Major
carvedilol × Theophylline
Alpha and beta blocker (non-selective β + α1)×Methylxanthine
Mechanism
Carvedilol blocks β2-adrenergic receptors (non-selective beta-blocker) and causes bronchoconstriction in asthma or COPD. Theophylline becomes less effective in these conditions.
Symptoms
Recurrence of asthma or COPD symptoms: dyspnoea, wheezing, need for additional short-acting β2-agonist doses. In severe asthma: risk of severe bronchospasm.
Management
Avoid the combination in asthma and severe COPD. In heart failure with mild COPD, a selective beta-blocker (bisoprolol, metoprolol) is preferred. Alternative to theophylline: long-acting inhaled β2-agonists with anticholinergics.
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.
Sources
- ESC: 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2021)– Eur Heart J 2021;42(36):3599–3726