Rifampicin Beta blockers

RIFAMPICIN BETA-BLOCKERS 1 plasma concentrations and efficacy of bisoprolol, carvedilol, celiprolol, metoprolol and propanolol Rifampicin induces hepatic enzymes (e.g. CYP2C19), which t metabolism of the beta-blockers in addition, it may also t P-gp expression Monitor PR and BP watch for poor response to beta-blockers... 

Beta-blockers interact with a large number of other medications. The combination of beta-blockers with calcium antagonists should be avoided, given the risk for hypotension and cardiac arrhythmias. Cimetidine, hydralazine, and alcohol all increase blood levels of beta-blockers, whereas rifampicin decreases their concentrations. Beta-blockers may increase blood levels of phenothiazines and other neuroleptics, clonidine, phen-ytoin, anesthetics, lidocaine, epinephrine, monoamine oxidase inhibitors and other antidepressants, benzodiazepines, and thyroxine. Beta-blockers decrease the effects of insulin and oral hypoglycemic agents. Smoking, oral contraceptives, carbamazepine, and nonsteroidal anti-inflammatory analgesics decrease the effects of beta-blockers (Coffey, 1990). 

Rifampicin increases the clearance of bisoprolol, carvedilol, celiprolol, metoproioi, propranolol, tertatolol and talinolol, and reduces their serum levels. The extent to which this reduces the effects of these beta blockers is uncertain, but it is probably small. Similar effects have been seen when atenolol is given with rifampicin, but a case report su ests that occasional the effects may be of clinical relevance. 

Rifampicin is a potent liver-enzyme inducer that inereases the metabolism and loss of extensively metabolised beta blockers sueh as propranolol and metoproioi. Rifampicin may also interact by mechanisms other than enzyme induction. Rifampicin increases duodenal P-glyeoprotein expres-... 

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