التداخل بين ميتوبرولول وهيدروكلوروثيازيد وأولانزابين وفلوكسيتين

CYP2D6 inhibitors: Increased metoprolol concentration.

…catecholamine-depleting drugs (e.g., reserpine, monoamine oxidase (MAO) inhibitors) with beta adrenergic blockers may have an additive affect and increase the risk of hypotension or bradycardia CYP2D6 Inhibitors: Drugs that are strong inhibitors of CYP2D6 such as quinidine, fluoxetine, paroxetine, and propafenone were shown to double metoprolol concentrations.

…and fluoxetine capsules should be used with particular caution in patients with known cardiovascular disease (history of myocardial infarction or ischemia, heart failure, or conduction abnormalities), cerebrovascular disease, or conditions that would predispose patients to hypotension (dehydration, hypovolemia, and treatment with antihypertensive medications).

Also, patients taking diuretics or who are otherwise volume depleted may be at greater risk.

Antihypertensive Agent : Enhanced antihypertensive effect ( 7.7 )

Antihypertensive Agents — Because of the potential for olanzapine to induce hypotension, olanzapine and fluoxetine capsules may enhance the effects of certain antihypertensive agents [see Warnings and Precautions ( 5.11 )] .