Beta blockers and verapamil: a cautionary tale.

Hutchison, S.J.; Lorimer, A. R.; Lakhdar, A A; McAlpine, Stuart G.

doi:10.1136/bmj.289.6446.659-a

Cited by 23 publications

(6 citation statements)

References 5 publications

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“…These observations showed that under controlled clinical settings, the combination of verapamil and a beta blocker was an important addition to the armamentarium in angina treatments, substantiating previous anecdotal reports. These favorable results also contradict several reports by Benaim [41], Meinertz [42] and others [43][44][45][46][47], who pointed out the dangers of combining verapamil with a beta blocker in patients with severe arrhythmia. Left ventricular failures, and even deaths occurred.…”

Section: Chronic Stable Anginacontrasting

confidence: 79%

“…Several studies by McGourthy et al [50] and Hutchinson et al [44] have also corroborated that this caution is warranted, since both have reported that patients develop side effects, heart blocks, when given atenolol and verapamil concomitantly. Eisenberg and Oakley [51] described a patient on verapamil and metoprolol who developed a Wenkebach-type atrioventricular block.…”

Section: Chronic Stable Anginamentioning

confidence: 84%

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Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Lessem

Singh

1989

Cardiovasc Drug Ther

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Calcium-channel antagonists and beta-adrenergic blocking agents have become important modalities in the cardiovascular therapeutic armamentarium. These drugs are often administered as monotherapy to a wide range of cardiological patients with angina pectoris, hypertension, arrhythmias, congestive heart failure, and other diseases. Since within each class these drugs exhibit pharmacologic differences, it follows that their effectiveness varies in different disease states and that they exhibit a wide variety of side effects. In an attempt to optimize therapy, the individual drugs from these two classes can be combined; and the efficaciousness and side-effect profile of various combinations between calcium-channel antagonists and beta blockers are discussed in this review. Recommendations as to which patients may benefit from a combination and as to which patients may be harmed by the combination therapy will be made. Very few studies have compared the safety and efficacy of a single agent with the combination and with placebo in a controlled randomized fashion. To determine which therapy is superior and to determine which combination one should recommend under what circumstances, such placebo-controlled, randomized trials are a necessity, and will hopefully be performed although the complexity is enormous.

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Section: Chronic Stable Anginacontrasting

confidence: 79%

Section: Chronic Stable Anginamentioning

confidence: 84%

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Lessem

Singh

1989

Cardiovasc Drug Ther

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“…Nitrendipine has also been used in combination with P-adrenoceptor antagonists in the treatment of hypertension (Oro & Ryman, 1984;de Divitiis et al, 1984) and the combination has been found to be more effective than either agent alone, in keeping with previous experience of combinations of drugs of these groups (Lynch et al, 1980;Harris et al, 1982). However, electrophysiological interactions have been reported between 1Badrenoceptor antagonists and certain calcium antagonist drugs, both intravenously (Winniford et al, 1982;Kawai et al, 1981) and orally (Hutchison et al, 1984;Eisenberg et al, 1984;McGourty et al, 1985), particularly with verapamil. It has therefore been recommended that verapamil and perhaps other calcium antagonists should be used cautiously with 3-adrenoceptor antagonists especially in patients with underlying abnormalities of the heart's conduction system (Winniford et al, 1982).…”

Section: Introductionmentioning

confidence: 74%

The effects of oral nitrendipine and propranolol, alone and in combination, on hypertensive patients with special reference to AV conduction.

Maltz¹,

Davies²,

Lau³

et al. 1986

Brit J Clinical Pharma

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The effects of oral nitrendipine and oral propranolol, alone and in combination, on AV conduction have been examined in 11 patients with essential hypertension in whom arterial pressure was not adequately controlled despite treatment with thiazide diuretics. The study was performed double‐blind. After a drug free period of 1 week, the patients received two 7 day courses of drug therapy after initial control measurements. Five of the eleven patients were randomised to receive nitrendipine 20 mg daily, the other six patients received propranolol (Inderal LA 160 mg daily) for the first week of therapy. During week 2, 10 patients received combined therapy. In the 10 patients who completed the study, oral nitrendipine, given either alone or in combination with oral propranolol, had no significant effect on resting PR, QRS, QT intervals nor on AV conduction as assessed by ambulatory electrocardiography. Propranolol did not affect the resting PR interval but significantly increased PR intervals on the ambulatory ECG recordings during single and combined therapy. However the maximum PR intervals remained within normal limits.

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“…32 33 The reported frequency of haemodynamic and electrophysiological adverse reac-341 342 Findlay, MacLeod, Gillen, Elliott, Aitchison, Dargie tions is variable; and in one review it was reported to be approximately 14%.3 These results were obtained in selected patients who had previously tolerated both types of drug,1 31 and in whom the dose was titrated to avoid adverse effects,1 8 and who had been studied in a previous trial' or under hospital supervision.8 9 23 31 Furthermore, in patients with poor effort capacity and depressed ventricular ejection fraction the frequency of adverse reactions rises significantly.3'…”

Section: Discussionmentioning

confidence: 99%

A double blind placebo controlled comparison of verapamil, atenolol, and their combination in patients with chronic stable angina pectoris.

Findlay¹,

MacLeod²,

Gillen³

et al. 1987

Heart

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SUMMARY The efficacy and effect on cardiac function of verapamil 120 mg three times a day and atenolol 100mg once a day, singly and in combination, were evaluated in 15 patients with angina pectoris. While they were on the combination treatment four patients withdrew from the study. Episodes of angina pectoris and glyceryl trinitrate consumption were significantly reduced only on the combination. On the combination only four patients developed evidence of ischaemia during exercise compared with seven on verapamil and ten on atenolol. ST segment depression at peak exercise, assessed by 16 point precordial mapping, was reduced by all active treatments from 7 1 on placebo to 2-7, 0-9, and 0-6 mm on atenolol, verapamil, and the combination respectively. Mean left ventricular ejection fraction fell significantly from 60% on placebo to 53% on the combination but was unchanged on verapamil and atenolol.

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Beta blockers and verapamil: a cautionary tale.

Cited by 23 publications

References 5 publications

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

Calcium channel antagonism and beta blockade in combination—A therapeutic alternative in cardiovascular disorders. A review

The effects of oral nitrendipine and propranolol, alone and in combination, on hypertensive patients with special reference to AV conduction.

A double blind placebo controlled comparison of verapamil, atenolol, and their combination in patients with chronic stable angina pectoris.

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