Drug interactions
Metoprolol + Nebivolol
Severity: Major
Metoprolol 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
Both are beta-1 selective blockers, so concurrent use duplicates therapy and adds the risk of bradycardia, hypotension and heart block without added benefit. Nebivolol is also partly metabolized by CYP2D6, but the main concern is additive effect.
What this interaction means in plain words
Metoprolol 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.
Metoprolol belongs to Cardiovascular; Nebivolol belongs to Cardiovascular.
Why it happens
Duplicate beta-1 adrenergic blockade with additive negative chronotropic and hypotensive effects.
What to do
Avoid combining the two and use one beta-blocker at an optimized dose. When switching, stop the first agent before starting the other and monitor heart rate and blood pressure.
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 Metoprolol
- Metoprolol + Thioridazine Contraindicated
- Amifostine + Metoprolol Major
- Amiodarone + Metoprolol Major
- Atenolol-chlorthalidone + Metoprolol Major
- Atenolol + Metoprolol Major
- Betaxolol + Metoprolol Major
Other interactions of Nebivolol
- Acebutolol + Nebivolol Major
- Aldesleukin + Nebivolol Major
- Amiodarone + Nebivolol Major
- Atenolol-chlorthalidone + Nebivolol Major
- Atenolol + Nebivolol Major
- Betaxolol + Nebivolol Major
Frequently asked questions
Can I take Metoprolol with Nebivolol?
MediHelp rates the interaction as major. Metoprolol 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. Both are beta-1 selective blockers, so concurrent use duplicates therapy and adds the risk of bradycardia, hypotension and heart block without added benefit. Nebivolol is also partly metabolized by CYP2D6, but the main concern is additive effect.
How serious is the interaction between Metoprolol 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: Avoid combining the two and use one beta-blocker at an optimized dose. When switching, stop the first agent before starting the other and monitor heart rate and blood pressure.
What other medicines interact with Metoprolol?
MediHelp also lists interactions of Metoprolol with, for example, Thioridazine, Amifostine, Amiodarone. The full list is on the Metoprolol page.
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