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Drug Interactions between S2 Inhalant and Visken

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

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Major

pindolol racepinephrine

Applies to: Visken (pindolol) and S2 Inhalant (racepinephrine)

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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Drug and food interactions

Moderate

pindolol food

Applies to: Visken (pindolol)

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 (1991) "Fluoxetine-associated potentiation of calcium-channel blockers." J Clin Psychopharmacol, 11, p. 390-1
  2. Shook TL, Kirshenbaum JM, Hundley RF, Shorey JM, Lamas GA (1984) "Ethanol intoxication complicating intravenous nitroglycerin therapy." Ann Intern Med, 101, p. 498-9
  3. Feder R (1991) "Bradycardia and syncope induced by fluoxetine." J Clin Psychiatry, 52, p. 139
  4. Ellison JM, Milofsky JE, Ely E (1990) "Fluoxetine-induced bradycardia and syncope in two patients." J Clin Psychiatry, 51, p. 385-6
  5. Rodriguez de la Torre B, Dreher J, Malevany I, et al. (2001) "Serum levels and cardiovascular effects of tricyclic antidepressants and selective serotonin reuptake inhibitors in depressed patients." Ther Drug Monit, 23, p. 435-40
  6. Cerner Multum, Inc. "Australian Product Information."
  7. Pacher P, Kecskemeti V (2004) "Cardiovascular side effects of new antidepressants and antipsychotics: new drugs, old concerns?" Curr Pharm Des, 10, p. 2463-75
  8. Andrews C, Pinner G (1998) "Postural hypotension induced by paroxetine." BMJ, 316, p. 595
View all 8 references

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Moderate

pindolol food

Applies to: Visken (pindolol)

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 (1981) "Interaction of atenolol with furosemide and calcium and aluminum salts." Clin Pharmacol Ther, 30, p. 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.

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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.

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