Drug Interactions between Duo-Medihaler and landiolol

MONITOR CLOSELY: Coadministration of landiolol with positive inotropes, vasoconstrictors, or sympathomimetic agents may decrease the therapeutic effects of landiolol. According to the package labeling, concomitant use reduced landiolol's heart rate and blood pressure lowering effects. In addition, concomitant dobutamine also reduced landiolol's effect on PR-interval prolongation.

MANAGEMENT: If coadministration is clinically necessary, careful titration of the landiolol infusion and close hemodynamic monitoring is advised. Consultation with package labeling and relevant institutional protocols may be advisable for further guidance.

MONITOR: Coadministration of beta-2 adrenergic agonists with other adrenergic agents may potentiate the risk of cardiovascular side effects. Beta-2 adrenergic agonists can produce clinically significant cardiovascular effects including increases in pulse rate and systolic or diastolic blood pressure as well as ECG changes such as flattening of the T wave, prolongation of the QTc interval, and ST segment depression. The risk is lower when beta-2 adrenergic agonists are inhaled at normally recommended dosages. However, these effects may be more common when the drugs are administered systemically or when recommended dosages are exceeded.

MANAGEMENT: Caution is advised if beta-2 adrenergic agonists are used concomitantly with other adrenergic agents, particularly in patients with cardiovascular disorders such as coronary insufficiency, cardiac arrhythmias, hypertrophic obstructive cardiomyopathy, or hypertension. Blood pressure and heart rate should be closely monitored.

GENERALLY AVOID: Some beta-blockers may antagonize the bronchodilatory, hypotensive, and tachycardic effects of isoproterenol. The mechanism is blockade of beta-adrenergic receptors, which leads to bronchoconstriction, vasodilation, and increased heart rate. Beta-blockers have been used successfully to treat catecholamine or isoproterenol-induced tachyarrhythmias.

MANAGEMENT: This combination should generally be avoided. Patients who are receiving isoproterenol for cardiac conditions should be closely monitored for adequate therapeutic effect if a beta blocker is added. If no alternative exists, small doses of a B-1 selective beta-blocker (e.g., acebutolol, atenolol, betaxolol, bisoprolol, or metoprolol) may be preferable; however, respiratory status should be closely monitored in patients with obstructive pulmonary disease.