Drug interactions
Propranolol + Verapamil
Severity: Major
Propranolol 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 and propranolol both depress sinoatrial and AV nodal conduction and myocardial contractility. Together they can cause severe bradycardia, high-grade AV block, hypotension and acute heart failure, particularly with intravenous verapamil or reduced ventricular function.
What this interaction means in plain words
Propranolol 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.
Propranolol belongs to Cardiovascular; Verapamil belongs to Cardiovascular.
Why it happens
Additive negative chronotropic, dromotropic and inotropic effects; verapamil may also modestly reduce propranolol clearance.
What to do
Avoid the combination, especially intravenous verapamil with a beta blocker. If used orally, monitor ECG, heart rate and blood pressure closely, with low starting 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 Propranolol
- Propranolol + Thioridazine Contraindicated
- Acebutolol + Propranolol Major
- Adrenaline-articaine + Propranolol Major
- Amifostine + Propranolol Major
- Amiodarone + Propranolol Major
- Arformoterol + Propranolol 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 Propranolol with Verapamil?
MediHelp rates the interaction as major. Propranolol 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 and propranolol both depress sinoatrial and AV nodal conduction and myocardial contractility. Together they can cause severe bradycardia, high-grade AV block, hypotension and acute heart failure, particularly with intravenous verapamil or reduced ventricular function.
How serious is the interaction between Propranolol 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 the combination, especially intravenous verapamil with a beta blocker. If used orally, monitor ECG, heart rate and blood pressure closely, with low starting doses.
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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