Drug General Information (ID: DDIRPI4M1G)
Drug Name			Disopyramide		Drug Info		Nebivolol		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antiarrhythmic Agents				Antihypertensive Agents
Structure

Mechanism of Disopyramide-Nebivolol Interaction (Severity Level: Major)
Additive hypotensive effects Click to Show/Hide Mechanism Graph
Drug Name		Disopyramide				Nebivolol
Mechanism 1		Antihypertensive agent				Antihypertensive agent
Key Mechanism Factor 1
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Disopyramide and Nebivolol
Mechanism 2		Hypotensive effects				Antihypertensive agent
Key Mechanism Factor 2
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Disopyramide and Nebivolol
Mechanism 3		Antihypertensive agent				Hypotensive effects
Key Mechanism Factor 3
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Disopyramide and Nebivolol
Mechanism 4		Hypotensive effects				Hypotensive effects
Key Mechanism Factor 4
		Factor Name		Hypotensive effects
		Factor Description		Hypotension is a blood pressure reading below the prescribed limit (90/60 mmHg). Symptoms of hypotension may include: blurred or faded vision , dizziness or light-headedness, fainting , fatigue , difficulty concentrating, nausea.
Mechanism Description		Additive hypotensive effects by the combination of Disopyramide and Nebivolol
Increased risk of bradycardia Click to Show/Hide Mechanism Graph
Drug Name		Disopyramide				Nebivolol
Mechanism 5		Bradycardia				Bradycardia
Key Mechanism Factor 5
		Factor Name		Bradycardia
		Factor Description		Bradycardia is a slow heart rate in which the heart beats less than 60 times per minute. If the heart rate is very slow and the heart is not pumping enough oxygen-rich blood to the body, and you may feel dizzy, very tired or weak, and short of breath.
Mechanism Description		Increased risk of bradycardia by the combination of Disopyramide and Nebivolol
Increased risk of hypoglycemia Click to Show/Hide Mechanism Graph
Drug Name		Disopyramide				Nebivolol
Mechanism 6		Hypoglycemia				Hypoglycemia
Key Mechanism Factor 6
		Factor Name		Hypoglycemia
		Factor Description		Hypoglycemia is a condition in which your blood sugar (glucose) level is below the standard range. It causes irregular or rapid heartbeat, pale skin, numbness of the lips, tongue or cheeks, and sweating.
Mechanism Description		Increased risk of hypoglycemia by the combination of Disopyramide and Nebivolol
Increased risk of prolong QT interval Click to Show/Hide Mechanism Graph
Drug Name		Disopyramide				Nebivolol
Mechanism 7		Prolong QT interval				Prolong QT interval
Key Mechanism Factor 7
		Factor Name		QT interval
		Factor Description		Long QT syndrome is a heart signaling disorder that can cause a fast, chaotic heartbeat (arrhythmia). Many people may not exhibit symptoms, and usually the condition is detected during routine medical tests. In others, the most common symptoms include: sudden fainting, palpitations, dizziness, seizures, sudden death.
Mechanism Description		Increased risk of prolong QT interval by the combination of Disopyramide and Nebivolol

Recommended Action
Management		The use of disopyramide in combination with beta-blockers should generally be avoided unless the benefits are anticipated to outweigh the risks. Close monitoring of cardiac output, blood pressure, heart rate, and/or ECG is recommended if these drugs must be used together. Patients should be advised to seek medical attention if they experience dizziness, lightheadedness, syncope, palpitations, slow or fast pulse, or irregular heartbeats.

References
1	Bonde J, Bodtker S, Angelo HR, Svedsen TL, Kampmann JP "Atenolol inhibits the elimination of disopyramide." Eur J Clin Pharmacol 28 (1985): 41-3. [PMID: 3987784]
2	Bonde J, Pedersen LE, Angelo HR, Trap-Jensen J, Svedsen TL, Kampmann JP "Haemodynamic effects and kinetics of concomitant intravenous disopyramide and atenolol in patients with ischaemic heart disease." Eur J Clin Pharmacol 30 (1986): 161-6. [PMID: 3709640]
3	Cumming AD, Robertson C "Interaction between disopyramide and practolol." Br Med J 2 (1979): 1264. [PMID: 519408]
4	Product Information. Norpace (disopyramide). Searle, Skokie, IL.
5	Product Information. Tenormin (atenolol). ICN Pharmaceuticals Inc, Cost Mesa, CA.