Interactions between Nadolol and Wellbutrin

The buPROPion in Wellbutrin has a major potential interaction with Alcoholism.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

Nadolol has a major potential interaction with Allergies.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) in patients with a history of allergic reactions or anaphylaxis may be associated with heightened reactivity to culprit allergens. The frequency and/or severity of attacks may be increased during beta-blocker therapy. In addition, these patients may be refractory to the usual doses of epinephrine used to treat acute hypersensitivity reactions and may require a beta-agonist such as isoproterenol.

The buPROPion in Wellbutrin has a major potential interaction with Anorexia Nervosa.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

Nadolol has a major potential interaction with Asthma.

Some beta-adrenergic receptor blocking agents (i.e., non-cardioselective beta-blockers) are contraindicated in patients with bronchial asthma or with a history of bronchial asthma, or severe chronic obstructive pulmonary disease. In general, beta-adrenergic receptor blocking agents should not be used in patients with bronchospastic diseases. Beta blockade may adversely affect pulmonary function by counteracting the bronchodilation produced by catecholamine stimulation of beta-2 receptors. If beta-blocker therapy is necessary in these patients, an agent with beta-1 selectivity (e.g., atenolol, metoprolol, betaxolol) is considered safer, but should be used with caution nonetheless. Cardioselectivity is not absolute and can be lost with larger doses.

The buPROPion in Wellbutrin has a major potential interaction with Bipolar Disorder.

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.

The buPROPion in Wellbutrin has a moderate potential interaction with Bipolar Disorder.

Bupropion is not approved for the treatment of bipolar depression. Antidepressant therapy can trigger a manic, mixed, or hypomanic episode; the risk appears increased in patients with bipolar disorder or with risk factors for bipolar disorder. Before starting bupropion, patients should be screened for history of bipolar disorder and risk factors for bipolar disorder (e.g., family history of bipolar disorder, suicide, or depression). Depressed patients treated with bupropion have had various neuropsychiatric signs/symptoms, including delusions, hallucinations, psychosis, concentration disturbance, confusion, and paranoia; some of these patients had a diagnosis of bipolar disorder. In some cases, these symptoms abated with dose reduction and/or discontinuation of therapy. Bupropion should be discontinued if such reactions occur.

The buPROPion in Wellbutrin has a major potential interaction with Brain Tumor.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

The buPROPion in Wellbutrin has a major potential interaction with Bulimia.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

Nadolol has a major potential interaction with Cardiogenic Shock.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

Nadolol has a moderate potential interaction with Cerebrovascular Insufficiency.

Beta-adrenergic blocking agents (beta-blockers), should be used with caution in patients with cerebrovascular insufficiency because of their potential effects relative to blood pressure and pulse. If signs or symptoms suggesting reduced cerebral blood flow are observed, consideration should be given to discontinuing these agents.

The buPROPion in Wellbutrin has a major potential interaction with CNS Infection.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

Nadolol has a major potential interaction with COPD.

Some beta-adrenergic receptor blocking agents (i.e., non-cardioselective beta-blockers) are contraindicated in patients with bronchial asthma or with a history of bronchial asthma, or severe chronic obstructive pulmonary disease. In general, beta-adrenergic receptor blocking agents should not be used in patients with bronchospastic diseases. Beta blockade may adversely affect pulmonary function by counteracting the bronchodilation produced by catecholamine stimulation of beta-2 receptors. If beta-blocker therapy is necessary in these patients, an agent with beta-1 selectivity (e.g., atenolol, metoprolol, betaxolol) is considered safer, but should be used with caution nonetheless. Cardioselectivity is not absolute and can be lost with larger doses.

The buPROPion in Wellbutrin has a major potential interaction with Depression.

Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.

Nadolol has a major potential interaction with Diabetes Mellitus.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may mask symptoms of hypoglycemia such as tremors, tachycardia and blood pressure changes. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may inhibit catecholamine-mediated glycogenolysis, thereby potentiating insulin-induced hypoglycemia and delaying the recovery of normal blood glucose levels. Since cardioselectivity is not absolute, larger doses of beta-1 selective agents may demonstrate these effects as well. Therapy with beta-blockers should be administered cautiously in patients with diabetes or predisposed to spontaneous hypoglycemia.

The buPROPion in Wellbutrin has a major potential interaction with Diabetes Mellitus.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

The buPROPion in Wellbutrin has a major potential interaction with Drug Dependence.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

The buPROPion in Wellbutrin has a moderate potential interaction with Glaucoma, Narrow Angle.

The pupillary dilation that occurs after use of many antidepressant drugs (including bupropion) can induce increased intraocular pressure and result in angle-closure (narrow-angle) glaucoma in a patient with anatomically narrow angles who does not have a patent iridectomy. Patients may want to be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure (e.g., iridectomy), if they are susceptible. The use of antidepressants (including bupropion-dextromethorphan) should be avoided in patients with untreated anatomically narrow angles.

Nadolol has a moderate potential interaction with Glaucoma/Intraocular Hypertension.

Systemic beta-adrenergic receptor blocking agents (aka beta-blockers) may lower intraocular pressure. Therefore, patients with glaucoma or intraocular hypertension may require adjustments in their ophthalmic regimen following a dosing change or discontinuation of beta-blocker therapy.

The buPROPion in Wellbutrin has a major potential interaction with Head Injury.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

Nadolol has a major potential interaction with Heart Block.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

Nadolol has a major potential interaction with Heart Failure.

Beta-adrenergic receptor blocking agents (aka beta-blockers) in general should not be used in patients with overt congestive heart failure (CHF). Sympathetic stimulation may be important in maintaining the hemodynamic function in these patients, thus beta-blockade can worsen the heart failure. However, therapy with beta-blockers may be beneficial and can be administered cautiously in some CHF patients provided they are well compensated and receiving digitalis, diuretics, an ACE inhibitor, and/or nitrates. Carvedilol, specifically, is indicated for use with these agents in the treatment of mild to severe heart failure of ischemic or cardiomyopathic origin. There is also increasing evidence that the addition of a beta-blocker to standard therapy can improve morbidity and mortality in patients with advanced heart failure, although it is uncertain whether effectiveness varies significantly with the different agents. Data from one meta-analysis study suggest a greater reduction of mortality risk for nonselective beta-blockers than for beta-1 selective agents.

Nadolol has a major potential interaction with Hemodialysis.

Therapy with beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in patients requiring hemodialysis. When given after dialysis, hemodynamic stability should be established prior to drug administration to avoid marked falls in blood pressure. The hemodynamic status should be closely monitored before and after the dose.

Nadolol has a moderate potential interaction with High Cholesterol.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may alter serum lipid profiles. Increases in serum VLDL and LDL cholesterol and triglycerides, as well as decreases in HDL cholesterol, have been reported with some beta-blockers. Patients with preexisting hyperlipidemia may require closer monitoring during beta-blocker therapy, and adjustments made accordingly in their lipid-lowering regimen.

Nadolol has a moderate potential interaction with Hyperthyroidism.

When beta-adrenergic receptor blocking agents (aka beta-blockers) are used to alleviate symptoms of hyperthyroidism such as tachycardia, anxiety, tremor and heat intolerance, abrupt withdrawal can exacerbate thyrotoxicosis or precipitate a thyroid storm. To minimize this risk, cessation of beta-blocker therapy, when necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks. Patients should be advised not to discontinue treatment without first consulting with the physician. Close monitoring is recommended during and after therapy withdrawal.

The buPROPion in Wellbutrin has a major potential interaction with Hypoglycemia.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

The buPROPion in Wellbutrin has a major potential interaction with Hyponatremia.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

Nadolol has a major potential interaction with Hypotension.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with hypotension or cardiogenic shock. Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to further depress cardiac output and blood pressure, which can be detrimental in these patients.

Nadolol has a major potential interaction with Ischemic Heart Disease.

Heightened sensitivity to catecholamines may occur after prolonged use of beta-adrenergic receptor blocking agents (aka beta-blockers). Exacerbation of angina, myocardial infarction and ventricular arrhythmias have been reported in patients with coronary artery disease following abrupt withdrawal of therapy. Cessation of beta-blocker therapy, whenever necessary, should occur gradually with incrementally reduced dosages over a period of 1 to 2 weeks in patients with coronary insufficiency. Patients should be advised not to discontinue treatment without first consulting with the physician. In patients who experience an exacerbation of angina following discontinuation of beta-blocker therapy, the medication should generally be reinstituted, at least temporarily, along with other clinically appropriate measures.

The buPROPion in Wellbutrin has a major potential interaction with Liver Disease.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

The buPROPion in Wellbutrin has a moderate potential interaction with Liver Disease.

Bupropion is primarily metabolized by the liver. The systemic exposure and half-life of bupropion and its metabolites may be increased in patients with liver dysfunction. A reduced dose and/or dosing frequency should be considered in patients with mild liver dysfunction (Child-Pugh score: 5 to 6). A dosage reduction is required in patients with moderate to severe liver dysfunction (Child-Pugh score: 7 to 15) who are using a single-ingredient bupropion product; the dosage should not exceed 75 mg/day with immediate-release bupropion hydrochloride (HCl), 100 mg/day or 150 mg every other day with sustained-release bupropion HCl, 150 mg every other day with extended-release bupropion HCl, and 174 mg every other day with extended-release bupropion hydrobromide. Bupropion-dextromethorphan is not recommended for patients with severe liver dysfunction (Child-Pugh C), and no dose adjustment of bupropion-dextromethorphan is recommended in patients with mild or moderate liver dysfunction (Child-Pugh A or B).

The buPROPion in Wellbutrin has a minor potential interaction with Malnourishment.

The use of bupropion is associated with weight alterations. Both weight gain and weight loss may occur, although the latter is much more common. Weight loss greater than 2.27 kg was reported in up to 28% of patients, which may be undesirable in patients suffering from anorexia, malnutrition, or excessive weight loss. Weight change should be monitored during therapy if bupropion is used in these patients.

The buPROPion in Wellbutrin has a moderate potential interaction with Mania.

Bupropion is not approved for the treatment of bipolar depression. Antidepressant therapy can trigger a manic, mixed, or hypomanic episode; the risk appears increased in patients with bipolar disorder or with risk factors for bipolar disorder. Before starting bupropion, patients should be screened for history of bipolar disorder and risk factors for bipolar disorder (e.g., family history of bipolar disorder, suicide, or depression). Depressed patients treated with bupropion have had various neuropsychiatric signs/symptoms, including delusions, hallucinations, psychosis, concentration disturbance, confusion, and paranoia; some of these patients had a diagnosis of bipolar disorder. In some cases, these symptoms abated with dose reduction and/or discontinuation of therapy. Bupropion should be discontinued if such reactions occur.

Nadolol has a moderate potential interaction with Myasthenia Gravis.

Beta-adrenergic receptor blocking agents (aka beta-blockers) may potentiate muscle weakness consistent with certain myasthenic symptoms such as diplopia, ptosis, and generalized weakness. Several beta-blockers have been associated rarely with aggravation of muscle weakness in patients with preexisting myasthenia gravis or myasthenic symptoms. Use cautiously in patients with myasthenia gravis.

Nadolol has a major potential interaction with Peripheral Arterial Disease.

Due to their negative inotropic and chronotropic effects on the heart, beta-adrenergic receptor blocking agents (aka beta-blockers) reduce cardiac output and may precipitate or aggravate symptoms of arterial insufficiency in patients with peripheral vascular disease. In addition, the nonselective beta-blockers (e.g., propranolol, pindolol, timolol) may attenuate catecholamine-mediated vasodilation during exercise by blocking beta-2 receptors in peripheral vessels. Therapy with beta-blockers should be administered cautiously in patients with peripheral vascular disease. Close monitoring for progression of arterial obstruction is advised.

Nadolol has a moderate potential interaction with Pheochromocytoma.

Administration of beta-blockers alone in the setting of pheochromocytoma has been associated with a paradoxical increase in blood pressure due to the attenuation of beta receptor-mediated vasodilatation in skeletal muscle. In patients with pheochromocytoma, an alpha-blocking agent should be initiated prior to the use of any beta-blocking agent. Caution should be taken in the administration of these agents to patients suspected of having pheochromocytoma.

Nadolol has a moderate potential interaction with Prinzmetal's Angina.

Agents with non-selective beta-blocking activity may provoke chest pain in patients with Prinzmetal's variant angina. the use of non-selective beta blockers is not recommended in these patients. Caution should be taken in the administration of these agents to patients suspected of having Prinzmetal's variant angina.

Nadolol has a moderate potential interaction with Psoriasis.

The use of beta-blockers in psoriatic patients should be carefully weighed since the use of these agents may cause an aggravation in psoriasis.

Nadolol has a major potential interaction with Renal Dysfunction.

Nadolol is primarily eliminated by the kidney. Patients with renal impairment may be at greater risk for adverse effects from nadolol due to decreased drug clearance. Therapy with nadolol should be administered cautiously in patients with renal impairment. Dosage adjustments (i.e. prolongation of dosing interval) are recommended for patients with moderate to severe renal dysfunction (CrCl <= 50 mL/min).

The buPROPion in Wellbutrin has a moderate potential interaction with Renal Dysfunction.

Bupropion and its metabolites, some of which are pharmacologically active with one-fifth to one-half the potency of the parent drug, are cleared renally and may accumulate in patients with renal dysfunction (GFR less than 90 mL/min) to a greater extent than usual. Therefore, bupropion should be used with caution in patients with renal dysfunction. A reduced dose and/or dosing frequency should be considered, and patients should be closely monitored for adverse effects that could indicate high bupropion or metabolite exposures. Bupropion-dextromethorphan is not recommended for patients with severe renal dysfunction (estimated GFR 15 to 29 mL/min/1.73 m2); dosage adjustment of bupropion-dextromethorphan is recommended in patients with moderate renal dysfunction (estimated GFR 30 to 59 mL/min/1.73 m2).

The buPROPion in Wellbutrin has a major potential interaction with Seizures.

Bupropion is contraindicated in patients with a seizure disorder. Bupropion can cause seizure; the risk is dose-related. In 1 study, the seizure incidence was about 0.4% with immediate-release bupropion hydrochloride (HCl) in the range of 300 to 450 mg/day (equal to 348 to 522 mg/day of extended-release bupropion hydrobromide [HBr]); the incidence of seizures increases dramatically at higher dosages (almost 10-fold between 450 and 600 mg/day as bupropion HCl [equal to 522 and 696 mg/day as bupropion HBr]). The risk of seizures (related to patient factors, clinical situations, and concomitant medications that lower the seizure threshold) should be considered before starting bupropion. Bupropion is also contraindicated in patients with current/prior diagnosis of bulimia or anorexia nervosa (a higher incidence of seizures was observed in such patients treated with immediate-release bupropion) and in patients undergoing abrupt discontinuation of alcohol, benzodiazepines, barbiturates, and antiepileptic drugs. Bupropion should be administered with caution in patients with conditions that increase the risk of seizure or who have other predisposing conditions including severe head injury; arteriovenous malformation; CNS infection or CNS tumor; severe stroke; metabolic disorders (e.g., hypoglycemia, hyponatremia, severe hepatic impairment, hypoxia); excessive use of alcohol, benzodiazepines, sedative/hypnotics, or opiates; use of illicit drugs (e.g., cocaine); abuse/misuse of prescription drugs (e.g., CNS stimulants); diabetes mellitus treated with oral hypoglycemic agents or insulin; use of anorectic agents; and concomitant use of medications that lower the seizure threshold. The risk of seizure can be reduced if the maximum recommended dosage is not exceeded (e.g., 450 mg/day [as 150 mg 3 times a day] for immediate-release bupropion HCl; 400 mg/day [as 200 mg twice a day] for sustained-release bupropion HCl; 450 mg once a day for extended-release bupropion HCl; 522 mg once a day for extended-release bupropion HBr), and the titration rate is gradual. Bupropion should be discontinued and should not be restarted if the patient has a seizure.

Nadolol has a major potential interaction with Sinus Node Dysfunction.

The use of beta-adrenergic receptor blocking agents (aka beta-blockers) is contraindicated in patients with sinus bradyarrhythmia or heart block greater than the first degree (unless a functioning pacemaker is present). Due to their negative inotropic and chronotropic effects on the heart, the use of beta-blockers is likely to exacerbate these conditions.

Nadolol has a moderate potential interaction with Tachyarrhythmia.

Beta-adrenergic blockade in patients with Wolff-Parkinson-White syndrome and tachycardia has been associated with severe bradycardia requiring treatment with a pacemaker. In one case, this result was reported after an initial dose of 5 mg propranolol. The use of beta-adrenergic receptor blocking agents (aka beta-blockers) should be administered cautiously in these patients.