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Drug Interactions between bromocriptine and esmolol

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

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Interactions between your drugs

Moderate

bromocriptine esmolol

Applies to: bromocriptine and esmolol

MONITOR: Several case reports have suggested that beta-blockers may potentiate the vasoconstrictive action of ergot alkaloids. The exact mechanism of interaction is unknown, but may involve blockade of beta-2-mediated (i.e., sympathetic) vasodilatation. In addition, beta-1 blockade reduces cardiac output, which can diminish blood flow and exacerbate ergot-induced vasospasm. Peripheral ischemia, hypertension with chest pain, gangrene resulting in surgical amputation, and migraine exacerbation have been described in suspected cases of the interaction. Reported cases have involved the noncardioselective beta-blockers, propranolol and oxprenolol. However, a theoretical risk also exists with cardioselective beta-blockers, since beta-1 selectivity is not absolute and may be lost with larger doses. The interaction may also occur with beta-blocker ophthalmic preparations, since they may be systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. In any case, the interaction appears to be rare, and patients have taken both drugs without adverse effects.

MANAGEMENT: Except for increased awareness of the interaction, no specific intervention appears to be necessary. Patients should be advised to seek immediate medical attention if they experience potential symptoms of ischemia such as coldness, pallor, cyanosis, numbness, tingling, or pain in the extremities; muscle weakness; severe or worsening headache; visual disturbances; severe abdominal pain; chest pain; and shortness of breath.

References

  1. Gandy W (1990) "Dihydroergotamine interaction with propranolol ." Ann Emerg Med, 19, p. 221
  2. Baumrucker JF (1973) "Drug interaction: propranolol and cafergot." N Engl J Med, 288, p. 916-7
  3. Venter CP, Joubert PH, Buys AC (1984) "Severe peripheral ischaemia during concomitant use of beta blockers and ergot alkaloids." Br Med J, 289, p. 288-9
  4. Blank NK, Rieder MJ (1973) "Paradoxical response to propranolol in migraine." Lancet, 2, p. 1336
  5. (2001) "Product Information. Migranal (dihydroergotamine nasal)." Novartis Pharmaceuticals
  6. (2004) "Product Information. Cafergot (caffeine-ergotamine)." Novartis Pharmaceuticals
View all 6 references

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Drug and food interactions

Moderate

bromocriptine food

Applies to: bromocriptine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Moderate

esmolol food

Applies to: esmolol

MONITOR: Many psychotherapeutic and CNS-active agents (e.g., anxiolytics, sedatives, hypnotics, antidepressants, antipsychotics, opioids, alcohol, muscle relaxants) exhibit hypotensive effects, especially during initiation of therapy and dose escalation. Coadministration with antihypertensives and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis.

MANAGEMENT: Caution and close monitoring for development of hypotension is advised during coadministration of these agents. Some authorities recommend avoiding alcohol in patients receiving vasodilating antihypertensive drugs. Patients should be advised to avoid rising abruptly from a sitting or recumbent position and to notify their physician if they experience dizziness, lightheadedness, syncope, orthostasis, or tachycardia.

References

  1. Sternbach H (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

bromocriptine food

Applies to: bromocriptine

MONITOR: Nicotine may cause vasoconstriction in some patients and potentiate the ischemic response to ergot alkaloids.

MANAGEMENT: Caution may be advisable when ergot alkaloids are used in combination with nicotine products. Patients should be advised to seek immediate medical attention if they experience potential symptoms of ischemia such as coldness, pallor, cyanosis, numbness, tingling, or pain in the extremities; muscle weakness; severe or worsening headache; visual disturbances; severe abdominal pain; chest pain; and shortness of breath.

References

  1. (2001) "Product Information. Migranal (dihydroergotamine nasal)." Novartis Pharmaceuticals
  2. (2004) "Product Information. Cafergot (caffeine-ergotamine)." Novartis Pharmaceuticals
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. Cerner Multum, Inc. "Australian Product Information."
View all 4 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

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

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Drug Interaction Classification

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

Further information

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

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