ACEI-Beta Bloker

The combination of an ACE inhibitor with a beta blocker is in established

clinical use. Enhanced blood pressure-lowering effects
occur, as would be expected. Although not all combinations have
been studied, no clinically significant pharmacokinetic interactions
appear to occur between the ACE inhibitors and beta blockers.

ACEI CCB

The combination of an ACE inhibitor and a dihydropyridine calcium-

channel blocker is in established clinical use for hypertension,
and, although only certain combinations have been studied,
no clinically significant pharmacokinetic interactions appear to occur between the dihydropyridine-type calcium-
channel blockers and ACE inhibitors.

Beta Bloker Diltiazem

The cardiac depressant effects of diltiazem and beta blockers are
additive, and although concurrent use can be beneficial, close
monitoring is recommended. A number of patients, (usually those
with pre-existing ventricular failure or conduction abnormalities)
have developed serious and potentially life-threatening bradycardia.
Diltiazem increases the serum levels of propranolol and metoprolol,
but not those of atenolol, but these changes are probably
not clinically important.
ACEI-Beta Bloker :
Kombinasi ACE inhibitor dengan beta bloker digunakan secara klinis. Terjadi efek penurunan tekanan darah
yang meningkat, seperti yang diharapkan. Meskipun tidak semua kombinasi telah dipelajari, tidak ada interaksi
farmakokinetik yang signifikan secara klinis antara penghambat ACE dan beta bloker.

ACEI- CCB :
Kombinasi ACE inhibitor dan penghambat kanal kalsium dihydropiridin digunakan secara klinis untuk hipertensi
dan walaupun hanya kombinasi tertentu yang telah dipelajari, tidak terjadi interaksi farmakokinetik klinis yang
signifikan antara penghambat kanal kalsium (dihydropiridin) dan ACE inhibitor.

BETA BLOKER ASPIRIN/OAINS

There is evidence that most NSAIDs can increase blood pressure

in patients taking antihypertensives, although some studies have
not found the increase to be clinically relevant. In various small
studies, indometacin reduced the antihypertensive effects of the
beta blockers. There is some evidence that piroxicam usually interacts
similarly. Ibuprofen and naproxen have reduced the effect
of beta blockers in some small studies but not others. Two isolated
cases of hypertension have been reported with naproxen and ibuprofen
in patients treated with propranolol and pindolol, respectively.
Celecoxib, but not rofecoxib, inhibits the metabolism of
metoprolol. Limited information suggests that normally diclofenac
imidazole salicylate, oxaprozin, tenoxicam and probably
sulindac do not interact.
Multiple-dose aspirin, both in high and low dose, did not reduce
the efficacy of antihypertensives including beta blockers in three
studies, but one study using single, high doses showed antagonism
of the effect of intravenous beta blockers. Another study suggested
aspirin may attenuate the benefit of carvedilol in heart failure.

BETA BLOKER CCB DIHIDROPIRIDIN

The use of beta blockers with felodipine, isradipine, lacidipine,

nicardipine, nimodipine and nisoldipine normally appears to be
useful and safe. However, severe hypotension and heart failure
have occurred rarely when a beta blocker was given with nifedipine
or nisoldipine. Changes in the pharmacokinetics of the beta
blockers and calcium-channel blockers may also occur on concurrent
use, but they do not appear to be clinically important.