OBJECT DRUGS

Beta-blockers (CYP2D6 Substrates):

• Carvedilol (Coreg, etc.)
• Metoprolol (Lopressor, etc.)
• Nebivolol (Bystolic)
• Propranolol (Inderal, etc.)
• Timolol (Blocadren, etc.)

PRECIPITANT DRUGS

Antidepressants:

• Bupropion (Wellbutrin, etc.)
• Duloxetine (Cymbalta)
• Fluoxetine (Prozac, etc.)
• Paroxetine (Paxil, etc.)

Comment:

Antidepressants that are inhibitors of CYP2D6 can increase the concentration of beta-blockers, potentially resulting in bradycardia, hypotension or heart failure. Rapid metabolizers of CYP2D6 (over 90% of the population) will be at the greatest risk.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative:
• Antidepressant: Sertraline (Zoloft), citalopram (Celexa), desvenlafaxine (Pristiq), and escitalopram (Lexapro) are weak inhibitors of CYP2D6, while venlafaxine (Effexor) and fluvoxamine (Luvox) have little or no effect on CYP2D6.
• Beta-blocker: Select a beta-blocker that is not a CYP2D6 substrate such as atenolol (Tenormin) or nadolol (Corgard).
• Monitor:Monitor for altered beta-blocker effect if inhibitor is initiated, discontinued, or changed in dosage.