metoprolol and verapamil

MajorAvoid this combination where possible.

Mechanism

Additive negative chronotropic, dromotropic and inotropic effects. Verapamil inhibits CYP2D6, increasing metoprolol plasma concentrations.

What it means clinically

Increased risk of bradycardia, hypotension, atrioventricular block and worsening heart failure. The effect is greater with higher doses and in patients with pre-existing conduction disease.

What to do

Avoid concomitant use. If unavoidable, monitor heart rate, blood pressure and ECG closely, and consider reducing the dose of metoprolol. Alternative calcium channel blockers such as amlodipine may be safer.

Evidence

Well-established interaction, supported by pharmacokinetic studies and case reports. Caution is advised by guidelines.

The two drugs

metoprololBeta-adrenergic blockersRead the monograph verapamilCalcium channel blocker (non-dihydropyridine)Read the monograph

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Other interactions involving metoprolol or verapamil

Educational reference for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.