التداخل بين ميتوبرولول وهيدروكلوروثيازيد وفيراباميل

A decrease in metoprolol and propranolol clearance has been observed when either drug is administered concomitantly with verapamil.

Control patients with milder ventricular dysfunction, if possible, with optimum doses of digitalis and/or diuretics before verapamil treatment is started [see Drug Interactions ( 7.5 )] .

Beta blockers: reports of excess bradycardia and AV block, including complete heart block; monitor closely ( 7.4 )

Beta Blockers Concomitant therapy with beta-adrenergic blockers and verapamil may result in additive negative effects on heart rate, atrioventricular conduction, and/or cardiac contractility.

Antihypertensive Agents Verapamil administered concomitantly with oral antihypertensive agents (e.g., vasodilators, angiotensin-converting enzyme inhibitors, diuretics, beta blockers) will usually have an additive effect on lowering blood pressure.

Digitalis, Clonidine, and Calcium Channel Blockers: Digitalis glycosides, clonidine, diltiazem and verapamil slow atrioventricular conduction and decrease heart rate.

Digitalis glycosides, clonidine, diltiazem and verapamil: Bradycardia.

Because of its relative beta 1 cardio-selectivity, however, metoprolol tartrate may be used in patients with bronchospastic disease who do not respond to, or cannot tolerate, other antihypertensive treatment.