Selected Beta-Blockers/Selected Calcium Channel Blockers Interactions
This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.
Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
When these two medicines are taken together, the effects of one or both medicines may increase.
What might happen:
An increase in the beneficial and toxic effects of one or both medicines may occur. Additional problems may develop if you have a low heart rate. Using these medicines together may reveal an additional problem with your heart.
What you should do about this interaction:
If you experience a slow heart rate, weakness, fatigue, or dizziness, contact your doctor. The dose of your medicines may need adjusting. Heart problems and high doses of your beta-blocker may increase the chance for harmful effects. Using additional heart medicines may also lead to harmful effects.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this drug interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
- 1.Vinceneux P, Canal M, Domart Y, Roux A, Cascio B, Orofiamma B, Larribaud J, Flouvat B, Carbon C. Pharmacokinetic and pharmacodynamic interactions between nifedipine and propranolol or betaxolol. Int J Clin Pharmacol Ther Toxicol 1986 Mar;24(3):153-8.
- 2.Rosenkranz B, Ledermann H, Frolich JC. Interaction between nifedipine and atenolol: pharmacokinetics and pharmacodynamics in normotensive volunteers. J Cardiovasc Pharmacol 1986 Sep-Oct;8(5):943-9.
- 3.Anastassiades CJ. Nifedipine and beta-blocker drugs. Br Med J 1980 Nov 8; 281(6250):1251-2.
- 4.Staffurth JS, Emery P. Adverse interaction between nifedipine and beta-blockade. Br Med J 1981 Jan 17;282:225.
- 5.Joshi PI, Dalal JJ, Ruttley MS, Sheridan DJ, Henderson AH. Nifedipine and left ventricular function in beta-blocked patients. Br Heart J 1981 Apr; 45(4):457-9.
- 6.Winniford MD, Markham RV Jr, Firth BG, Nicod P, Hillis LD. Hemodynamic and electrophysiologic effects of verapamil and nifedipine in patients on propranolol. Am J Cardiol 1982 Oct;50(4):704-710.
- 7.Packer M, Meller J, Medina N, Yushak M, Smith H, Holt J, Guererro J, Todd GD, McAllister RG Jr, Gorlin R. Hemodynamic consequences of combined beta-adrenergic and slow calcium channel blockade in man. Circulation 1982 Apr;65(4):660-8.
- 8.Robson RH, Vishwanath MC. Nifedipine and beta-blockade as a cause of cardiac failure. Br Med J (Clin Res Ed) 1982 Jan 9;284(6309):104.
- 9.Anastassiades C. Nifedipine and beta-blockade as a cause of cardiac failure. Br Med J (Clin Res Ed) 1982 Feb 13;284(6314):506.
- 10.Vanhaleweyk GL, Serruys PW, Hugenholtz PG. Anti-anginal, electrophysiologic and hemodynamic effects of combined beta-blocker/calcium antagonist therapy. Eur Heart J 1983 Jul;4 Suppl D:117-28.
- 11.Sinclair NI, Benzie JL. Timolol eye drops and verapamil--a dangerous combination. Med J Aust 1983 Jun 11;1(12):548.
- 12.Eisenberg JN, Oakley GD. Probable adverse interaction between oral metoprolol and verapamil. Postgrad Med J 1984 Oct;60(708):705-6.
- 13.Findlay IN, McInnes GT, Dargie HJ. Beta blockers and verapamil: a cautionary tale. Br Med J (Clin Res Ed) 1984 Oct 20;289(6451):1074.
- 14.Zatuchni J. Bradycardia and hypotension after propranolol HCl and verapamil. Heart Lung 1985 Jan;14(1):94-5.
- 15.Winniford MD, Fulton KL, Hillis LD. Symptomatic sinus bradycardia during concomitant propranolol-verapamil administration. Am Heart J 1985 Aug; 110(2):498.
- 16.Lam YW, Giard MJ, Warren JB. Calcium channel blockers and treatment of hypertension. Drug Intell Clin Pharm 1986 Mar;20(3):187-98.
- 17.Opie LH, White DA. Adverse interaction between nifedipine and beta-blockade. Br Med J 1980 Nov 29;281(6253):1462.
- 18.Gangji D, Juvent M, Niset G, Wathieu M, Degreve M, Bellens R, Poortmans J, Degre S, Fitzsimons TJ, Herchuelz A. Study of the influence of nifedipine on the pharmacokinetics and pharmacodynamics of propranolol, metoprolol and atenolol. Br J Clin Pharmacol 1984;17 Suppl 1:29S-35S.
- 19.Kendall MJ, Jack DB, Laugher SJ, Lobo J, Rolf Smith S. Lack of a pharmacokinetic interaction between nifedipine and the beta- adrenoceptor blockers metoprolol and atenolol. Br J Clin Pharmacol 1984 Sep; 18(3):331-5.
- 20.Leon MB, Rosing DR, Bonow RO, Epstein SE. Combination therapy with calcium-channel blockers and beta blockers for chronic stable angina pectoris. Am J Cardiol 1985 Jan 25;55(3):69B-80B.
- 21.Vetrovec GW, Parker VE. Acute electrophysiologic, hemodynamic and left ventricular effects of nifedipine and beta-blocker interactions. Maintenance of global and regional left ventricular wall motion. Am J Cardiol 1985 May 17;55(12):21E-26E.
- 22.Hamann SR, Kaltenborn KE, McAllister RG Jr. Nifedipine-propranolol interaction: dependence of cardiovascular effects on plasma drug concentrations. J Cardiovasc Pharmacol 1987 Aug;10(2):182-9.
- 23.Lubsen J, Tijssen JG. Efficacy of nifedipine and metoprolol in the early treatment of unstable angina in the coronary care unit: findings from the Holland Interuniversity Nifedipine/metoprolol Trial (HINT). Am J Cardiol 1987 Jul 15;60(2):18A-25A.
- 24.Nayler WG. The potential for added benefits with beta-blockers and calcium antagonists in treating cardiovascular disorders. Drugs 1988;35 Suppl 4:1-8.
- 25.Anonymous. Nifedipine and atenolol singly and combined for treatment of essential hypertension: comparative multicentre study in general practice in the United Kingdom. Nifedipine-Atenolol Study Review Committee. Br Med J (Clin Res Ed) 1988 Feb 13;296(6620):468-72.
- 26.Maclean D, Mitchell ET, Coulson RR, Fitzsimons TJ, McDevitt DG. Atenolol-nifedipine combinations compared to atenolol alone in hypertension: efficacy and tolerability. Br J Clin Pharmacol 1988 Apr; 25(4):425-31.
- 27.Stanley NN, Thirkettle JL, Varma MP, Larkin H, Heath ID. The efficacy and tolerability of atenolol, nifedipine, and their combination in the management of hypertension. Eur J Clin Pharmacol 1988;34(6):543-8.
- 28.McCourty JC, Silas JH, Tucker GT, Lennard MS. The effect of combined therapy on the pharmacokinetics and pharmacodynamics of verapamil and propranolol in patients with angina pectoris. Br J Clin Pharmacol 1988 Mar;25(3):349-57.
- 29.Keech AC, Harper RW, Harrison PM, Pitt A, McLean AJ. Extent and pharmacokinetic mechanisms of oral atenolol-verapamil interaction in man. Eur J Clin Pharmacol 1988;35(4):363-6.
- 30.Carruthers SG, Freeman DJ, Bailey DG. Pharmacodynamic interaction between beta-blockers and verapamil: possible relevance of ancillary properties. Clin Pharmacol Ther 1989 Feb;45(2):170.
- 31.Murdoch D, McInnes GI, Thomson GD, Murray GD, Brodie MJ. Pharmacodynamics and pharmacokinetics of verapamil and propranolol after single and repeated administration. Br J Clin Pharmacol 1989;28:233P-4P.
- 32.Hunt BA, Bottorff MB, Herring VL, Self TH, Lalonde RL. Effects of calcium channel blockers on the pharmacokinetics of propranolol stereoisomers. Clin Pharmacol Ther 1990 May;47(5):584-91.
- 33.Murdoch DL, Thomson GD, Thompson GG, Murray GD, Brodie MJ, McInnes GT. Evaluation of potential pharmacodynamic and pharmacokinetic interactions between verapamil and propranolol in normal subjects. Br J Clin Pharmacol 1991 Mar;31(3):323-32.
- 34.Bailey DG, Carruthers SG. Interaction between oral verapamil and beta-blockers during submaximal exercise: relevance of ancillary properties. Clin Pharmacol Ther 1991 Apr;49(4):370-6.
- 35.Posicor (mibefradil) US prescribing information. Roche Pharmaceuticals December, 1997.
- 36.Phansalkar S, van der Sijs H, Tucker AD, Desai AA, Bell DS, Teich JM, Middleton B, Bates DW. Drug-drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. J Am Med Inform Assoc 2012 Sep 25.
CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.