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Drug Interactions between Inderal LA and metaproterenol

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

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Interactions between your drugs

Major

propranolol metaproterenol

Applies to: Inderal LA (propranolol) and metaproterenol

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 (40)
  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

Drug and food interactions

Moderate

propranolol food

Applies to: Inderal LA (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 (2)
  1. Olanoff LS, Walle T, Cowart TD, et al. (1986) "Food effects on propranolol systemic and oral clearance: support for a blood flow hypothesis." Clin Pharmacol Ther, 40, p. 408-14
  2. 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, s45-50
Moderate

propranolol food

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

metaproterenol food

Applies to: metaproterenol

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

propranolol food

Applies to: Inderal LA (propranolol)

MONITOR: Smoking cessation may lead to elevated plasma concentrations and enhanced pharmacologic effects of drugs that are substrates of CYP450 1A2 (and possibly CYP450 1A1) and/or certain drugs with a narrow therapeutic index (e.g., flecainide, pentazocine). One proposed mechanism is related to the loss of CYP450 1A2 and 1A1 induction by polycyclic aromatic hydrocarbons in tobacco smoke; when smoking cessation agents are initiated and smoking stops, the metabolism of certain drugs may decrease leading to increased plasma concentrations. The mechanism by which smoking cessation affects narrow therapeutic index drugs that are not known substrates of CYP450 1A2 or 1A1 is unknown. The clinical significance of this interaction is unknown as clinical data are lacking.

MANAGEMENT: Until more information is available, caution is advisable if smoking cessation agents are used concomitantly with drugs that are substrates of CYP450 1A2 or 1A1 and/or those with a narrow therapeutic range. Patients receiving smoking cessation agents may require periodic dose adjustments and closer clinical and laboratory monitoring of medications that are substrates of CYP450 1A2 or 1A1.

References (4)
  1. (2024) "Product Information. Cytisine (cytisinicline)." Consilient Health Ltd
  2. jeong sh, Newcombe D, sheridan j, Tingle M (2015) "Pharmacokinetics of cytisine, an a4 b2 nicotinic receptor partial agonist, in healthy smokers following a single dose." Drug Test Anal, 7, p. 475-82
  3. Vaughan DP, Beckett AH, Robbie DS (1976) "The influence of smoking on the intersubject variation in pentazocine elimination." Br J Clin Pharmacol, 3, p. 279-83
  4. Zevin S, Benowitz NL (1999) "Drug interactions with tobacco smoking: an update" Clin Pharmacokinet, 36, p. 425-38

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

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