p. 1376 → Also see TABLE 8 p. 1376

▶ Oral calcium channel blockers (verapamil) increase the risk of

cardiovascular side-effects when given with beta blockers,

non-selective.rStudy → Also see TABLE 6 p. 1376 → Also see

TABLE 8 p. 1376

▶ Ciclosporin

o

is predicted to increase the exposure to nadolol.

Study

▶ Eliglustat is predicted to increase the exposure to propranolol.

Adjust dose.oStudy

▶ Beta blockers, non-selective are predicted to increase the risk

of peripheral vasoconstriction when given with

r

ergometrine.

Study

▶ Beta blockers, non-selective are predicted to increase the risk

of peripheral vasoconstriction when given with

r

ergotamine.

Study

▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are

predicted to increase the exposure to nadolol.oStudy

▶ Beta blockers, non-selective are predicted to increase the risk

of bradycardia when given with lanreotide.oTheoretical

▶ Lapatinib

o

is predicted to increase the exposure to nadolol.

Study

▶ Macrolides

o

are predicted to increase the exposure to nadolol.

Study

▶ Mexiletine potentially increases the risk of cardiovascular

side-effects when given with beta blockers, non-selective.

Avoid or monitor.rTheoretical

▶ Ranolazine

o

is predicted to increase the exposure to nadolol.

Study

▶ Rifampicin

o

moderately decreases the exposure to carvedilol.

Study

▶ Rifampicin decreases the exposure to propranolol. Monitor and

adjust dose.oStudy

▶ Propranolol slightly to moderately increases the exposure to

rizatriptan. Adjust rizatriptan dose and separate

administration by at least 2 hours, p. 480.oStudy

▶ SSRIs (fluvoxamine) moderately increase the concentration of

propranolol.oStudy

▶ Beta blockers, non-selective increase the risk of hypertension

and bradycardia when given with sympathomimetics, inotropic

(dobutamine).rTheoretical

▶ Beta blockers, non-selective are predicted to increase the risk

of hypertension and bradycardia when given with

sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

noradrenaline/norepinephrine).rStudy

▶ Beta blockers, non-selective are predicted to increase the risk

of bronchospasm when given with

Theoretical

theophylline. Avoid.r

▶ Vemurafenib

o

is predicted to increase the exposure to nadolol.

Study

Beta blockers, selective → see TABLE 6 p. 1376 (bradycardia), TABLE 8

p. 1376 (hypotension)

acebutolol . atenolol . betaxolol . bisoprolol . celiprolol . esmolol . metoprolol . nebivolol.

1414 Bedaquiline — Beta blockers, selective BNF 78

Interactions | Appendix 1

A1

▶ Since systemic absorption can follow topical application of

betaxolol, the possibility of interactions should be borne in

mind.

▶ Orange juice greatly decreases the exposure to celiprolol.

▶ Abiraterone is predicted to increase the exposure to

metoprolol.oStudy

▶ Beta blockers, selective are predicted to increase the risk of

bronchospasm when given with

Theoretical

aminophylline. Avoid.r

▶ Antiarrhythmics (amiodarone, disopyramide, dronedarone,

flecainide, lidocaine) are predicted to increase the risk of

cardiovascular side-effects when given with beta blockers,

selective. Use with caution or avoid.rStudy → Also see

TABLE 6 p. 1376

▶ Antiarrhythmics (propafenone) are predicted to increase the

exposure to metoprolol.oStudy

▶ Antiarrhythmics (propafenone) are predicted to increase the

exposure to nebivolol and nebivolol is predicted to increase the

risk of cardiodepression when given with antiarrhythmics

(propafenone). Avoid.rTheoretical

▶ Antiarrhythmics (propafenone) are predicted to increase the risk

of cardiovascular side-effects when given with beta blockers,

selective (acebutolol, atenolol, betaxolol, bisoprolol, celiprolol,

esmolol). Use with caution or avoid.rStudy

▶ Anticholinesterases, centrally acting are predicted to increase

the risk of bradycardia when given with beta blockers,

selective.oAnecdotal → Also see TABLE 6 p. 1376

▶ Antiepileptics (phenobarbital, primidone) are predicted to

decrease the exposure to beta blockers, selective (acebutolol,

bisoprolol, metoprolol, nebivolol).oStudy

▶ Antimalarials (mefloquine) are predicted to increase the risk of

bradycardia when given with

Theoretical

beta blockers, selective.r

▶ Bupropion is predicted to increase the exposure to beta

blockers, selective (metoprolol, nebivolol).oStudy

▶ Calcium channel blockers (diltiazem) are predicted to increase

the risk of cardiodepression when given with beta blockers,

selective.rStudy → Also see TABLE 6 p. 1376 → Also see

TABLE 8 p. 1376

▶ Intravenous calcium channel blockers (verapamil) increase the

risk of cardiovascular side-effects when given with beta

blockers, selective. Avoid.rStudy → Also see TABLE 6

p. 1376 → Also see TABLE 8 p. 1376

▶ Oral calcium channel blockers (verapamil) increase the risk of

cardiovascular side-effects when given with beta blockers,

selective.rStudy → Also see TABLE 6 p. 1376 → Also see

TABLE 8 p. 1376

▶ Cinacalcet is predicted to increase the exposure to beta

blockers, selective (metoprolol, nebivolol).oStudy

▶ Duloxetine

o

is predicted to increase the exposure to metoprolol.

Study

▶ Eliglustat is predicted to increase the exposure to metoprolol.

Adjust dose.oStudy

▶ Beta blockers, selective are predicted to increase the risk of

peripheral vasoconstriction when given with

r

ergometrine.

Study

▶ Beta blockers, selective are predicted to increase the risk of

peripheral vasoconstriction when given with

r

ergotamine.

Study

▶ Grapefruit juice

o

greatly decreases the exposure to celiprolol.

Study

▶ HIV-protease inhibitors (ritonavir) are predicted to increase the

exposure to metoprolol.oStudy

▶ Beta blockers, selective are predicted to increase the risk of

bradycardia when given with lanreotide.oTheoretical

▶ Mexiletine potentially increases the risk of cardiovascular

side-effects when given with beta blockers, selective. Avoid or

monitor.rTheoretical

▶ Mirabegron is predicted to increase the exposure to

metoprolol.oStudy

▶ Panobinostat is predicted to increase the exposure to

metoprolol. Monitor and adjust dose.oTheoretical

▶ Panobinostat is predicted to increase the exposure to

nebivolol. Monitor and adjust dose.nTheoretical

▶ Rifampicin slightly decreases the exposure to beta blockers,

selective (bisoprolol, metoprolol).nStudy

▶ Rifampicin

o

moderately decreases the exposure to celiprolol.

Study

▶ Rolapitant is predicted to moderately increase the exposure to

metoprolol.rStudy

▶ SSRIs (fluoxetine, paroxetine) are predicted to increase the

exposure to

o

beta blockers, selective (metoprolol, nebivolol).

Study

▶ Beta blockers, selective increase the risk of hypertension and

bradycardia when given with sympathomimetics, inotropic

(dobutamine).oTheoretical

▶ Beta blockers, selective are predicted to increase the risk of

hypertension and bradycardia when given with

sympathomimetics, vasoconstrictor (adrenaline/epinephrine,

noradrenaline/norepinephrine).rStudy

▶ Terbinafine is predicted to increase the exposure to beta

blockers, selective (metoprolol, nebivolol).oStudy

▶ Beta blockers, selective are predicted to increase the risk of

bronchospasm when given with

Theoretical

theophylline. Avoid.r

Beta2 agonists → see TABLE 17 p. 1379 (reduced serum potassium)

bambuterol . formoterol .indacaterol . olodaterol . salbutamol . salmeterol .terbutaline .vilanterol. ▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are

predicted to increase the exposure to

r

salmeterol. Avoid.

Study

▶ Apalutamide is predicted to decrease the exposure to

salmeterol. Avoid or monitor.oStudy

▶ Aprepitant

o

is predicted to increase the exposure to salmeterol.

Study

▶ Atomoxetine is predicted to increase the risk of cardiovascular

side-effects when given with

o

beta2 agonists (high-dose).

Study

▶ Cobicistat is predicted to increase the exposure to salmeterol.

Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to salmeterol. Avoid.rStudy

▶ Idelalisib is predicted to increase the exposure to salmeterol.

Avoid.rStudy

▶ Beta2 agonists are predicted to increase the risk of glaucoma

when given with ipratropium.oAnecdotal

▶ Beta2 agonists are predicted to increase the risk of elevated

blood pressure when given with

Theoretical

linezolid. Avoid.r

▶ Macrolides (clarithromycin) are predicted to increase the

exposure to salmeterol. Avoid.rStudy

▶ Monoamine-oxidase A and B inhibitors, irreversible are

predicted to increase the risk of cardiovascular side-effects

when given with beta2 agonists.oAnecdotal

▶ Monoamine-oxidase B inhibitors (rasagiline, selegiline) are

predicted to increase the risk of severe hypertension when

given with beta2 agonists. Avoid.rTheoretical

▶ Monoamine-oxidase B inhibitors (safinamide) are predicted to

increase the risk of severe hypertension when given with beta2

agonists.rTheoretical

▶ Netupitant

o

is predicted to increase the exposure to salmeterol.

Study

Betahistine

▶ Antihistamines, non-sedating are predicted to decrease the

effects of betahistine.oTheoretical

▶ Antihistamines, sedating are predicted to decrease the effects

of betahistine.oTheoretical

Betamethasone → see corticosteroids

Betaxolol → see beta blockers, selective

Bevacizumab → see monoclonal antibodies

Bexarotene → see retinoids

Bezafibrate → see fibrates

Bicalutamide

▶ Bicalutamide is predicted to increase the exposure to

lomitapide

Theoretical

. Separate administration by 12 hours.o

Bictegravir

▶ Antacids decrease the exposure to bictegravir. Separate

administration by at least 2 hours.oStudy

BNF 78 Beta blockers, selective — Bictegravir 1415

Interactions | Appendix 1

A1

Bictegravir (continued)

▶ Antiarrhythmics (amiodarone, dronedarone) are predicted to

increase the exposure to bictegravir. Use with caution or

avoid.oTheoretical

▶ Antiepileptics (carbamazepine, fosphenytoin, phenobarbital,

phenytoin, primidone) are predicted to decrease the exposure

to bictegravir. Avoid.oStudy

▶ Antiepileptics (oxcarbazepine) are predicted to decrease the

exposure to bictegravir. Avoid.oTheoretical

▶ Antifungals, azoles (itraconazole, ketoconazole) are predicted to

increase the exposure to bictegravir. Use with caution or

avoid.oTheoretical

▶ Antifungals, azoles (posaconazole) are predicted to increase the

exposure to bictegravir.oTheoretical

▶ Calcium channel blockers (verapamil) are predicted to increase

the exposure to

o

bictegravir. Use with caution or avoid.

Theoretical

▶ Ciclosporin is predicted to increase the exposure to bictegravir.

Use with caution or avoid.oTheoretical

▶ Enzalutamide is predicted to decrease the exposure to

bictegravir. Avoid.oStudy

▶ HIV-protease inhibitors (atazanavir) moderately increase the

exposure to bictegravir. Avoid.rStudy

▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are

predicted to increase the exposure to bictegravir. Use with

caution or avoid.oTheoretical

▶ Iron (oral) decrease the exposure to bictegravir. Bictegravir

should be taken 2 hours before iron (oral).oStudy

▶ Lapatinib is predicted to increase the exposure to bictegravir.

Use with caution or avoid.oTheoretical

▶ Macrolides are predicted to increase the exposure to

bictegravir. Use with caution or avoid.oTheoretical

▶ Bictegravir

o

slightly increases the exposure to metformin.

Study

▶ Mitotane is predicted to decrease the exposure to bictegravir.

Avoid.oStudy

▶ Bictegravir is predicted to increase the exposure to opioids

(methadone).oTheoretical

▶ Ranolazine is predicted to increase the exposure to bictegravir.

Use with caution or avoid.oTheoretical

▶ Rifabutin

o

slightly decreases the exposure to bictegravir. Avoid.

Study

▶ Rifampicin is predicted to decrease the exposure to bictegravir.

Avoid.oStudy

▶ St John’s Wort is predicted to decrease the exposure to

bictegravir. Avoid.oTheoretical

▶ Sucralfate is predicted to decrease the exposure to bictegravir.

Avoid.oTheoretical

▶ Vemurafenib is predicted to increase the exposure to

bictegravir. Use with caution or avoid.oTheoretical

Bilastine → see antihistamines, non-sedating

Bisoprolol → see beta blockers, selective

Bisphosphonates → see TABLE 2 p. 1375 (nephrotoxicity)

alendronic acid .ibandronic acid . pamidronate .risedronate . sodium clodronate . zoledronic acid. ▶ Aminoglycosides increase the risk of hypocalcaemia when

given with bisphosphonates.oAnecdotal → Also see

TABLE 2 p. 1375

▶ Antacids decrease the absorption of alendronic acid. Alendronic

acid

o

should be taken at least 30 minutes before antacids.

Study

▶ Antacids are predicted to decrease the absorption of

ibandronic acid. Avoid antacids for at least 6 hours before or

1 hour after ibandronic acid.oTheoretical

▶ Antacids decrease the absorption of risedronate. Separate

administration by at least 2 hours.oStudy

▶ Antacids decrease the absorption of sodium clodronate. Avoid

antacids

o

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