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Atrial fibrillation - Management
What key drug interactions should I be aware of forbeta-blockers ?

  • Verapamil and diltiazem
    • The combination of a beta-blocker and verapamil should not be prescribed in primary care because bradycardia, asystole, severe hypotension, and heart failure can occur.
    • The combination of a beta-blocker and diltiazem should not be prescribed in primary care because bradycardia and atrioventricular (AV) block can occur. Asystole and sudden death have also been reported.
    • Combining a beta-blocker with either verapamil or diltiazem may be initiated in secondary care.
  • Class I antiarrhythmics (for example quinidine and flecainide)
    • The combination of a beta-blocker and a class I antiarrhythmic is not recommended in primary care because bradycardia and myocardial depression can occur. This combination may be initiated in secondary care.
  • Class III antiarrhythmics (for example 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, AV block, and myocardial depression.
  • 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 carefully.
  • Other drugs that reduce blood pressure (for example angiotensin-converting enzyme inhibitors)
    • An additive hypotensive effect may occur — monitor for signs of hypotension (such as dizziness, light-headedness, and confusion).
Basis for recommendation

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