Interaction with other drugs
Floktaphenin: in the case of shock or hypotension caused by reception floctafenine, beta-blockers attenuate compensatory mechanisms of the cardiovascular system.
Sulphoprid: increased risk of ventricular arrhythmia, especially as a "pirouette" (torsade des pointes).
With simultaneous use of beta-blockers with blockers of "slow" calcium channels (BCC) (verapamil and diltiazem) the negative effect on myocardial contractility and AV conductivity. Contraindicated in / in the administration of verapamil on the background of nebivolol. When combined with antihypertensive drugs, nitroglycerin or BCCC, severe arterial hypotension may develop (special caution is necessary when combined with prazosin).
When used simultaneously with antiarrhythmic drugs of the first class and with amiodarone, an increase in the negative inotropic effect and prolongation of the excitation time at the atria are possible.
With the simultaneous use of nebivolol with cardiac glycosides, there is no increase in the effect on slowing down AV conductivity.
Simultaneous use of nebivolol and preparations for general anesthesia can cause suppression of reflex tachycardia and increase the risk of developing arterial hypotension.
Clinically significant interactions of nebivolol and non-steroidal anti-inflammatory drugs (NSAIDs) have not been established. Acetylsalicylic acid as an antiplatelet agent can be used concomitantly with nebivolol.
The simultaneous use of tricyclic antidepressants, barbiturates and phenothiazine derivatives can enhance the antihypertensive effect of nebivolol.
Pharmacokinetic interaction.
When used simultaneously with drugs that inhibit serotonin reuptake, or other means, biotransforming with the participation of isoenzyme CYP2D6, the metabolism of nebivolol slows down.
With simultaneous application nebivolol no impact on the pharmacokinetic parameters of digoxin.
With simultaneous use with cimetidine, the concentration of nebivolol in the blood plasma increases (there is no evidence of an effect on the pharmacological effects of the drug). The simultaneous use of ranitidine does not affect the pharmacokinetic parameters of nebivolol.
When - the simultaneous use of nebivolol with nicardipine concentrations of active substances in the blood plasma increase slightly, but this has no clinical significance.
Simultaneous administration of ethanol, furosemide or hydrochlorothiazide does not affect the pharmacokinetics of nebivolol.
Clinically significant interactions of nebivolol and warfarin have not been established.
With the simultaneous use of sympathomimetic drugs suppress the activity of nebivolol.