Drug interactions
Metoprolol + Propafenone
Severity: Major
Metoprolol and Propafenone: 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
Propafenone inhibits CYP2D6 and substantially raises metoprolol concentrations, in addition to having its own beta-blocking and negative inotropic effects. This can lead to marked bradycardia, hypotension and heart failure worsening.
What this interaction means in plain words
Metoprolol and Propafenone 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; Propafenone belongs to Cardiovascular.
Why it happens
CYP2D6 inhibition reducing metoprolol clearance, with additive beta-blocking and conduction effects.
What to do
Monitor heart rate, blood pressure and ECG, and reduce the metoprolol dose as needed. Consider an alternative beta-blocker not dependent on CYP2D6.
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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Metoprolol and Propafenone, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
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 Propafenone
- Dofetilide + Propafenone Contraindicated
- Dronedarone + Propafenone Contraindicated
- Nilotinib + Propafenone Contraindicated
- Nirmatrelvir / ritonavir + Propafenone Contraindicated
- Nirmatrelvir + Propafenone Contraindicated
- Pimozide + Propafenone Contraindicated
Frequently asked questions
Can I take Metoprolol with Propafenone?
MediHelp rates the interaction as major. Metoprolol and Propafenone 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. Propafenone inhibits CYP2D6 and substantially raises metoprolol concentrations, in addition to having its own beta-blocking and negative inotropic effects. This can lead to marked bradycardia, hypotension and heart failure worsening.
How serious is the interaction between Metoprolol and Propafenone?
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, blood pressure and ECG, and reduce the metoprolol dose as needed. Consider an alternative beta-blocker not dependent on CYP2D6.
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.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
