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Drug Interactions between formoterol / mometasone and Istalol

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

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Interactions between your drugs

Major

timolol ophthalmic formoterol

Applies to: Istalol (timolol ophthalmic) and formoterol / mometasone

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 (1986) "Effect of single doses of labetalol, metoprolol, and placebo on ventilatory function in patients with bronchial asthma: interaction with isoproterenol." J Asthma, 23, p. 251-60
  2. Rasch D, Holt J, Wilson M, Smith RB (1983) "Bronchospasm following intraocular injection of acetylcholine in a patient taking metoprolol." Anesthesiology, 59, p. 583-5
  3. Chodosh S, Tuck J, Blasucci DJ (1988) "The effects of dilevalol, metoprolol, and placebo on ventilatory function in asthmatics." J Cardiovasc Pharmacol, 11, s18-24
  4. Dunn TL, Gerber MJ, Shen AS, Fernandez E, Iseman MD, Cherniak RM (1986) "The effect of topical ophthalmic instillation of timolol and betaxolol on lung function in asthmatic subjects." Am Rev Respir Dis, 133, p. 264-8
  5. Gold MR, Dec GW, Cocca-Spofford D, Thompson BT (1991) "Esmolol and ventilatory function in cardiac patients with COPD." Chest, 100, p. 1215-8
  6. Bloom B, Chalmers PC, Danker PR, Kumar S, Sheikh F (1989) "Cardiovascular collapse and refractory bronchospasm following administration of vancomycin, esmolol, and heparin." J Cardiothorac Anesth, 3, p. 748-51
  7. Sheppard D, DiStefano S, Byrd RC, Eschenbacher WL, Bell V, Steck J, Laddu A (1986) "Effects of esmolol on airway function in patients with asthma." J Clin Pharmacol, 26, p. 169-74
  8. De Bono G, Kaye CM, Roland E, Summers AJ (1985) "Acebutolol: ten years of experience." Am Heart J, 109, p. 1211-3
  9. Ruffin RE, Frith PA, Anderton RC, Kumana CR, Newhouse MT, Hargreave FE (1979) "Selectivity of beta adrenoreceptor antagonist drugs assessed by histamine bronchial provocation." Clin Pharmacol Ther, 25, p. 536-40
  10. (2002) "Product Information. Normodyne (labetalol)." Schering Corporation
  11. (2002) "Product Information. Corgard (nadolol)." Bristol-Myers Squibb
  12. (2001) "Product Information. Inderal (propranolol)." Wyeth-Ayerst Laboratories
  13. Johnsson G, Svedmyr N, Thiringer G (1975) "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, p. 175-80
  14. (2001) "Product Information. Blocadren (timolol)." Merck & Co., Inc
  15. Brooks AM, Burden JG, Gillies WE (1989) "The significance of reactions to betaxolol reported by patients." Aust N Z J Ophthalmol, 17, p. 353-5
  16. Herschman Z, Kaufman B (1989) "Complications arising from the use of ophthalmologic medications in an intensive care unit patient." N Y State J Med, 89, p. 537-8
  17. Thiringer G, Svedmyr N (1976) "Interaction of orally administered metoprolol, practolol and propranolol with isoprenaline in asthmatics." Eur J Clin Pharmacol, 10, p. 163-70
  18. (2022) "Product Information. OptiPranolol (metipranolol ophthalmic)." Bausch and Lomb Americas, Inc.
  19. Mooss AN, Hilleman DE, Mohiuddin SM, Hunter CB (1994) "Safety of esmolol in patients with acute myocardial infarction treated with thrombolytic therapy who had relative contraindications to beta-blocker therapy." Ann Pharmacother, 28, p. 701-3
  20. Brooks AM, Gillies WE (1992) "Ocular beta-blockers in glaucoma management. Clinical pharmacological aspects." Drugs Aging, 2, p. 208-21
  21. (2022) "Product Information. Betagan (levobunolol ophthalmic)." Allergan Inc
  22. (2001) "Product Information. Coreg (carvedilol)." SmithKline Beecham
  23. Craig TJ (1996) "Drugs to be used with caution in patients with asthma." Am Fam Physician, 54, p. 947-53
  24. (2001) "Product Information. Timoptic (timolol ophthalmic)." Merck & Co., Inc
  25. Tafreshi MJ, Weinacker AB (1999) "Beta-adrenergic-blocking agents in broncospastic diseases: a therapeutic dilemma." Pharmacotherapy, 19, p. 974-8
  26. Chafin CC, Soberman JE, Demirkan K, Self T (1999) "Beta-blockers after myocardial infarction: Do benefits ever outweigh risks in asthma?." Cardiology, 92, p. 99-105
  27. (2001) "Product Information. Volmax (albuterol)." Muro Pharmaceuticals Inc
  28. Salpeter SS, Ormiston T, Salpeter E, Poole P, Cates D (2002) "Cardioselective beta-blockers for chronic obstructive pulmonary disease." Cochrane Database Syst Rev, 2, CD0003566
  29. Salpeter SR, Ormiston TM, Salpeter EE (2002) "Cardioselective beta-blockers in patients with reactive airway disease: a meta-analysis." Ann Intern Med, 137, p. 715-25
  30. van der Woude HJ, Zaagsma J, Postma DS, Winter TH, van Hulst M, Aalbers R (2005) "Detrimental effects of beta-blockers in COPD: a concern for nonselective beta-blockers." Chest, 127, p. 818-24
  31. Hollenberg NK (2005) "The role of beta-blockers as a cornerstone of cardiovascular therapy." Am J Hypertens, 18(12 Pt 2), 165S-168S
  32. (2006) "Product Information. Brovana (arformoterol)." Sepracor Inc
  33. Cazzola M, Noschese P, D'Amato G, Matera MG (2002) "The pharmacologic treatment of uncomplicated arterial hypertension in patients with airway dysfunction." Chest, 121, p. 230-41
  34. Cazzola M, Noschese P, D'Amato M, D'Amato G (2000) "Comparison of the effects of single oral doses of nebivolol and celiprolol on airways in patients with mild asthma." Chest, 118, p. 1322-6
  35. Macquin-Mavier I, Roudot-Thorval F, Clerici C, George C, Harf A (1988) "Comparative effects of bisoprolol and acebutolol in smokers with airway obstruction." Br J Clin Pharmacol, 26, p. 279-84
  36. Ashrafian H, Violaris AG (2005) "Beta-blocker therapy of cardiovascular diseases in patients with bronchial asthma or COPD: the pro viewpoint." Prim Care Respir J, 14, p. 236-41
  37. Baselli LM, Oswald MA, Nashelsky JM (2005) "Do beta-blockers worsen respiratory status for patients with COPD?" J Fam Pract, 54, p. 472-3
  38. (2011) "Product Information. Arcapta Neohaler (indacaterol)." Novartis Pharmaceuticals
  39. (2013) "Product Information. Breo Ellipta (fluticasone-vilanterol)." GlaxoSmithKline
  40. (2014) "Product Information. Striverdi Respimat (olodaterol)." Boehringer Ingelheim
View all 40 references

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Minor

formoterol mometasone

Applies to: formoterol / mometasone and formoterol / mometasone

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

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

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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