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Cardiovascular adverse drug reaction associated with combined beta-adrenergic and calcium entry-blocking agents
Y Edoute1, P Nagachandran, B Svirski
1Department of Internal Medicine C, Rambam Medical Center and The Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technlology, Haifa.
Insights
Combination therapy with beta-blockers and calcium antagonists can cause serious bradyarrhythmias in elderly patients. Careful monitoring is essential when using these drugs together for cardiovascular conditions.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Beta-blockers and calcium antagonists are commonly used for anginal syndrome and hypertension.
- Both drug classes have negative chronotropic effects, potentially leading to bradyarrhythmias when combined.
Purpose of the Study:
- To describe clinical experience with cardiovascular adverse drug reactions (CVADRs) from combined beta-blocker and calcium antagonist therapy.
- To identify the incidence and characteristics of CVADRs in patients receiving this combination.
Main Methods:
- Prospective study of 26 patients experiencing CVADRs from combination therapy.
- Analysis of patient demographics, drug combinations, and clinical outcomes over a 2-year period.
Main Results:
- Cardiac bradyarrhythmias were observed in 22 out of 26 patients.
- Diltiazem plus propranolol was the most frequent combination associated with CVADRs.
- Most rhythm abnormalities resolved after drug discontinuation, with only one patient requiring a pacemaker.
Conclusions:
- Cardiovascular adverse drug reactions are not uncommon in elderly patients on combined beta-blocker and calcium antagonist therapy.
- This combination can unpredictably cause hemodynamic events, sinus node suppression, and AV conduction prolongation.
- Enhanced therapeutic monitoring is recommended for patients receiving concomitant calcium antagonists and beta-blockers.
Abstract:
Numerous studies have shown a beneficial effect of combination therapy with beta-blockers and calcium antagonists in patients with anginal syndrome and/or hypertension. However, because both agents exert a negative chronotropic effect, their combined use may cause bradyarrhythmias with resultant symptoms of cerebral, coronary, and systemic hypoperfusion. We describe our clinical experience with patients who had cardiovascular adverse drug reactions (CVADRs) with combination therapy. This prospective study included 26 patients who had CVADRs among 2,574 admissions during a 2-year period. The study group included 14 men and 12 women with a median age of 73 years. Various combinations of calcium antagonists and beta-blockers were associated with the CVADRs. The most frequent pharmacologic combination was diltiazem plus propranolol. The CVADRs were the cause for hospital admission in 10 patients, an associated cause in nine patients, and developed during hospitalization in seven patients. Cardiac bradyarrhythmias were found in 22 patients. These rhythm abnormalities resolved within 24 h after discontinuation of the offending drugs. Temporary transvenous pacemaker insertion was necessary in only one patient with complete atrioventricular block. Twenty-two patients recovered, two patients died of pump failure not associated with CVADRs, and in two patients, the CVADRs contributed to the patients' death. CVADRs are not uncommon in elderly patients with ischemic heart disease and/or hypertension treated with the concomitant use of calcium antagonist and beta-adrenergic blocking drugs. Use of calcium antagonist plus beta-blocker may unpredictably cause serious hemodynamic events, marked suppression of sinus node activity, and prolongation of atrioventricular conduction in some patients. Enhanced therapeutic monitoring may be warranted when calcium antagonists are combined with beta-blockers.