Drug General Information (ID: DDII4JZP97)
Drug Name			Nifedipine		Drug Info		Levobetaxolol (ophthalmic)		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Analgesics				Cardiotonic Agents
Structure

Mechanism of Nifedipine-Levobetaxolol (ophthalmic) Interaction (Severity Level: Moderate)
Increased risk of cardiac depression Click to Show/Hide Mechanism Graph
Drug Name		Nifedipine				Levobetaxolol (ophthalmic)
Mechanism		Cardiac depressant effects				Cardiac depressant effects
Key Mechanism Factor 1
		Factor Name		Cardiac depression
		Factor Description		Cardiac depression may manifest as negative heart rate, negative conduction, and negative contractility. Symptoms include: excessive or more than normal sleep, irritability, loss of interest in activities, and fatigue.
Mechanism Description		Increased risk of cardiac depression by the combination of Nifedipine and Levobetaxolol (ophthalmic)

Recommended Action
Management		Close clinical monitoring of patient hemodynamic response and tolerance is recommended if a calcium channel blocker is prescribed with a beta blocker, and the dosage of one or both agents adjusted as necessary. The same precaution should be observed when beta blocker ophthalmic solutions are used, since they are systemically absorbed and can produce clinically significant systemic effects even at low or undetectable plasma levels.

References
1	Henry M, Kay MM, Viccellio P "Cardiogenic shock associated with calcium-channel and beta blockers: reversal with intravenous calcium chloride." Am J Emerg Med 3 (1985): 334-6. [PMID: 2860911]
2	Pouleur H, Etienne J, Van Mechelen H, et al "Effects of nicardipine or nifedipine added to propranolol in patients with coronary artery disease." Postgrad Med J 60 (1984): 23-8. [PMID: 6527976]
3	Strauss WE, Egan T, McIntyre KM, Parisi AF "Combination therapy with diltiazem and propranolol: precipitation of congestive heart failure." Clin Cardiol 8 (1985): 363-6. [PMID: 4006348]