Drug Interactions between brimonidine / dorzolamide / latanoprost / timolol ophthalmic and pasireotide

MONITOR: Topically administered alpha-2 adrenergic receptor agonists such as apraclonidine and brimonidine are systemically absorbed, with the potential for producing rare but clinically significant systemic effects such as hypotension and bradycardia. The possibility for an additive or potentiating effect on blood pressure and heart rate should be considered when used with other medications that affect these parameters, such as ophthalmic and systemic beta blockers, vasodilators, cardiac glycosides, and antihypertensive agents.

MANAGEMENT: Blood pressure and pulse rate should be monitored regularly when topical alpha-2 adrenergic receptor agonists are prescribed in combination with cardiovascular drugs. Patients should be advised to notify their physician if they experience slow pulse, irregular heartbeat, dizziness, lightheadedness, or syncope.

MONITOR: The risk of significant bradycardia and atrioventricular (AV) block may be increased during concomitant treatment of pasireotide with other drugs that slow heart rate or AV conduction such as beta-blockers, calcium channel blockers, atazanavir, digitalis, flecainide, lacosamide, mefloquine, moricizine, and propafenone.

MANAGEMENT: Pasireotide has not been studied in patients receiving other bradycardic drugs. Because bradycardia and AV block are recognized risk factors for torsade de pointes arrhythmia, electrocardiographic monitoring is recommended prior to initiation of pasireotide and during treatment. Dose adjustments of beta blockers and calcium channel blockers or correction of electrolyte disturbances may be necessary.