Drug General Information (ID: DDIZVTI3XM)
Drug Name			Bisoprolol		Drug Info		Gadobutrol		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antihypertensive Agents				Diagnostic Agents
Structure

Mechanism of Bisoprolol-Gadobutrol Interaction (Severity Level: Moderate)
Increased risk of angioedema/anaphylactoid reactions Click to Show/Hide Mechanism Graph
Drug Name		Bisoprolol				Gadobutrol
Mechanism		Anaphylactoid reactions				Anaphylactoid reactions
Key Mechanism Factor 1
		Factor Name		Angioedema/anaphylactoid reactions
		Factor Description		Anaphylactoid reaction is a condition in which symptoms similar to an allergic reaction occur, but no immune sensitization is detected. Most commonly, the syndrome begins with skin involvement, usually pruritus, flushing, urticaria, or angioedema. Angioedema is a reaction to a trigger that causes swelling of the tissue below the inner layer of the skin, called the dermis or submucosa, and the swelling can occur on the face, throat, or around the genitals.
Mechanism Description		Increased risk of angioedema by the combination of Bisoprolol and Gadobutrol

Recommended Action
Management		Patients who have received beta-blockers should be closely monitored for adverse reactions to contrast media. If anaphylaxis occurs, clinicians should be aware that beta-blockers may attenuate the response to epinephrine. Thus, larger doses of epinephrine may be necessary to overcome the bronchospasm, although such large doses can also cause excessive alpha-adrenergic stimulation resulting in hypertension, reflex bradycardia, heart block, and possible potentiation of bronchospasm. alternative treatments recommended include vigorous supportive care (e.g., fluids) and the use of parenteral beta-agonists for bronchospasm and norepinephrine for hypotension.

References
1	Cerner Multum, Inc. "Australian Product Information.".
2	Cerner Multum, Inc. "UK Summary of Product Characteristics.".
3	EMEA. European Medicines Agency "EPARs. European Union Public Assessment Reports.".