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Inderal LA (propranolol) Disease Interactions

There are 20 disease interactions with Inderal LA (propranolol):

Major

Beta-Blockers (Includes Inderal LA) ↔ Asthma/Copd

Severe Potential Hazard, High plausibility

Applies to: Chronic Obstructive Pulmonary Disease, Asthma

Some beta-adrenergic receptor blocking agents (i.e., beta-blockers) are contraindicated in patients with bronchial asthma or with a history of bronchial asthma, or severe chronic obstructive pulmonary disease. In general, beta-adrenergic receptor blocking agents should not be used in patients with bronchospastic diseases. Beta blockade may adversely affect pulmonary function by counteracting the bronchodilation produced by catecholamine stimulation of beta-2 receptors. If beta-blocker therapy is necessary in these patients, an agent with beta-1 selectivity (e.g., atenolol, metoprolol, betaxolol) is considered safer, but should be used with caution nonetheless. Cardioselectivity is not absolute and can be lost with larger doses.

References

  1. Horvath JS, Woolcock AJ, Tiller DJ, Donnelly P, Armstrong J, Caterson R "A comparison of metoprolol and propranolol on blood pressure and respiratory function in patients with hypertension." Aust N Z J Med 8 (1978): 1-6
  2. 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):
  3. Falliers CJ, Vincent ME, Medakovic M "Effect of single doses of labetalol, metoprolol, and placebo on ventilatory function in patients with bronchial asthma: interaction with isoproterenol." J Asthma 23 (1986): 251-60
  4. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  5. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  6. Morris R, Bulteau P "Respiratory arrest after beta-blocker in an asthmatic patient." Med J Aust 2 (1980): 576
  7. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  8. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  9. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  10. Raine JM, Palazzo MG, Kerr JH, Sleight P "Near-fatal bronchospasm after oral nadolol in a young asthmatic and response to ventilation with halothane." Br Med J 282 (1981): 548-9
  11. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  12. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  13. Durant PA, Joucken K "Bronchospasm and hypotension during cardiopulmonary bypass after preoperative cimetidine and labetalol therapy." Br J Anaesth 56 (1984): 917-20
  14. van Zyl AI, Jennings AA, Bateman ED, Opie LH "Comparison of respiratory effects of two cardioselective beta-blockers, celiprolol and atenolol, in asthmatics with mild to moderate hypertension." Chest 95 (1989): 209-13
  15. Adam WR, Meagher EJ, Barter CE "Labetalol, beta blockers, and acute deterioration of chronic airway obstruction." Clin Exp Hypertens A A4 (1982): 1419-28
  16. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  17. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  18. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  19. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  20. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  21. Benson MK, Berrill WT, Cruickshank JM, Sterling GS "A comparison of four B-adrenoceptor antagonists in patients with asthma." Br J Clin Pharmacol 5 (1978): 415-9
  22. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  23. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  24. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  25. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  26. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  27. Schoenberger JA, Croog SH, Sudilovsky A, et al "Self-reported side effects from antihypertensive drugs: a clinical trial." Am J Hypertens 3 (1990): 123-32
  28. Chodosh S, Tuck J, Blasucci DJ "The effects of dilevalol, metoprolol, and placebo on ventilatory function in asthmatics." J Cardiovasc Pharmacol 11 (1988): s18-24
  29. Stephen SA "Unwanted effects of propranolol." Am J Cardiol 18 (1966): 463-72
View all 29 references
Major

Beta-Blockers (Includes Inderal LA) ↔ Bradyarrhythmia/Av Block

Severe Potential Hazard, High plausibility

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

Beta-Blockers (Includes Inderal LA) ↔ Cardiogenic Shock/Hypotension

Severe Potential Hazard, High plausibility

Applies to: Cardiogenic Shock, Hypotension

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

Beta-Blockers (Includes Inderal LA) ↔ Diabetes

Severe Potential Hazard, High plausibility

Applies to: 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. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  4. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  5. 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
  6. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  7. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  8. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  9. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  10. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  11. Velde TM, Kaiser FE "Ophthalmic timolol treatment causing altered hypoglycemic response in a diabetic patient." Arch Intern Med 143 (1983): 1627
  12. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  13. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  14. 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
  15. 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
  16. Uusitupa M, Aro A, Pietikainen M "Severe hypoglycaemia caused by physical strain and pindolol therapy." Ann Clin Res 12 (1980): 25-7
  17. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  18. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  19. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  20. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  21. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
View all 21 references
Major

Beta-Blockers (Includes Inderal LA) ↔ Hypersensitivity

Severe Potential Hazard, High plausibility

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

Beta-Blockers (Includes Inderal LA) ↔ Pvd

Severe Potential Hazard, High plausibility

Applies to: 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. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  4. 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
  5. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  6. 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
  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. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  10. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  11. 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
  12. Lepantalo M "Beta blockade and intermittent claudication." Acta Med Scand 700 (1985): 1-48
  13. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  14. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  15. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  16. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  17. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  18. Myers J, Morgan T, Waga S, et al "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  19. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  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. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  22. 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
  23. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  24. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  25. Eliasson K, Danielson M, Hylander B, Lindblad LE "Raynaud's phenomenon caused by beta-receptor blocking drugs." Acta Med Scand 215 (1984): 333-9
View all 25 references
Major

Propranolol (Includes Inderal LA) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Propranolol is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from propranolol due to decreased drug clearance. Therapy with propranolol should be administered cautiously in patients with liver disease. Dosage adjustments may be necessary.

References

  1. Arthur MJ, Tanner AR, Patel C, et al "Pharmacology of propranolol in patients with cirrhosis and portal hypertension." Gut 26 (1985): 14-9
  2. George CF, Orme ML, Buranapong P, et al "Contribution of the liver to overall elimination of propranolol." J Pharmacokinet Biopharm 4 (1976): 17-27
  3. Silber BM, Holford NH, Riegelman S "Dose-dependent elimination of propranolol and its major metabolites in humans." J Pharm Sci 72 (1983): 725-32
  4. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. Sotaniemi EA, Anttila M, Pelkonen RO, et al "Plasma clearance of propranolol and sotalol and hepatic drug-metabolizing enzyme activity." Clin Pharmacol Ther 26 (1979): 153-61
  6. Walle T, Walle K, Mathur RS, Palesch YY, Conradi EC "Propranolol metabolism in normal subjects: association with sex steroid hormones." Clin Pharmacol Ther 56 (1994): 127-32
  7. Jones DB "Propranolol disposition in cirrhosis ." Gut 26 (1985): 865
  8. Branch RA, Shand DG "Propranolol disposition in chronic liver disease: a physiological approach." Clin Pharmacokinet 1 (1976): 264-79
  9. Routledge PA, Shand DG "Clinical pharmacokinetics of propranolol." Clin Pharmacokinet 4 (1979): 73-90
  10. Watson RG, Bastain W, Larkin KA, et al "A comparative pharmacokinetic study of conventional propranolol and long acting preparation of propranolol in patients with cirrhosis and normal controls." Br J Clin Pharmacol 24 (1987): 527-35
  11. Pessayre D, Lebrec D, Descatoire V, et al "Mechanism for reduced drug clearance in patients with cirrhosis." Gastroenterology 74 (1978): 566-71
View all 11 references
Moderate

Beta-Blockers (Includes Inderal LA) ↔ Cerebrovascular Insufficiency

Moderate Potential Hazard, Moderate plausibility

Applies to: Cerebrovascular Insufficiency

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 (Includes Inderal LA) ↔ Chf

Moderate Potential Hazard, High plausibility

Applies to: 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. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  2. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
  3. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  4. 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
  5. Tcherdakoff P "Side-effects with long-term labetalol: an open study of 251 patients in a single centre." Pharmatherapeutica 3 (1983): 342-8
  6. Cleland JGF, Swedberg K "Carvedilol for heart failure, with care." Lancet 347 (1996): 1199-201
  7. 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
  8. 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
  9. 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
  10. Altus P "Timolol-induced congestive heart failure." South Med J 74 (1981): 88
  11. 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
  12. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  13. Myers J, Morgan T, Waga S, et al "Long-term experiences with labetalol." Med J Aust 1 (1980): 665-6
  14. 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
  15. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  16. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  17. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  18. 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
  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. Frishman WH "Carvedilol." N Engl J Med 339 (1998): 1759-65
  21. 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
  22. 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
  23. 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
  24. Maisel AS "Beneficial effects of metoprolol treatment in congestive heart failure - reversal of sympathetic-induced alterations of immunologic function." Circulation 90 (1994): 1774-80
  25. 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
  26. 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
  27. Moye LA, Abernethy D "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318
  28. 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
  29. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  30. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  31. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  32. Packer M, Cohn JN, Colucci WS "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1310-20
  33. 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
  34. CIBIS-II Investigators and Committees. "The cardiac insufficiency bisoprolol study II (CIBIS-II): a randomised trial." Lancet 353 (1999): 9-13
  35. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  36. 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
  37. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  38. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  39. 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
  40. 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
  41. Von Olshausen K, Pop T, Berger J "Carvedilol in patients with chronic heart failure." N Engl J Med 335 (1996): 1318-20
  42. Hart SM "Influence of B-blockers on mortality in chronic heart failure." Ann Pharmacother 34 (2000): 1440-51
  43. 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
  44. "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals, Wilmington, DE.
  45. Mashford ML, Coventry D, Hecker R, et al. "Adverse Drug Reactions Advisory Committee: ADRAC report for 1980." Med J Aust 1 (1982): 416-9
  46. Kelly DT "Carvedilol in heart failure." Cardiology 82 Suppl 3 (1993): 45-9
  47. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
View all 47 references
Moderate

Beta-Blockers (Includes Inderal LA) ↔ Glaucoma

Moderate Potential Hazard, Moderate plausibility

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

Beta-Blockers (Includes Inderal LA) ↔ Hyperlipidemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperlipidemia

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. 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
  5. 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
  6. Lithell H, Andersson PE "Metabolic effects of carvedilol in hypertensive patients." Eur J Clin Pharmacol 52 (1997): 13-7
  7. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  8. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  9. 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
  10. "Product Information. Betapace (sotalol)." Berlex, Richmond, CA.
  11. 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
  12. 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
  13. Clucas A, Miller N "Effects of acebutolol on the serum lipid profile." Drugs 36 Suppl 2 (1988): 41-50
  14. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  15. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  16. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  17. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  18. 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
  19. 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
  20. Disler LJ, Joffe BI, Seftel HC "Massive hypertriglyceridemia associated with atenolol." Am J Med 85 (1988): 586-7
  21. 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
  22. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  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. Lind L, Pollare T, Berne C, Lithell H "Long-term metabolic effects of antihypertensive drugs." Am Heart J 128 (1994): 1177-83
  25. Northcote RJ, Packard CJ, Ballantyne D "The effect of sotalol on plasma lipoproteins and apolipoproteins." Clin Chim Acta 158 (1986): 187-91
  26. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  27. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  28. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  29. Leren P, Foss PO, Nordvik B, Fossbakk B "The effect of enalapril and timolol on blood lipids." Acta Med Scand 223 (1988): 321-6
  30. 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
  31. 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
  32. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  33. 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
  34. 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
  35. Kasiske BL, Ma JZ, Kalil RS, Louis TA "Effects of antihypertensive therapy on serum lipids." Ann Intern Med 122 (1995): 133-41
  36. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  37. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  38. 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
  39. "Product Information. Kerlone (betaxolol)." Searle, Skokie, IL.
View all 39 references
Moderate

Beta-Blockers (Includes Inderal LA) ↔ Hyperthyroidism

Moderate Potential Hazard, High plausibility

Applies to: Hyperthyroidism

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

Beta-Blockers (Includes Inderal LA) ↔ Hyperthyroidism Pks

Moderate Potential Hazard, High plausibility

Applies to: Hyperthyroidism

During chronic administration, the clearance of beta-blockers that are primarily metabolized by the liver (e.g., labetalol, metoprolol, penbutolol, propranolol) may be increased in patients with hyperthyroidism due to increased liver blood flow and enhanced activity of drug-metabolizing enzymes. Pharmacokinetic studies have demonstrated an approximately 50% increase in systemic clearance of propranolol during long-term therapy. In general, the dosage required to achieve therapeutic blood concentrations in such patients may be higher than that required in euthyroid patients and should be individualized.

References

  1. Feely J "Clinical pharmacokinetics of beta-adrenoceptor blocking drugs in thyroid disease." Clin Pharmacokinet 8 (1983): 1-16
  2. O'Connor P, Feely J "Clinical pharmacokinetics and endocrine disorders. Therapeutic implications." Clin Pharmacokinet 13 (1987): 345-64
Moderate

Beta-Blockers (Includes Inderal LA) ↔ Ischemic Heart Disease

Moderate Potential Hazard, High plausibility

Applies to: Ischemic Heart Disease

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. Kerlone (betaxolol)." Searle, Skokie, IL.
  3. "Product Information. Levatol (penbutolol)." Reed and Carnrick, Jersey City, NJ.
  4. "Product Information. Visken (pindolol)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  5. "Product Information. Lopressor (metoprolol)." Novartis Pharmaceuticals, East Hanover, NJ.
  6. 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
  7. "Product Information. Coreg (carvedilol)." SmithKline Beecham, Philadelphia, PA.
  8. "Product Information. Sectral (acebutolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  9. "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical, Abbott Park, IL.
  10. "Product Information. Normodyne (labetalol)." Schering Laboratories, Kenilworth, NJ.
  11. "Product Information. Zebeta (bisoprolol)." Lederle Laboratories, Wayne, NJ.
  12. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  13. "Product Information. Trandate (labetalol)." Glaxo Wellcome, Research Triangle Park, NC.
  14. "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc, Cost Mesa, CA.
  15. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb, Princeton, NJ.
  16. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  17. Walden RJ, Hernandez J, Yu Y, et al "Withdrawal of beta-blocking drugs." Am Heart J 104 (1982): 515-20
  18. Rangno RE, Langlois S "Comparison of withdrawal phenomena after propranolol, metoprolol, and pindolol." Am Heart J 104 (1982): 473-8
  19. 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
View all 19 references
Moderate

Beta-Blockers (Includes Inderal LA) ↔ Myasthenia Gravis

Moderate Potential Hazard, Low plausibility

Applies to: 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.

References

  1. "Product Information. Blocadren (timolol)." Merck & Co, Inc, West Point, PA.
  2. Coppeto JR "Timolol-associated myasthenia gravis." Am J Ophthalmol 98 (1984): 244-5
  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 (Includes Inderal LA) ↔ Pheochromocytoma

Moderate Potential Hazard, Moderate plausibility

Applies to: Pheochromocytoma

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 alph-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 (Includes Inderal LA) ↔ Psoriasis

Moderate Potential Hazard, Moderate plausibility

Applies to: Psoriasis

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 (Includes Inderal LA) ↔ Tachycardia

Moderate Potential Hazard, Moderate plausibility

Applies to: 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

Non-Selective Beta-Blockers (Includes Inderal LA) ↔ Prinzmetal's Variant Angina

Moderate Potential Hazard, Moderate plausibility

Applies to: Prinzmetal's Angina

Agents with non-selective beta-blocking activity may provoke chest pain in patients with Prinzmetal's variant angina. the use of non-selective beta blockers is not recommended in these patients. Caution should be taken in the administration of these agents to patients suspected of having Prinzmetal's variant angina.

Moderate

Propranolol (Includes Inderal LA) ↔ Renal Impairment

Moderate Potential Hazard, Moderate plausibility

Applies to: Renal Dysfunction

Propranolol plasma clearance was reduced in patients with chronic renal failure. Chronic renal failure has been associated with a decrease in drug metabolism via downregulation of hepatic cytochrome P450 activity resulting in a lower "first-pass" clearance; therefore, therapy with propranolol should be administered cautiously in patients with impaired renal function. Propranolol is not significantly dialyzable.

Inderal LA (propranolol) drug Interactions

There are 1055 drug interactions with Inderal LA (propranolol)

Inderal LA (propranolol) alcohol/food Interactions

There are 4 alcohol/food interactions with Inderal LA (propranolol)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
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 information available.

Do not stop taking any medications without consulting your healthcare provider.

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