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Drug Interactions between Coreg and hydralazine

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

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Interactions between your drugs

Minor

hydrALAZINE carvedilol

Applies to: hydralazine and Coreg (carvedilol)

Hydralazine may increase serum levels of some oral beta blockers. The proposed mechanism is reduced hepatic blood flow resulting in decreased biotransformation of beta blockers that undergo extensive first-pass metabolism. The interaction is less likely to occur with sustained-release preparations. Renally excreted beta-blockers such as atenolol, carteolol, nadolol, or sotalol are not expected to interact. This combination generally tends to have beneficial effects and is used commonly in the treatment of hypertension. The patient's clinical response should be monitored. A dosage adjustment for the beta blocker may be required when given concomitantly with hydralazine.

References (25)
  1. Schneck DW, Vary JE (1984) "Mechanism by which hydralazine increases propranolol bioavailability." Clin Pharmacol Ther, 35, p. 447-53
  2. Stagni G, Davis PJ, Ludden TM (1991) "Human pharmacokinetics of betaxolol enantiomers." J Pharm Sci, 80, p. 321-4
  3. Janku I, Perlik F, Tkaczykova M, Brodanova M (1992) "Disposition kinetics and concentration-effect relationship of metipranolol in patients with cirrhosis and healthy subjects." Eur J Clin Pharmacol, 42, p. 337-40
  4. Lindeberg S, Holm B, Lundborg P, Regardh CG, Sandstrom B (1988) "The effect of hydralazine on steady-state plasma concentrations of metoprolol in pregnant hypertensive women." Eur J Clin Pharmacol, 35, p. 131-5
  5. Piquette-Miller M, Foster RT, Kappagoda CT, Jamali F (1992) "Effect of aging on the pharmacokinetics of acebutolol enantiomers." J Clin Pharmacol, 32, p. 148-56
  6. McLean AJ, Skews H, Bobik A, Dudley FJ (1980) "Interaction between oral propranolol and hydralazine." Clin Pharmacol Ther, 27, p. 726-32
  7. Byrne AJ, McNeil JJ, Harrison PM, Louis W, Tonkin AM, McLean AJ (1984) "Stable oral availability of sustained release propranolol when co-administered with hydralazine or food: evidence implicating substrate delivery rate as a determinant of presystemic drug interactions." Br J Clin Pharmacol, 17 Suppl, s45-50
  8. Smith RL (1985) "Polymorphic metabolism of the beta-adrenoreceptor blocking drugs and its clinical relevance." Eur J Clin Pharmacol, 28, p. 77-84
  9. McGourty JC, Silas JH, Fleming JJ, McBurney A, Ward JW (1985) "Pharmacokinetics and beta-blocking effects of timolol in poor and extensive metabolizers of debrisoquin." Clin Pharmacol Ther, 38, p. 409-13
  10. Le Coz F, Sauleman P, Poirier JM, Cuche JL, Midavaine M, Rames A, Lecocq B, Jaillon P (1991) "Oral pharmacokinetics of bisoprolol in resting and exercising healthy volunteers." J Cardiovasc Pharmacol, 18, p. 28-34
  11. Amemiya M, Tabei K, Furuya H, Sakairi Y, Asano Y (1992) "Pharmacokinetics of carteolol in patients with impaired renal function." Eur J Clin Pharmacol, 43, p. 417-21
  12. (2002) "Product Information. Tenormin (atenolol)." ICN Pharmaceuticals Inc
  13. (2002) "Product Information. Normodyne (labetalol)." Schering Corporation
  14. (2002) "Product Information. Corgard (nadolol)." Bristol-Myers Squibb
  15. (2001) "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories
  16. McLean AJ, Wilhelm D, Heinzow BG (1983) "Stable oral availability of atenolol coadministered with hydralazine. Comparison with propranolol, metoprolol and other B-Adrenoceptor antagonists." Drugs, 25, p. 131-5
  17. (2001) "Product Information. Blocadren (timolol)." Merck & Co., Inc
  18. (2001) "Product Information. Brevibloc (esmolol)." DuPont Pharmaceuticals
  19. (2001) "Product Information. Cartrol (carteolol)." Abbott Pharmaceutical
  20. (2001) "Product Information. Betapace (sotalol)." Berlex Laboratories
  21. (2001) "Product Information. Levatol (penbutolol)." Reed and Carnrick
  22. Morgan T (1994) "Clinical pharmacokinetics and pharmacodynamics of carvedilol." Clin Pharmacokinet, 26, p. 335-46
  23. McTavish D, Campoli-Richards D, Sorkin EM (1993) "Carvedilol. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy." Drugs, 45, p. 232-58
  24. Seffart G ed. (1991) "Drug Dosage in Renal Insufficiency." Dordrecht, South Holland, : Kluwer Academic Publishers
  25. Limbird LE eds., Gilman AG, Hardman JG (1995) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: McGraw-Hill

Drug and food interactions

Moderate

hydrALAZINE food

Applies to: hydralazine

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. Patients should also avoid driving or operating hazardous machinery until they know how the medications affect them.

References (10)
  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
  9. (2023) "Product Information. Buprenorphine (buprenorphine)." G.L. Pharma UK Ltd
  10. (2023) "Product Information. Temgesic (buprenorphine)." Reckitt Benckiser Pty Ltd

Therapeutic duplication warnings

No warnings were found for your selected drugs.

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

See also

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Drug Interaction Classification

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

Further information

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