RiteMED Bisoprolol Drug Interactions

Combinations not recommended: Applies only to CHF: Class-I antiarrhythmic agents: Effect on atrio-ventricular conduction time may be potentiated and negative inotropic effect increased.
Applies to all indications: Calcium antagonists of the verapamil type and to a lesser extent of the diltiazem type: Negative effect on contractility and atrio-ventricular conduction. Intravenous administration of verapamil in patients on beta-blocker treatment may lead to profound hypotension and atrio-ventricular block.
Centrally-acting antihypertensive agents: Concomitant use of centrally-acting antihypertensive agents may lead to reduction of heart rate and cardiac output and to vasodilatation. Abrupt withdrawal may increase the risk of 'rebound hypertension'.
Combinations to be used with caution: Applies only to hypertension or angina pectoris: Class-l antiarrhythmic agents: Effect on atrio-ventricular conduction time may be potentiated and negative inotropic effect increased.
Applies to all indications: Calcium antagonists of the dihydropyridine: Concomitant use may increase the risk of hypotension, and an increase in the risk of a further deterioration of the ventricular pump function in patients with heart failure cannot be excluded.
Class-III antiarrhythmic agents: Effect on atrio-ventricular conduction time may be potentiated.
Parasympathomimetic agents: Concomitant use may increase atrio-ventricular conduction time and the risk of bradycardia.
Topical beta-blockers (e.g. eye drops for glaucoma treatment): May add to the systemic effects of bisoprolol.
Insulin and oral antidiabetic agents: Increase of blood sugar lowering effect. Blockade of beta-adrenoceptors may mask symptoms of hypoglycaemia.
Anaesthetic agents: Attenuation of the reflex tachycardia and increase of the risk of hypotension.
Digitalis glycosides: Increase of atrio-ventricular conduction time, reduction in heart rate.
Non-steroidal anti-inflammatory agents (NSAIDs): NSAIDs may reduce the hypotensive effect of bisoprolol.
Beta-sympathomimetics: Combination with bisoprolol may reduce the effect of both agents.
Sympathomimetics that activate both beta- and alpha-adrenoreceptors: Combination with bisoprolol may lead to blood pressure increase.
Concomitant use with antihypertensive agents as well as with other medicinal products with blood pressure lowering potential may increase the risk of hypotension.
Combinations to be considered: Mefloquine: Increased risk of bradycardia.
Monoamine oxidase inhibitors (except MAO-B inhibitors): Enhanced hypotensive effect of the beta-blockers but also risk of hypertensive crisis.