Drug interactions
Metoprolol + Physostigmine
Severity: Moderate
Metoprolol and Physostigmine: moderate 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
Physostigmine increases cholinergic tone and can slow heart rate, and metoprolol also lowers heart rate and slows AV conduction. Together they may cause pronounced bradycardia or heart block.
What this interaction means in plain words
Metoprolol and Physostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Additive negative chronotropic effects from acetylcholinesterase inhibition and beta-1 blockade.
What to do
Monitor heart rate and ECG during physostigmine administration; have atropine available.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Metoprolol
- Metoprolol + Thioridazine Contraindicated
- Amifostine + Metoprolol Major
- Amiodarone + Metoprolol Major
- Atenolol-chlorthalidone + Metoprolol Major
- Atenolol + Metoprolol Major
- Betaxolol + Metoprolol Major
Frequently asked questions
Can I take Metoprolol with Physostigmine?
MediHelp rates the interaction as moderate. Metoprolol and Physostigmine can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Physostigmine increases cholinergic tone and can slow heart rate, and metoprolol also lowers heart rate and slows AV conduction. Together they may cause pronounced bradycardia or heart block.
How serious is the interaction between Metoprolol and Physostigmine?
MediHelp rates it moderate, 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 during physostigmine administration; have atropine available.
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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