Lodoz Drug Interactions

Interactions related to bisoprolol: Contraindication: Sultopride: Increased risk of ventricular arrhythmias, notably torsades de pointes.
Not recommended combinations: Verapamil, Diltiazem: Risk of bradycardia, as well as negative effects on heart contractility and auriculo-ventricular conduction. Such a combination requires a close clinical and ECG monitoring, notably in the elderly and at the beginning of the treatment.
Bepridil: Risk of bradycardia, as well as negative effects on heart contractility and auriculo-ventricular conduction. Additionally, increased risk of ventricular arrhythmias, notably torsades de pointes. Such a combination requires a close clinical and ECG monitoring, notably in the elderly and at the beginning of the treatment.
Combinations requiring a caution for use: Centrally-acting antihypertensive drugs (e.g. clonidine, methyldopa, moxonidine, rilmenidine): Concomitant use of centrally-acting antihypertensive drugs with bisoprolol may further decrease the central sympathetic tonus and may thus lead to an additive reduction in heart rate and cardiac output and to vasodilatation/hypotension.
Abrupt withdrawal, particularly if prior to beta-blocker discontinuation, may increase the risk of rebound hypertension. Avoid any sudden interruption of the centrally-acting antihypertensive agent.
Propafenone, Cibenzoline, Flecainide: Risk of bradycardia, as well as negative effects on heart contractility and auriculo-ventricular conduction. Clinical monitoring and ECG, if appropriate, are required.
Lidocaine: Increased lidocaine plasma levels increasing the likelihood of neurologic and cardiac side-effects, due to reduced hepatic blood flow by the beta-blocking agent and subsequent reduced clearance of lidocaine. Clinical and biological monitoring and ECG, if appropriate, are required, with dosage adjustment of lidocaine if necessary.
Antidiabetics (insulin, sulphonylureas, glinides): All beta-blockers may mask warning signs of hypoglycemia, notably palpitations and tachycardia. Diabetic patients should be aware of the risk of hypoglycemic episodes and of the increased need for careful home glucose monitoring, especially in the initial phase of therapy.
Other bradycardia-inducing drugs (anticholinesterases, digitalis glycosides, mefloquine…): Increased risk of bradycardia. A regular clinical monitoring should be made.
Calcium channel blockers of the dihydropyridine type (e.g. nifedipine, amlodipine): Concomitant use may increase the risk of hypotension, and a further risk of deterioration of the ventricular pump function in patients with heart failure cannot be excluded.
Topical beta-blockers (e.g. eye drops for glaucoma treatment): They may add their effects to the systemic ones of bisoprolol.
Interactions related to hydrochlorothiazide: Not recommended combinations: Lithium: Increased lithium plasma levels with signs of overdosage, as occur on a low-sodium diet, due to reduced urinary lithium excretion. If this combination cannot be avoided, provide close lithium plasma level monitoring and adjust dosage as necessary.
Combinations requiring a caution for use: NSAIDs (systemic), acetylsalicylic acid at anti-inflammatory dosage regimen: Acute renal failure in dehydrated patients (NSAIDs reduce glomerular blood flow by inhibiting vasodilatory prostaglandins). Patients should be rehydrated and the kidney function monitored at the start of the therapy.
Potassium-sparing diuretics (alone or combined): Such a combination, possibly useful, does not preclude hypo- or hyperkalemia, the latter being more frequent in case of diabetes or renal impairment. Kalemia should be monitored and, if appropriate, ECG. Treatment may possibly have to be reconsidered.
Hypokalemic drugs (IV amphotericin, systemic corticosteroids, tetracosactide, stimulating laxatives): Increased risk of hypokalaemia. Monitor and, if appropriate, correct plasma potassium. This is notably of importance with the concomitant use of digitalis glycosides. Rather use non stimulating laxatives.
Angiotensin Converting Enzyme Inhibitors (ACEI), Angiotensin II receptors antagonists (AIIA): Risk of significant blood pressure decrease and/or acute renal failure during initiation of ACEI therapy in patients with preexisting sodium depletion (particularly in patients with renal artery stenosis). If prior diuretic therapy may have produced sodium depletion, either stop the diuretic 3 days before starting ACEI or AIIA therapy and reintroduce the diuretic later if necessary, or start patient on a reduced ACEI or AIIA dose to be gradually increased thereafter.
Carbamazepine: Risk of symptomatic hyponatremia.
Clinical and biological monitoring is required. Another class of diuretics should be eventually used.
Iodinated contrast media: In case of diuretic-induced dehydration, there is an increased risk of acute renal failure, especially with high doses of the iodine product. Patients should be rehydrated before the administration.
Resins: Reduction of the absorption of hydrochlorothiazide.
A time-interval of at least two hours should separate the resin intake from Lodoz administration.
Uric acid-lowering agents: Their effect may be attenuated with the concomitant administration of hydrochlorothiazide.
Calcium salts: Risk of hypercalcemia due to reduced urinary excretion.
Cyclosporine: Risk of increased creatininemia without change of cyclosporine levels, even out of any sodium depletion.
Interactions related to both bisoprolol and hydrochlorothiazide: Combinations requiring a caution for use: Antiarrhythmic drugs inducing torsades de pointes (agents of the subclass IA: quinidine, hydroquinidine, disopyramide, and of the subclass III: amiodarone, sotalol, dofetilide, ibutilide): Increased risk of ventricular arrhythmias, notably torsades de pointes, favoured by bradycardia and/or hypokalemia. Clinical and ECG monitoring are required.
Non antiarrhythmic drugs inducing torsades de pointes (e.g. astemizole, bepridil, cisapride, diphemanil, IV erythromycin, halofantrine, lumefantrine, methadone, moxifloxacin, pentamidine, sotalol, IV spiramycin, sparfloxacin, terfenadine, vincamine, some antipsychotics like pimozide, haloperidol, benzamides): Increased risk of ventricular arrhythmias, notably torsades de pointes, favoured by bradycardia and/or hypokalemia. Clinical and ECG monitoring are required.
Digitalis glycosides: Due to hydrochlorothiazide, there is a risk of hypokalemia, which may facilitate the toxic effects of cardiac glycosides. Due to bisoprolol, there is a risk of bradycardia and negative effect on AV conduction. A regular clinical monitoring should be made. Plasma potassium should be monitored and, if appropriate, ECG.
Combinations to be taken into account: Other antihypertensive agents, tricyclics, phenothiazines, baclofene, amifostine: Concomitant use with these drugs that lower blood pressure, as main or side-effect, may increase the risk of hypotension.
NSAIDs: Reduced antihypertensive efficiency by inhibition of vasodilatory prostaglandins (pyrazole derivatives also induce sodium retention).
Corticosteroids, tetracosactide: Reduced antihypertensive efficiency by a sodium retention effect.