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Angina - stable - Management
What key drug interactions with beta-blockers should I be aware of?
- Verapamil and diltiazem
- The combination of a beta-blocker and verapamil must not be prescribed because bradycardia, asystole, severe hypotension, and heart failure can occur.
- The combination of a beta-blocker and diltiazem should only be prescribed on specialist advice.
- Class I antiarrhythmics (such as quinidine, disopyramide, flecainide, lidocaine)
- The combination of a beta-blocker and a class I antiarrhythmic is not recommended because bradycardia and myocardial depression can occur.
- Amiodarone
- The combination of a beta-blocker and amiodarone should be prescribed with caution — monitor pulse and blood pressure, and check for signs of worsening heart failure, as there is an increased risk of bradycardia, atrioventricular (AV) block, and myocardial depression. Amiodarone should not be initiated in primary care unless on specialist advice.
- Digoxin
- Concomitant administration of a beta-blocker and digoxin can reduce heart rate and prolong AV conduction time, increasing the risk of AV block and bradycardia — monitor pulse.
- Other drugs that reduce blood pressure
- An additive hypotensive effect may occur — monitor for signs of hypotension (such as dizziness, light-headedness, and confusion).
[Baxter, 2008; BNF 57, 2009]
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