Metoprolol Propoxyphene

Drugs that may affect benzodiazepines include alcohol, antacids, barbiturates, cimetidine, disulfiram, fluoxetine, isoniazid, ketoconazole, metoprolol, oral contraceptives, narcotics, probenecid, propoxyphene, propranolol, ranitidine, rifampin, scopolamine, theophylline, and valproic acid. 

Inhibitors codeine, encainide, flecainide, fluoxetine, haloperidol, hydrocodone, 4-methoxy-amphetamine, metoprolol, mexiletine, oxycodone, paroxetine, propafenone, propoxyphene, risperidone, selegiline (deprenyl), thioridazine, most tricyclic antidepressants, timolol Fluoxetine, haloperidol, paroxetine, quinidine... 

A 76-year-old woman taking lisinopril 20 mg/day and metoprolol for hypertension developed headaches, nausea, and a tingling sensation in her arms. Her serum sodium was 109 mmol/1, with a serum osmolality of 225 mosm/kg, urine osmolality of 414 mosm/kg, and urine sodium of 122 mmol/1. She had taken diclofenac 75 mg/day for arthritic pain for 6 years and naproxen for about 1 month. Propoxyphene napsylate and paracetamol had then been substituted and zolpidem had been started. A diagnosis of SIADH was postulated and thyroid and adrenal causes were excluded. Lisinopril was withdrawn and fluid was restricted to 100 ml/day. The serum sodium gradually corrected to 143 mmol/1. 

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.)... 

Among drugs considered to be absorbed more quickly with food are carbamazepine, phenytoin, diazepam, dicoumarol, erythromycin (contentious), griseofulvin, hydralazine, hydrochlorothiazide, lithium citrate, labetalol, propranolol, metoprolol, nitrofurantoin, propoxyphene and spironolactone,... 

Also analyzed acebutolol, acetaminophen, alprazolam, amphetamine, atenolol, betaxolol, brotizolam, caffeine, camazepam, captopril, chloroquine, clobazam, clomipramine, cloth-iapine, clotiazepam, cloxazolam, cocaine, codeine, diclofenac, dihydralazine, dihydrocodeine, dihydroergotamine, diphenhydramine, domperidone, doxepin, droperidol, ergota-mine, ethyl loflazepate, fenethylline, fluoxetine, flupentixol, flurazepam, furosemide, gliclazide, hydrochlorothiazide, hydroxyzine, ibuprofen, imipramine, ketazolam, loprazo-1am, lorazepam, lormetazepam, maprotUine, medazepam, mepyramine, methadone, methaqualone, methyldopa, methylphenidate, metoclopramide, metoprolol, mexiletine, mianserin, midazolam, minoxidil, morphine, nadolol, nitrazepam, oxprenolol, papaverine, pentazocine, phenprocoumon, phenylbutazone, pipamperone, piritramide, practolol, pra-zepam, prazosin, promazine, promethazine, propoxyphene, propranolol, prothipendyl, quinine, sotalol, sulpride, thioridazine, trazodone, triazolam, trimipramine, tripelennamine, lyramine, verapeunil, yohimbine... 

Schill, G. Wainer, I.W. Barkan, S.A. Chiral separation of cationic drugs on an al-acid glycoprotein bonded stationary phase. J.Liq.Chromatogr, 1986, 9, 641-666 [chiral also bromdiphenhydramine, brompheniramine, bupivacaine, butorphanol, carbinoxamine, chlorpheniramine, clidinium, cocaine, cyclopentolate, dimethindene, diperidone, disopyramide, doxylamine, ephedrine, homatropine, labe-talol B, labetalol, labetalol A, mepensolate, mepivacaine, methadone, methorphan, methylatropine, methylhomatropine, methylphenidate, metoprolol, nadolol, nadolol A, nadolol B, oxprenolol, oxy-phencyclimine, phenmetrazine, phenoxybenzamine, promethazine, pronethalol, propoxyphene, propranolol, pseudoephedrine, terbutaline, tocainide, tridihexethyl]... 

The liver is the most important site of presystemic elimination because of high levels of drug-metabolizing enzymes, its ability to rapidly metabolize different types of drugs, and its unique anatomical location. The following are selected examples of drugs that are subject to considerable hepatic first-pass metabolism the 3-blockers propranolol and metoprolol the analgesics propoxyphene, meperidine, and pentazocine the antidepressants imipramine and nortriptyline and the antiarrhythmic lidocaine. 

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