Skip to main content

Drug Interactions between esmolol and Proventil

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

esmolol albuterol

Applies to: esmolol and Proventil (albuterol)

GENERALLY AVOID: Although cardioselective beta-blockers do not generally inhibit the bronchodilating effect of beta-2 adrenergic agonists, they may worsen pulmonary function in patients with asthma or other obstructive airway diseases. Cardioselective beta-blockers can occasionally precipitate acute bronchospasm in these patients, despite relative selectivity for beta-1 receptors in cardiac tissues. Presumably, beta-1 selectivity is dose-dependent and may be lost given a sufficient dose of the beta-blocker in susceptible patients. Other mechanisms may also be involved in bronchoconstriction that are unrelated to beta-2 blockade--for example, their effects on cholinergic M2 receptors and alpha-1 adrenoreceptors. Numerous single- and multiple-dose studies have been conducted in asthmatic and COPD patients with various cardioselective beta-blockers, including acebutolol, atenolol, bisoprolol, celiprolol, metoprolol, and nebivolol. Some reported no significant effects on pulmonary function or bronchodilator response to beta-2 agonists, while others reported some negative effects on pulmonary function and/or airway hyperresponsiveness. Overall, a meta-analysis of more than two dozen studies found that use of cardioselective beta-blockers in patients with mild to moderate reversible airway disease produced no adverse respiratory effects or decreased responsiveness to beta-2 agonists in the short term. A meta-analysis of 19 studies conducted in patients with COPD by the same group of investigators reported similar results. However, little data exist regarding their safety during chronic use or use in patients with severe respiratory disease. There have been reports of worsening asthma and bronchospasm in patients receiving cardioselective beta-blockers including betaxolol (both systemic and ophthalmic) and esmolol. Several studies have suggested enhanced bronchosparing effects of celiprolol over other cardioselective beta-blockers due to its partial beta-2 agonistic and alpha-2 blocking activities. However, one study found no difference between celiprolol and nebivolol. A few studies also suggested a lower degree of beta-1 selectivity for acebutolol compared to other cardioselective beta-blockers. The clinical significance is unknown.

MANAGEMENT: Beta-blockers, including those with relative cardioselectivity, should generally be avoided in patients with bronchospastic diseases. However, given their demonstrated benefit in such conditions as heart failure, myocardial infarction, cardiac arrhythmias and hypertension, cardioselective beta-blockers may be administered with caution to those who do not respond to or tolerate alternative treatment. The benefits generally outweigh the risks in patients with mild or moderate reactive airway disease that is well controlled on inhaled corticosteroids and beta-2 agonists, provided they have no prior history suggesting a predisposition to severe exacerbations. The dosage should start low, preferably in divided doses to avoid the higher plasma levels associated with longer dosing intervals, and titrated slowly according to therapeutic response and pulmonary function. Patients should be advised to contact their physician if they experience worsening of respiratory symptoms, which would warrant a reevaluation of the appropriateness of beta-blocker therapy. Cardioselective beta-blockers should be used with extreme caution, if at all, in patients prone to frequent exacerbations of their respiratory disease.

References

  1. 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
  2. Rasch D, Holt J, Wilson M, Smith RB "Bronchospasm following intraocular injection of acetylcholine in a patient taking metoprolol." Anesthesiology 59 (1983): 583-5
  3. 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
  4. Dunn TL, Gerber MJ, Shen AS, Fernandez E, Iseman MD, Cherniak RM "The effect of topical ophthalmic instillation of timolol and betaxolol on lung function in asthmatic subjects." Am Rev Respir Dis 133 (1986): 264-8
  5. Gold MR, Dec GW, Cocca-Spofford D, Thompson BT "Esmolol and ventilatory function in cardiac patients with COPD." Chest 100 (1991): 1215-8
  6. Bloom B, Chalmers PC, Danker PR, Kumar S, Sheikh F "Cardiovascular collapse and refractory bronchospasm following administration of vancomycin, esmolol, and heparin." J Cardiothorac Anesth 3 (1989): 748-51
  7. Sheppard D, DiStefano S, Byrd RC, Eschenbacher WL, Bell V, Steck J, Laddu A "Effects of esmolol on airway function in patients with asthma." J Clin Pharmacol 26 (1986): 169-74
  8. De Bono G, Kaye CM, Roland E, Summers AJ "Acebutolol: ten years of experience." Am Heart J 109 (1985): 1211-3
  9. Ruffin RE, Frith PA, Anderton RC, Kumana CR, Newhouse MT, Hargreave FE "Selectivity of beta adrenoreceptor antagonist drugs assessed by histamine bronchial provocation." Clin Pharmacol Ther 25 (1979): 536-40
  10. Johnsson G, Svedmyr N, Thiringer G "Effects of intravenous propranolol and metoprolol and their interaction with isoprenaline on pulmonary function, heart rate and blood pressure in asthmatics." Eur J Clin Pharmacol 8 (1975): 175-80
  11. Brooks AM, Burden JG, Gillies WE "The significance of reactions to betaxolol reported by patients." Aust N Z J Ophthalmol 17 (1989): 353-5
  12. Thiringer G, Svedmyr N "Interaction of orally administered metoprolol, practolol and propranolol with isoprenaline in asthmatics." Eur J Clin Pharmacol 10 (1976): 163-70
  13. Mooss AN, Hilleman DE, Mohiuddin SM, Hunter CB "Safety of esmolol in patients with acute myocardial infarction treated with thrombolytic therapy who had relative contraindications to beta-blocker therapy." Ann Pharmacother 28 (1994): 701-3
  14. Brooks AM, Gillies WE "Ocular beta-blockers in glaucoma management. Clinical pharmacological aspects." Drugs Aging 2 (1992): 208-21
  15. Craig TJ "Drugs to be used with caution in patients with asthma." Am Fam Physician 54 (1996): 947-53
  16. Tafreshi MJ, Weinacker AB "Beta-adrenergic-blocking agents in broncospastic diseases: a therapeutic dilemma." Pharmacotherapy 19 (1999): 974-8
  17. Chafin CC, Soberman JE, Demirkan K, Self T "Beta-blockers after myocardial infarction: Do benefits ever outweigh risks in asthma?." Cardiology 92 (1999): 99-105
  18. Salpeter SS, Ormiston T, Salpeter E, Poole P, Cates D "Cardioselective beta-blockers for chronic obstructive pulmonary disease." Cochrane Database Syst Rev 2 (2002): CD0003566
  19. Salpeter SR, Ormiston TM, Salpeter EE "Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis." Ann Intern Med 137 (2002): 715-25
  20. van der Woude HJ, Zaagsma J, Postma DS, Winter TH, van Hulst M, Aalbers R "Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers." Chest 127 (2005): 818-24
  21. Hollenberg NK "The role of beta-blockers as a cornerstone of cardiovascular therapy." Am J Hypertens 18(12 Pt 2) (2005): 165S-168S
  22. Cazzola M, Noschese P, D'Amato G, Matera MG "The pharmacologic treatment of uncomplicated arterial hypertension in patients with airway dysfunction." Chest 121 (2002): 230-41
  23. Cazzola M, Noschese P, D'Amato M, D'Amato G "Comparison of the effects of single oral doses of nebivolol and celiprolol on airways in patients with mild asthma." Chest 118 (2000): 1322-6
  24. Macquin-Mavier I, Roudot-Thorval F, Clerici C, George C, Harf A "Comparative effects of bisoprolol and acebutolol in smokers with airway obstruction." Br J Clin Pharmacol 26 (1988): 279-84
  25. Ashrafian H, Violaris AG "Beta-blocker therapy of cardiovascular diseases in patients with bronchial asthma or COPD: the pro viewpoint." Prim Care Respir J 14 (2005): 236-41
  26. Baselli LM, Oswald MA, Nashelsky JM "Do beta-blockers worsen respiratory status for patients with COPD?" J Fam Pract 54 (2005): 472-3
View all 26 references

Switch to consumer interaction data

Drug and food interactions

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 "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol 11 (1991): 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med 101 (1984): 498-9
  3. Feder R "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry 52 (1991): 139
  4. Ellison JM, Milofsky JE, Ely E "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry 51 (1990): 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit 23 (2001): 435-40
  6. Cerner Multum, Inc. "Australian Product Information." O 0
  7. Pacher P, Kecskemeti V "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des 10 (2004): 2463-75
  8. Andrews C, Pinner G "Postural hypotension induced by paroxetine." BMJ 316 (1998): 595
View all 8 references

Switch to consumer interaction data

Moderate

albuterol food

Applies to: Proventil (albuterol)

MONITOR: Coadministration of two or more sympathomimetic agents may increase the risk of adverse effects such as nervousness, irritability, and increased heart rate. Central nervous system (CNS) stimulants, particularly amphetamines, can potentiate the adrenergic response to vasopressors and other sympathomimetic agents. Additive increases in blood pressure and heart rate may occur due to enhanced peripheral sympathetic activity.

MANAGEMENT: Caution is advised if two or more sympathomimetic agents are coadministered. Pulse and blood pressure should be closely monitored.

References

  1. Rosenblatt JE, Lake CR, van Kammen DP, Ziegler MG, Bunney WE Jr "Interactions of amphetamine, pimozide, and lithium on plasma norepineophrine and dopamine-beta-hydroxylase in schizophrenic patients." Psychiatry Res 1 (1979): 45-52
  2. Cavanaugh JH, Griffith JD, Oates JA "Effect of amphetamine on the pressor response to tyramine: formation of p-hydroxynorephedrine from amphetamine in man." Clin Pharmacol Ther 11 (1970): 656
  3. "Product Information. Adderall (amphetamine-dextroamphetamine)." Shire Richwood Pharmaceutical Company Inc PROD (2001):
  4. "Product Information. Tenuate (diethylpropion)." Aventis Pharmaceuticals PROD (2001):
  5. "Product Information. Sanorex (mazindol)." Novartis Pharmaceuticals PROD (2001):
  6. "Product Information. Focalin (dexmethylphenidate)." Mikart Inc (2001):
  7. "Product Information. Strattera (atomoxetine)." Lilly, Eli and Company (2002):
View all 7 references

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer