Nebilet Drug Interactions

The following interactions apply to beta-adrenergic antagonists in general.
Calcium antagonists: Care should be exercised when administering beta-adrenergic antagonists with calcium antagonists of the verapamil or diltiazem type, because of their negative effect on contractility and atrio-ventricular conduction. Intravenous verapamil is contra-indicated in patients on Nebilet.
Anti-arrhythmics: Caution should be exercised when administering beta-adrenergic antagonists in association with Class I anti-arrhythmic drugs and amiodarone, as their effect on atrial conduction time and their negative inotropic effect may be potentiated.
Centrally-acting antihypertensives (clonidine, guanfacin, moxonidine, methyldopa, rilmenidine): concomitant use of centrally acting antihypertensive drugs may worsen heart failure by a decrease in the central sympathetic tonus (reduction of heart rate and cardiac output, vasodilation). Abrupt withdrawal, particularly if prior to beta-blocker discontinuation, may increase risk of "rebound hypertension".
Digitalis: Digitalis glycosides associated with beta-adrenergic antagonists may increase atrioventricular conduction time. Clinical trials with nebivolol have not shown any clinical evidence of an interaction. Nebivolol does not influence the kinetics of digoxin.
Insulin and oral antidiabetic drugs: Although Nebilet does not affect glucose levels, certain symptoms of hypoglycaemia (palpitations, tachycardia) may be masked.
Anaesthetics: Concomitant use of beta-adrenergic antagonists and anaesthetics may attenuate reflex tachycardia and increase the risk of hypotension. As a general rule, avoid sudden withdrawal of beta-blocker treatment. The anaesthesiologist should be informed when the patient is receiving Nebilet.
Other: Class III antiarrhythmic drugs (Amiodarone): effect on atrio-ventricular conduction time may be potentiated: Baclofen (antispastic agent), amifostine (antineoplastic adjunct): concomitant use with antihypertensives is likely to increase the fall in blood pressure, therefore the dosage of the antihypertensive medication should be adjusted accordingly.
Calcium antagonists of the dihydropyridine type (amlodipine, felodipine, lacidipine, nifedipine, nicardipine, nimodipine, nitrendipine): 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.
Concomitant use of NSAIDs had no effect on the blood pressure lowering effect of Nebilet. Co-administration of cimetidine increased the plasma levels of nebivolol, without changing the clinical effect. Co-administration of ranitidine did not affect the pharmacokinetics of nebivolol. Provided Nebilet is taken with the meal, and an antacid between meals, the two treatments can be co-prescribed. Combining nebivolol with nicardipine slightly increased the plasma levels of both drugs, without changing the clinical effect. Co-administration of alcohol, furosemide or hydrochlorothiazide did not affect the pharmacokinetics of nebivolol. Nebivolol does not affect the pharmacokinetics and pharmacodynamics of warfarin. Sympathicomimetic agents may counteract the effect of beta-adrenergic antagonists. Beta-adrenergic agents may lead to unopposed alpha-adrenergic activity of sympathicomimetic agents with both alpha- and beta-adrenergic effects (risk of hypertension, severe bradycardia and heart block). Concomitant administration of tricyclic antidepressants, barbiturates and phenothiazines may increase the blood pressure lowering effect. As nebivolol metabolism involves the CYP2D6 isoenzyme, concomitant administration of serotonin reuptake inhibitors, dextromethorphan or other compounds predominantly metabolised via this pathway, may make extensive metabolisers resemble poor metabolisers.