Drug interactions
Bisoprolol + Epinephrine
Severity: Major
Bisoprolol and Epinephrine: major interaction.
Last updated Sources: US FDA label
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
Beta-blockade blunts epinephrine's cardiac and bronchodilator effects and leaves alpha-mediated vasoconstriction unopposed. This can cause marked hypertension with reflex bradycardia and reduced efficacy in anaphylaxis.
What this interaction means in plain words
Bisoprolol and Epinephrine 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.
Bisoprolol belongs to Cardiovascular; Epinephrine belongs to Endocrine.
Why it happens
Antagonism of beta-adrenergic effects of epinephrine leaving alpha-adrenergic vasoconstriction unopposed (bisoprolol is cardioselective, so effect is less than with nonselective agents).
What to do
Monitor blood pressure and heart rate after epinephrine; in anaphylaxis unresponsive to epinephrine in a beta-blocked patient, consider glucagon.
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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References
Other interactions of Bisoprolol
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Frequently asked questions
Can I take Bisoprolol with Epinephrine?
MediHelp rates the interaction as major. Bisoprolol and Epinephrine 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. Beta-blockade blunts epinephrine's cardiac and bronchodilator effects and leaves alpha-mediated vasoconstriction unopposed. This can cause marked hypertension with reflex bradycardia and reduced efficacy in anaphylaxis.
How serious is the interaction between Bisoprolol and Epinephrine?
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 blood pressure and heart rate after epinephrine; in anaphylaxis unresponsive to epinephrine in a beta-blocked patient, consider glucagon.
What other medicines interact with Bisoprolol?
MediHelp also lists interactions of Bisoprolol with, for example, Aldesleukin, Amifostine, Amiodarone. The full list is on the Bisoprolol page.
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