Drug interactions
Amiodarone + Metoprolol
Severity: Major
Amiodarone and Metoprolol: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Amiodarone adds to the negative chronotropic and dromotropic effects of metoprolol, and it also inhibits CYP2D6, raising metoprolol exposure. This can result in severe bradycardia, sinus arrest or AV block, especially in those with conduction disease.
What this interaction means in plain words
Amiodarone and Metoprolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Amiodarone belongs to Cardiovascular; Metoprolol belongs to Cardiovascular.
Why it happens
Additive pharmacodynamic AV nodal and sinus depression plus amiodarone inhibition of CYP2D6 metabolism of metoprolol.
What to do
Monitor heart rate and ECG closely, especially at initiation, and reduce the metoprolol dose if bradycardia occurs. Avoid in patients with sick sinus syndrome or AV block unless paced.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Metoprolol
- Metoprolol + Thioridazine Contraindicated
- Amifostine + Metoprolol Major
- Atenolol-chlorthalidone + Metoprolol Major
- Atenolol + Metoprolol Major
- Betaxolol + Metoprolol Major
- Bisoprolol + Metoprolol Major
Other interactions of Amiodarone
- Amiodarone + Amisulpride Contraindicated
- Amiodarone + Arsenic trioxide Contraindicated
- Amiodarone + Dofetilide Contraindicated
- Amiodarone + Dronedarone Contraindicated
- Amiodarone + Droperidol Contraindicated
- Amiodarone + Eliglustat Contraindicated
Frequently asked questions
Can I take Amiodarone with Metoprolol?
MediHelp rates the interaction as major. Amiodarone and Metoprolol can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Amiodarone adds to the negative chronotropic and dromotropic effects of metoprolol, and it also inhibits CYP2D6, raising metoprolol exposure. This can result in severe bradycardia, sinus arrest or AV block, especially in those with conduction disease.
How serious is the interaction between Amiodarone and Metoprolol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor heart rate and ECG closely, especially at initiation, and reduce the metoprolol dose if bradycardia occurs. Avoid in patients with sick sinus syndrome or AV block unless paced.
What other medicines interact with Metoprolol?
MediHelp also lists interactions of Metoprolol with, for example, Thioridazine, Amifostine, Atenolol-chlorthalidone. The full list is on the Metoprolol page.
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