Drug interactions
Propranolol + Rivastigmine
Severity: Major
Propranolol and Rivastigmine: major interaction.
Last updated Sources: UK SmPC
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
Rivastigmine increases cholinergic tone and can slow the heart rate, and propranolol adds beta-blocker bradycardia. Together they can cause marked bradycardia, syncope or heart block, particularly in older adults.
What this interaction means in plain words
Propranolol and Rivastigmine 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.
Propranolol belongs to Cardiovascular; Rivastigmine belongs to Central Nervous System.
Why it happens
Additive bradycardic effects from cholinesterase inhibition (vagotonic) and beta-adrenergic blockade.
What to do
Monitor heart rate and watch for dizziness, syncope or falls when combining them. Reduce or stop one drug if symptomatic bradycardia occurs.
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 Propranolol
- Propranolol + Thioridazine Contraindicated
- Acebutolol + Propranolol Major
- Adrenaline-articaine + Propranolol Major
- Amifostine + Propranolol Major
- Amiodarone + Propranolol Major
- Arformoterol + Propranolol Major
Other interactions of Rivastigmine
Frequently asked questions
Can I take Propranolol with Rivastigmine?
MediHelp rates the interaction as major. Propranolol and Rivastigmine 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. Rivastigmine increases cholinergic tone and can slow the heart rate, and propranolol adds beta-blocker bradycardia. Together they can cause marked bradycardia, syncope or heart block, particularly in older adults.
How serious is the interaction between Propranolol and Rivastigmine?
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 and watch for dizziness, syncope or falls when combining them. Reduce or stop one drug if symptomatic bradycardia occurs.
What other medicines interact with Propranolol?
MediHelp also lists interactions of Propranolol with, for example, Thioridazine, Acebutolol, Adrenaline-articaine. The full list is on the Propranolol page.
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