Drug interactions
Diltiazem + Nebivolol
Severity: Major
Diltiazem and Nebivolol: 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
Diltiazem depresses sinus and AV nodal function and contractility, and nebivolol adds beta-1 blockade. Together they can cause bradycardia, AV block and hypotension, and diltiazem may also modestly increase nebivolol exposure through CYP inhibition.
What this interaction means in plain words
Diltiazem and Nebivolol 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.
Diltiazem belongs to Cardiovascular; Nebivolol belongs to Cardiovascular.
Why it happens
Additive negative chronotropic and dromotropic effects from beta-blockade and calcium channel blockade, plus possible CYP3A4/2D6 related changes in clearance.
What to do
Monitor heart rate, ECG and blood pressure, particularly at initiation and with dose changes. Avoid in patients with conduction disease or reduced ventricular function, or reduce doses if bradycardia develops.
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 Nebivolol
- Acebutolol + Nebivolol Major
- Aldesleukin + Nebivolol Major
- Amiodarone + Nebivolol Major
- Atenolol-chlorthalidone + Nebivolol Major
- Atenolol + Nebivolol Major
- Betaxolol + Nebivolol Major
Other interactions of Diltiazem
- Diltiazem + Flibanserin Contraindicated
- Diltiazem + Ivabradine Contraindicated
- Diltiazem + Lomitapide Contraindicated
- Diltiazem + Lonafarnib Contraindicated
- Acebutolol + Diltiazem Major
- Alfentanil + Diltiazem Major
Frequently asked questions
Can I take Diltiazem with Nebivolol?
MediHelp rates the interaction as major. Diltiazem and Nebivolol 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. Diltiazem depresses sinus and AV nodal function and contractility, and nebivolol adds beta-1 blockade. Together they can cause bradycardia, AV block and hypotension, and diltiazem may also modestly increase nebivolol exposure through CYP inhibition.
How serious is the interaction between Diltiazem and Nebivolol?
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, ECG and blood pressure, particularly at initiation and with dose changes. Avoid in patients with conduction disease or reduced ventricular function, or reduce doses if bradycardia develops.
What other medicines interact with Nebivolol?
MediHelp also lists interactions of Nebivolol with, for example, Acebutolol, Aldesleukin, Amiodarone. The full list is on the Nebivolol page.
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