Drug interactions
Esmolol + Verapamil
Severity: Major
Esmolol and Verapamil: 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
Verapamil strongly depresses sinus and AV nodal conduction and myocardial contractility, and esmolol adds beta-blockade. Together they can cause severe bradycardia, AV block, hypotension, heart failure and asystole, particularly with intravenous use.
What this interaction means in plain words
Esmolol and Verapamil 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.
Esmolol belongs to Cardiovascular; Verapamil belongs to Cardiovascular.
Why it happens
Additive negative chronotropic, dromotropic and inotropic effects from beta-blockade and non-dihydropyridine calcium channel blockade.
What to do
Avoid IV esmolol with IV verapamil, and avoid the combination in heart failure, conduction disease or hypotension. If unavoidable, use continuous ECG and blood pressure monitoring with reduced, staggered doses.
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 Esmolol
- Acebutolol + Esmolol Major
- Amifostine + Esmolol Major
- Amiodarone + Esmolol Major
- Celiprolol + Esmolol Major
- Diltiazem + Esmolol Major
- Epinephrine racemic + Esmolol Major
Other interactions of Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil Major
Frequently asked questions
Can I take Esmolol with Verapamil?
MediHelp rates the interaction as major. Esmolol and Verapamil 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. Verapamil strongly depresses sinus and AV nodal conduction and myocardial contractility, and esmolol adds beta-blockade. Together they can cause severe bradycardia, AV block, hypotension, heart failure and asystole, particularly with intravenous use.
How serious is the interaction between Esmolol and Verapamil?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid IV esmolol with IV verapamil, and avoid the combination in heart failure, conduction disease or hypotension. If unavoidable, use continuous ECG and blood pressure monitoring with reduced, staggered doses.
What other medicines interact with Esmolol?
MediHelp also lists interactions of Esmolol with, for example, Acebutolol, Amifostine, Amiodarone. The full list is on the Esmolol page.
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