Moderate
Bisoprolol × Bupropion
Selective beta-adrenergic blockers×Other antidepressants (NDRI)
Mechanism
Bupropion blocks CYP2D6. Bisoprolol is metabolised 50% via CYP3A4 and 50% renally, so the effect is clinically minor, unlike metoprolol (fully CYP2D6).
Symptoms
Minimal changes: mild additional bradycardia possible. Older patients: rare symptomatic hypotension.
Management
Dose adjustment is usually unnecessary. In older patients and reduced ejection fraction, check pulse and blood pressure 2 weeks after start.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.