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Drug Interactions between isoetharine and labetalol

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

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Interactions between your drugs

Major

labetalol isoetharine

Applies to: labetalol and isoetharine

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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Drug and food interactions

Moderate

labetalol food

Applies to: labetalol

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

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Moderate

labetalol food

Applies to: labetalol

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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Moderate

isoetharine food

Applies to: isoetharine

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

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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.

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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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