Drug Interaction Report

MONITOR CLOSELY: Concomitant use of landiolol and epinephrine may attenuate the response to epinephrine in the treatment of anaphylactic reactions. Some authorities suggest sensitivity and severity of allergic reactions, towards allergens, may be increased in patients taking beta-blockers alone and landiolol may reduce the response to usual doses of epinephrine. Additionally, epinephrine may reduce the therapeutic effects of landiolol. Coadministration with positive inotropes, vasoconstrictors, or sympathomimetic agents (e.g., epinephrine) may decrease landiolol's heart rate and blood pressure lowering effects.

MANAGEMENT : If coadministration is clinically necessary, careful titration of the landiolol infusion, dose adjustment of either agent to achieve the desired effect, and close hemodynamic monitoring are advised. Consultation with package labeling and relevant institutional protocols may be advisable for further guidance.

MONITOR: Beta-blockers may increase the risk of bupivacaine-induced side effects. The proposed mechanism is increased bupivacaine levels due to hepatic enzyme inhibition (propranolol) and/or additive negative inotropic effects on the heart. Patients with heart failure may be at a greater risk. Data have been conflicting and variable. Theoretically, beta-blocker ophthalmic solutions may also interact, as they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels.

MANAGEMENT: Caution is recommended if multiple doses of bupivacaine are administered in the presence of a beta-blocker. Monitoring for drowsiness, mental status changes, convulsions, ECG changes, and hypotension is advisable during concurrent therapy.

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.