronic effects of losartan in heart failure." J Hypertens 13 Suppl (1995): s59-61
  6. "Product Information. Teveten (eprosartan)." SmithKline Beecham, Philadelphia, PA.
  7. Crozier I, Ikram H, Awan N, Cleland J, Stephen N, Dickstein K, Frey M, Young J, Klinger G, Makris L, et al "Losartan in heart failure. Hemodynamic effects and tolerability. Losartan Hemodynamic Study Group." Circulation 91 (1995): 691-7
  8. "Product Information. Cozaar (losartan)." Merck & Co, Inc, West Point, PA.
  9. Goldberg MR, Bradstreet TE, McWilliams EJ, Tanaka WK, Lipert S, Bjornsson TD, Waldman SA, Osborne B, Pivadori L, Lewis G, et al "Biochemical effects of losartan, a nonpeptide angiotensin II receptor antagonist, on the renin-angiotensin-aldosterone system in hypertensive patients." Hypertension 25 (1995): 37-46
  10. Dickstein K, Gottlieb S, Fleck E, Kostis J, Levine B, DeKock M, LeJemtel T "Hemodynamic and neurohumoral effects of the angiotensin II antagonist losartan in patients with heart failure." J Hypertens Suppl 12 (1994): s31-5
  11. van den Meiracker AH, Admiraal PJ, Janssen JA, Kroodsma JM, de Ronde WA, Boomsma F, Sissmann J, Blankestijn PJ, Mulder PG, Man In 't Veld AJ "Hemodynamic and biochemical effects of the AT1 receptor antagonist irbesartan in hypertension." Hypertension 25 (1995): 22-9
  12. "Product Information. Atacand (candesartan)." Astra Pharmaceuticals, Wayne, PA.
  13. Pitt B, Segal R, Martinez FA, et al. "Randomised trial of losartan versus captopril in patients over 65 with heart failure (Evaluation of Losartan in the Elderly Study, ELITE)." Lancet 349 (1997): 747-52
  14. Gibbs CR, Ferner RE, Beevers DG "Angiotensin receptor antagonists - a new class of antihypertensive drug." J Clin Pharm Ther 21 (1996): 127-30
  15. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals, East Hanover, NJ.
  16. Goldberg MR, Tanaka W, Barchowsky A, Bradstreet TE, McCrea J, Lo MW, McWilliams EJ Jr, Bjornsson TD "Effects of losartan on blood pressure, plasma renin activity, and angiotensin II in volunteers." Hypertension 21 (1993): 704-13
  17. Weber MA, Byyny RL, Pratt JH, Faison EP, Snavely DB, Goldberg AI, Nelson EB "Blood pressure effects of the angiotensin II receptor blocker, losartan." Arch Intern Med 155 (1995): 405-11
  18. Gottlieb SS, Dickstein K, Fleck E, Kostis J, Levine TB, LeJemtel T, DeKock M "Hemodynamic and neurohormonal effects of the angiotensin II antagonist losartan in patients with congestive heart failure." Circulation 88 (1993): 1602-9
  19. Schaefer KL, Porter JA "Angiotensin II receptor antagonists: the prototype losartan." Ann Pharmacother 30 (1996): 625-36
  20. "Product Information. Benicar (olmesartan)." Sankyo Parke Davis, Parsippany, NJ.
  21. Waeber B, Brunner HR "Angiotensin II antagonists: a new class of antihypertensive agent." Br J Clin Pract 50 (1996): 265-8
  22. Ellis ML, Patterson H "A new class of antihypertensive therapy: angiotensin II receptor antagonists." Pharmacotherapy 16 (1996): 849-60
  23. Abdelrahman AM, Burrell LM, Johnston CI "Blockade of the renin-angiotensin system at different sites: effect on renin, angiotensin and aldosterone." J Hypertens 11 Suppl 3 (1993): s23-6
  24. Rush JE, Rajfer SI "Theoretical basis for the use of angiotensin II antagonists in the treatment of heart failure." J Hypertens 11 Suppl 3 (1993): s69-71
  25. "Product Information. Avapro (irbesartan)." Bristol-Myers Squibb, Princeton, NJ.
  26. Waeber B, Burnier M, Nussberger J, Brunner HR "Experience with angiotensin II antagonists in hypertensive patients." Clin Exp Pharmacol Physiol 23 ( Suppl (1996): s142-6
  27. "Product Information. Micardis (telmisartan)." Boehringer-Ingelheim, Ridgefield, CT.
View all 27 references
Moderate

AR antagonists (applies to nebivolol/valsartan) hyperkalemia

Moderate Potential Hazard, Moderate plausibility.

Drugs that inhibit the renin-angiotensin, such as angiotensin II receptor antagonist system can cause hyperkalemia. Concomitant use of these agents with drugs that increase potassium levels may increase the risk of hyperkalemia. Use caution when using these agents together and monitor serum potassium periodically.

Moderate

AR antagonists (applies to nebivolol/valsartan) renal artery stenosis

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Artery Atherosclerosis

In patients with bilateral renal artery stenosis or renal artery stenosis in a solitary kidney, angiotensin II receptor (AR) antagonists may reduce renal perfusion to a critically low level. Increases in serum creatinine or blood urea nitrogen have been reported with ACE inhibitors, a class of drugs that also block the renin-angiotensin-aldosterone system. Although there are no long-term data on the use of AR antagonists in patients with renal artery stenosis, a similar effect should be anticipated. Renal function should be monitored closely for the first few weeks of therapy.

References

  1. "Product Information. Benicar (olmesartan)." Sankyo Parke Davis, Parsippany, NJ.
  2. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals, East Hanover, NJ.
  3. "Product Information. Cozaar (losartan)." Merck & Co, Inc, West Point, PA.
Moderate

AR antagonists (applies to nebivolol/valsartan) renal impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Changes in renal function including acute renal failure can be caused by drugs that inhibit the renin-angiotensin system and by diuretics. Patients whose renal function may depend in part on the activity of the renin-angiotensin system (e.g., patients with renal artery stenosis, chronic kidney disease, severe congestive heart failure, or volume depletion) may be at particular risk of developing acute renal failure with these agents. Monitor renal function periodically in these patients. Consider withholding or discontinuing therapy in patients who develop a clinically significant decrease in renal function with these agents.

Moderate

Beta-blockers (applies to nebivolol/valsartan) cerebrovascular insufficiency

Moderate Potential Hazard, Moderate plausibility.

Beta-adrenergic blocking agents (beta-blockers), should be used with caution in patients with cerebrovascular insufficiency because of their potential effects relative to blood pressure and pulse. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.

Moderate

Beta-blockers (applies to nebivolol/valsartan) glaucoma

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Glaucoma/Intraocular Hypertension

Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.

References

  1. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  3. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  4. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  5. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  6. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  7. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  10. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  11. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  12. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  14. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  15. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
View all 15 references
Moderate

Beta-blockers (applies to nebivolol/valsartan) hyperlipidemia

Moderate Potential Hazard, Moderate plausibility.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles. Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Patients with preexisting hyperlipidemia may require closer monitoring during beta-blocker therapy, and adjustments made accordingly in their lipid-lowering regimen.

References

  1. Samuel P, Chin B, Schoenfeld BH, et al "Comparison of the effect of pindolol versus propranolol on the lipid profile in patients treated for hypertension." Br J Clin Pharmacol 24 (1987): s63-4
  2. Rossner S, Weiner L "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7
  3. Gordon NF, Scott CB, Duncan JJ "Effects of atenolol versus enalapril on cardiovascular fitness and serum lipids in physically active hypertensive men." Am J Cardiol 79 (1997): 1065-9
  4. Lithell H, Andersson PE "Metabolic effects of carvedilol in hypertensive patients." Eur J Clin Pharmacol 52 (1997): 13-7
  5. Szollar LG, Meszaros I, Tornoci L, et al "Effect of metoprolol and pindolol monotherapy on plasma lipid- and lipoprotein-cholesterol levels (including the HDL subclasses) in mild hypertensive males and females." J Cardiovasc Pharmacol 15 (1990): 911-7
  6. Rossner S, Weiner L "Atenolol and metoprolol: comparison of effects on blood pressure and serum lipoproteins, and side effects." Eur J Clin Pharmacol 24 (1983): 573-7
  7. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  8. Darga LL, Hakim MJ, Lucas CP, Franklin BA "Comparison of the effects of guanadrel sulfate and propranolol on blood pressure, functional capacity, serum lipoproteins and glucose in systemic hypertension." Am J Cardiol 67 (1991): 590-6
  9. Ferrara LA, Marotta T, Scilla A, et al "Effect of oxprenolol and metoprolol on serum lipid concentration." Eur J Clin Pharmacol 26 (1984): 331-4
  10. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  11. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  12. Terent A, Ribacke M, Carlson LA "Long-term effect of pindolol on lipids and lipoproteins in men with newly diagnosed hypertension." Eur J Clin Pharmacol 36 (1989): 347-50
  13. Safran AB, Simona F, Sansonetti A, Pometta D, James R "Effects of ocular carteolol and timolol on plasma high-density lipoprotein cholesterol level." Am J Ophthalmol 117 (1994): 683
  14. Northcote RJ, Packard CJ, Ballantyne D "The effect of sotalol on plasma lipoproteins and apolipoproteins." Clin Chim Acta 158 (1986): 187-91
  15. Sasaki J, Saku K, Ideishi M, et al "Effects of pindolol on serum lipids, apolipoproteins, and lipoproteins in patients with mild to moderate essential hypertension." Clin Ther 11 (1989): 219-24
  16. Clucas A, Miller N "Effects of acebutolol on the serum lipid profile." Drugs 36 Suppl 2 (1988): 41-50
  17. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  18. Valimaki M, Maass L, Harno K, Nikkila EA "Lipoprotein lipids and apoproteins during beta-blocker administration: comparison of penbutolol and atenolol." Eur J Clin Pharmacol 30 (1986): 17-20
  19. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  20. Sasaki J, Kajiyama G, Kusukawa R, Mori H, Koga S, Takagi R, Tanaka N, Ogawa N, Arakawa K "Effect of bevantolol and propranolol on serum lipids in patients with essential hypertension." Int J Clin Pharmacol Ther 32 (1994): 660-4
  21. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  22. Pasotti C, Capra A, Fiorella G, et al "Effects of pindolol and metoprolol on plasma lipids and lipoproteins." Br J Clin Pharmacol 13 (1982): s435-9
  23. Harvengt C, Heller FR, Martiat P, Nieuwenhuyze YV "Short-term effects of beta blockers atenolol, nadolol, pindolol, and propranolol on lipoprotein metabolism in normolipemic subjects." J Clin Pharmacol 27 (1987): 475-80
  24. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  25. Disler LJ, Joffe BI, Seftel HC "Massive hypertriglyceridemia associated with atenolol." Am J Med 85 (1988): 586-7
  26. Kasiske BL, Ma JZ, Kalil RS, Louis TA "Effects of antihypertensive therapy on serum lipids." Ann Intern Med 122 (1995): 133-41
  27. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  28. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  29. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  30. Lehtonen A, Hietanen E, Marniemi J, Peltonen P, Nikkila EA "Effect of sotalol withdrawal on serum lipids and lipoprotein lipase activity." Int J Clin Pharmacol Ther Toxicol 21 (1983): 73-6
  31. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  32. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  33. Carlson LA, Ribacke M, Terent A "A long-term study on the effect of pindolol on serum lipoproteins: a preliminary report." Br J Clin Pharmacol 24 (1987): s61-2
  34. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  35. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  36. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  37. Lind L, Pollare T, Berne C, Lithell H "Long-term metabolic effects of antihypertensive drugs." Am Heart J 128 (1994): 1177-83
  38. Leren P, Foss PO, Nordvik B, Fossbakk B "The effect of enalapril and timolol on blood lipids." Acta Med Scand 223 (1988): 321-6
  39. Weiner L, Rossner S "Atenolol 50 mg or metoprolol 200 mg: a comparison of antihypertensive efficacy, side effects and lipoprotein changes." Acta Med Scand 677 (1983): 153-7
View all 39 references
Moderate

Beta-blockers (applies to nebivolol/valsartan) hyperthyroidism

Moderate Potential Hazard, High plausibility.

When beta-adrenergic receptor blocking agents (aka beta-blockers) are used to alleviate symptoms of hyperthyroidism such as tachycardia, anxiety, tremor and heat intolerance, abrupt withdrawal can exacerbate thyrotoxicosis or precipitate a thyroid storm. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.

References

  1. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  2. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  3. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  4. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  5. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  6. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  7. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  8. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  9. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  10. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  11. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  12. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  15. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
View all 15 references
Moderate

Beta-blockers (applies to nebivolol/valsartan) myasthenia gravis

Moderate Potential Hazard, Low plausibility. Applicable conditions: Myoneural Disorder

Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.

References

  1. Coppeto JR "Timolol-associated myasthenia gravis." Am J Ophthalmol 98 (1984): 244-5
  2. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  3. Confavreux C, Charles N, Aimard G "Fulminant myasthenia gravis soon after initiation of acebutolol therapy." Eur Neurol 30 (1990): 279-81
  4. Herishanu Y, Rosenberg P "Beta-blockers and myasthenia gravis." Ann Intern Med 83 (1975): 834-5
  5. Berstein LP, Henkind P "Additional information on adverse reactions to timolol." Am J Ophthalmol 92 (1981): 295-6
  6. Choi KL, Wat MS, Ip TP, Kung AWC, Lam KSL "Phaeochromocytoma associated with myasthenia gravis precipitated by propranolol treatment." Aust N Z J Med 25 (1995): 257
  7. Verkijk A "Worsening of myasthenia gravis with timolol maleate eyedrops." Ann Neurol 17 (1985): 211-2
View all 7 references
Moderate

Beta-blockers (applies to nebivolol/valsartan) pheochromocytoma

Moderate Potential Hazard, Moderate plausibility.

Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.

Moderate

Beta-blockers (applies to nebivolol/valsartan) psoriasis

Moderate Potential Hazard, Moderate plausibility.

The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.

Moderate

Beta-blockers (applies to nebivolol/valsartan) tachycardia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Tachyarrhythmia

Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol. The use of beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in these patients.

Moderate

Cardioselective beta-blockers (applies to nebivolol/valsartan) asthma/COPD

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Chronic Obstructive Pulmonary Disease

Patients with bronchospastic disease, should, in general, not receive beta blockers, including cardioselective beta-blockers. Because of the relative beta-1 selectivity, cardioselective beta-blockers may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment. Because beta-1 selectivity is not absolute, the lowest possible dose of these agents should be used. Consider administering in smaller doses to avoid the higher plasma levels associated with the longer dosing intervals. If dosage must be increased, dividing the dose should be considered to achieve lower peak blood levels. It is recommended to have bronchodilators, including beta-2 agonists, readily available or administered concomitantly if necessary.

Moderate

Nebivolol (applies to nebivolol/valsartan) renal impairment

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Renal Dysfunction

Renal clearance of nebivolol is decreased in patients with severe renal impairment. The apparent clearance of nebivolol was unchanged following a single 5 mg dose of nebivolol in patients with mild renal impairment (CrCl 50 to 80 mL/min, n =7), and it was reduced negligibly in patients with moderate (CrCl 30 to 50 mL/min, n =9), but clearance was reduced by 53% in patients with severe renal impairment (CrCl<30 mL/min, n =5). Patients with severe renal impairment may be at greater risk for adverse effects from nebivolol due to decreased drug clearance. Therapy with nebivolol should be administered cautiously in patients with severe renal impairment. Dosage adjustments may be necessary. No studies have been conducted in patients on dialysis

Moderate

Valsartan (applies to nebivolol/valsartan) renal/liver disease

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Biliary Obstruction, Renal Dysfunction

Valsartan is primarily eliminated by biliary excretion, and a minority is excreted in the urine. Dosage adjustments are not necessary in patients with renal impairment unless they are also volume-depleted, in which case therapy should be initiated under medical supervision. Likewise, patients with mild to moderate hepatic impairment or biliary obstruction generally do not require a dosage adjustment. The manufacturer recommends administering valsartan therapy with caution in patients with impaired renal and/or liver function, particularly if these conditions are severe.

References

  1. "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals, East Hanover, NJ.

Nebivolol / valsartan drug interactions

There are 542 drug interactions with nebivolol / valsartan

Nebivolol / valsartan alcohol/food interactions

There are 4 alcohol/food interactions with nebivolol / valsartan

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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.