Morphine Esmolol

BETA-BLOCKERS OPIOIDS 1. Risk of t plasma concentrations and effects of labetalol, metoprolol and propranolol t systemic effects of timolol eye drops 2. t plasma concentrations of esmolol when morphine is added 3. t plasma concentrations of metoprolol and propranolol when dextro-propoxyphene is added 1. Methadone inhibits CYP2D6, which metabolizes these beta-blockers 2. Unknown 3. i hepatic clearance of metoprolol and propanolol 1. Monitor BP at least weekly until stable 2. Monitor BP closely 3. Monitor BP at least weekly until stable. Warn patients to report symptoms of hypotension (lightheadedness, dizziness on standing, etc.)... 

Johansen JW,FlaishonR- SebelPS. Esmolol reduces anesthetic requirement for skin incision during propofol/nitrous oxide/morphine anesftiesia. Anes esiology (1997) 86, 364-71. 

Morphine may moderate raise the serum levels of esmolol, but this is unlikefy to be clinically important The fatal doses of morphine and propranolol are markedly reduced by concurrent use in animals, but the clinical relevance of this in man is uncertain. 

In a study in 10 healthy men a 3-mg injeetion of morphine sulfate inereased the steady-state levels of a 300 mierogram/kg per minute infusion of esmolol, given over 4 hours. However, the inereases were only sta-tistieally signifieant in 2 of the subjeets (inerease of 46%), and were considered to be of no clinical importance. The pharmacokinetics of morphine were unchanged. ... 

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