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Drug Interactions between fluticasone / umeclidinium / vilanterol and Hemangeol

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

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Interactions between your drugs

Major

propranolol vilanterol

Applies to: Hemangeol (propranolol) and fluticasone / umeclidinium / vilanterol

GENERALLY AVOID: Beta-blockers may antagonize the effects of beta-2 adrenergic bronchodilators and precipitate acute, life-threatening bronchospasm in patients with asthma or other obstructive airway diseases. The mechanism involves increased airway resistance and reduced bronchodilation due to blockade of beta-2 adrenergic receptors. The interaction may also occur with ophthalmically applied beta-blockers, which are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels. Due to opposing effects on beta-2 adrenergic receptors, propranolol has been used in the treatment of albuterol overdose. Likewise, beta-2 adrenergic agonists may interfere with the pharmacologic effects of beta-blockers.

MANAGEMENT: Concomitant use of beta-2 adrenergic bronchodilators with beta-blockers, including ophthalmic formulations, should generally be avoided. If coadministration is required, a cardioselective beta-blocker (e.g., acebutolol, atenolol, betaxolol, bisoprolol, metoprolol, nebivolol) is usually preferred. Nevertheless, caution is advised and respiratory status should be closely monitored, as cardioselectivity is not absolute and larger doses of beta-1 selective agents may pose some of the same risks as nonselective agents. In general, nonselective beta-blockers are considered contraindicated in patients with obstructive airways 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. "Product Information. Normodyne (labetalol)." Schering Corporation PROD (2002):
  11. "Product Information. Corgard (nadolol)." Bristol-Myers Squibb PROD (2002):
  12. "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories PROD (2001):
  13. 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
  14. "Product Information. Blocadren (timolol)." Merck & Co., Inc PROD (2001):
  15. Brooks AM, Burden JG, Gillies WE "The significance of reactions to betaxolol reported by patients." Aust N Z J Ophthalmol 17 (1989): 353-5
  16. Herschman Z, Kaufman B "Complications arising from the use of ophthalmologic medications in an intensive care unit patient." N Y State J Med 89 (1989): 537-8
  17. Thiringer G, Svedmyr N "Interaction of orally administered metoprolol, practolol and propranolol with isoprenaline in asthmatics." Eur J Clin Pharmacol 10 (1976): 163-70
  18. "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc. (2022):
  19. 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
  20. Brooks AM, Gillies WE "Ocular beta-blockers in glaucoma management. Clinical pharmacological aspects." Drugs Aging 2 (1992): 208-21
  21. "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc (2022):
  22. "Product Information. Coreg (carvedilol)." SmithKline Beecham PROD (2001):
  23. Craig TJ "Drugs to be used with caution in patients with asthma." Am Fam Physician 54 (1996): 947-53
  24. "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc PROD (2001):
  25. Tafreshi MJ, Weinacker AB "Beta-adrenergic-blocking agents in broncospastic diseases: a therapeutic dilemma." Pharmacotherapy 19 (1999): 974-8
  26. 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
  27. "Product Information. Volmax (albuterol)." Muro Pharmaceuticals Inc PROD (2001):
  28. 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
  29. 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
  30. 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
  31. Hollenberg NK "The role of beta-blockers as a cornerstone of cardiovascular therapy." Am J Hypertens 18(12 Pt 2) (2005): 165S-168S
  32. "Product Information. Brovana (arformoterol)." Sepracor Inc (2006):
  33. 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
  34. 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
  35. 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
  36. 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
  37. Baselli LM, Oswald MA, Nashelsky JM "Do beta-blockers worsen respiratory status for patients with COPD?" J Fam Pract 54 (2005): 472-3
  38. "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals (2011):
  39. "Product Information. Breo Ellipta (fluticasone-vilanterol)." GlaxoSmithKline (2013):
  40. "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim (2014):
View all 40 references

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Minor

fluticasone vilanterol

Applies to: fluticasone / umeclidinium / vilanterol and fluticasone / umeclidinium / vilanterol

Although they are often combined in clinical practice, the concomitant use of beta-2 adrenergic agonists and corticosteroids may result in additive hypokalemic effects. Since beta-2 agonists can sometimes cause QT interval prolongation, the development of hypokalemia may potentiate the risk of ventricular arrhythmias including torsade de pointes. However, clinical data are limited, and the potential significance is unknown. Patients who are receiving systemic or nebulized formulations of beta-2 agonists, high dosages of inhaled beta-2 agonists, or systemic corticosteroid therapy may be at a greater risk of developing hypokalemia.

References

  1. "Product Information. Foradil (formoterol)." Novartis Pharmaceuticals PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0
  4. Agencia Española de Medicamentos y Productos Sanitarios Healthcare "Centro de información online de medicamentos de la AEMPS - CIMA. https://cima.aemps.es/cima/publico/home.html" (2008):
View all 4 references

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Drug and food interactions

Moderate

propranolol food

Applies to: Hemangeol (propranolol)

ADJUST DOSING INTERVAL: The bioavailability of propranolol may be enhanced by food.

MANAGEMENT: Patients may be instructed to take propranolol at the same time each day, preferably with or immediately following meals.

References

  1. Olanoff LS, Walle T, Cowart TD, et al. "Food effects on propranolol systemic and oral clearance: support for a blood flow hypothesis." Clin Pharmacol Ther 40 (1986): 408-14
  2. Byrne AJ, McNeil JJ, Harrison PM, Louis W, Tonkin AM, McLean AJ "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 (1984): s45-50

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Moderate

propranolol food

Applies to: Hemangeol (propranolol)

ADJUST DOSING INTERVAL: Concurrent administration with calcium salts may decrease the oral bioavailability of atenolol and possibly other beta-blockers. The exact mechanism of interaction is unknown. In six healthy subjects, calcium 500 mg (as lactate, carbonate, and gluconate) reduced the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of atenolol (100 mg) by 51% and 32%, respectively. The elimination half-life increased by 44%. Twelve hours after the combination, beta-blocking activity (as indicated by inhibition of exercise tachycardia) was reduced compared to that with atenolol alone. However, during a 4-week treatment in six hypertensive patients, there was no difference in blood pressure values between treatments. The investigators suggest that prolongation of the elimination half-life induced by calcium coadministration may have led to atenolol cumulation during long-term dosing, which compensated for the reduced bioavailability.

MANAGEMENT: It may help to separate the administration times of beta-blockers and calcium products by at least 2 hours. Patients should be monitored for potentially diminished beta-blocking effects following the addition of calcium therapy.

References

  1. Kirch W, Schafer-Korting M, Axthelm T, Kohler H, Mutschler E "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther 30 (1981): 429-35

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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.

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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