Unrecommended combinations
Class I antiarrhythmics (eg, quinidine, disopyramide, lidocaine, phenytoin; flecainide, propafenone) with simultaneous application with bisoprolol may reduce AV conduction and contractility of the heart.
Blocks of "slow" calcium channels (BCCI) type verapamil and, to a lesser extent, diltiazem, with simultaneous application with bisoprolol may lead to a decrease in myocardial contractility and disturbance of AV conductivity. In particular, intravenous administration of verapamil to patients taking beta-blockers can lead to severe arterial hypotension and AV blockade.
Hypotensive means of central action (such as clonidine, methyldopa, moxonidine, rilmenidine) can lead to a decrease in heart rate and a decrease in cardiac output, and to vasodilation due to a decrease in the central sympathetic tone.Abrupt cancellation, especially before the abolition of beta-blockers, may increase the risk of developing "ricochet" arterial hypertension.
Combinations, requiring caution
Antiarrhythmics III grade (eg, amiodarone) can increase the violation AV conductivity.
Action of beta-blockers for topical application (eg, eye drops for the treatment of glaucoma) can enhance the systemic effects of bisoprolol (lowering blood pressure, decreasing heart rate).
Parasympathomimetics with simultaneous use with bisoprolol may increase the violation AV conductivity and increase the risk of developing a bradycardia.
Simultaneous use of the drug Bisoprolol with beta-adrenomimetics (e.g., isoprenaline, dobutamine) can lead to a decrease in the effect of both drugs.
The combination of bisoprolol with adrenomimetics affecting beta and alpha-adrenergic receptors (eg, norepinephrine, epinephrine), may enhance the vasoconstrictor effects of these agents that occur with alpha-adrenergic receptors, leading to an increase in blood pressure. Such interactions are more likely when using nonselective beta-blockers.
Meflokhin when used with bisoprolol may increase the risk of developing bradycardia.
Allergens used for immunotherapy, or allergen extracts for skin tests increase the risk of severe systemic allergic reactions or anaphylaxis in patients receiving bisoprolol.
Iodine-containing radiopaque diagnostic agents for intravenous administration increase the risk of anaphylactic reactions.
Phenytoin with intravenous administration, means for inhalation anesthesia (derivatives of hydrocarbons) increase the severity of cardiodepressive action and the likelihood of reducing blood pressure.
Efficiency insulin and hypoglycemic agents for oral administration may vary with treatment with bisoprolol (masks the symptoms of developing hypogasLychemia: tachycardia, increased blood pressure).
Clearance lidocaine and xanthine (except theophylline) may decrease due to a possible increase in their concentration in the blood plasma, especially in patients with initially elevated clearance of theophylline under the influence of smoking.
Antihypertensive effect weaken Non-steroidal anti-inflammatory drugs (NSAIDs) (retention of sodium ions and blockade of prostaglandin synthesis by the kidneys), glucocorticosteroids and estrogens (sodium ion retention).
Cardiac glycosides, methyldopa, reserpine and guanfacine, blockers of "slow" calcium channels (verapamil, diltiazem), amiodarone and other antiarrhythmics increase the risk of developing or worsening bradycardia, AV blockade, cardiac arrest and heart failure.
Nifedipine can lead to a significant decrease in blood pressure.
Diuretics, clonidine, sympatholytics, hydralazine and other antihypertensive drugs may lead to an excessive decrease in blood pressure.
Act Nondepolarizing muscle relaxants and anticoagulant effect coumarins during the treatment with bisoprolol may be prolonged.
Tricyclic and tetracyclic antidepressants, antipsychotics (antipsychotics), ethanol, sedatives and hypnotics increase the inhibition of the central nervous system.
Do not use concurrently with MAO inhibitors (except for MAO B inhibitors) due to a significant increase in antihypertensive action.Simultaneous application can also lead to the development of hypertensive crisis. A break in treatment between taking MAO inhibitors and bisoprolol should be at least 14 days.
Unhydrated alkaloids of ergot increase the risk of peripheral circulatory disorders.
Ergotamine increases the risk of peripheral circulatory disorders.
Sulfasalazine increases the concentration of bisoprolol in the blood plasma.
Rifampicin shortens the half-life of bisoprolol.