Major

carvedilol × Verapamil

Alpha and beta blocker (non-selective β + α1)×Non-dihydropyridine calcium channel blocker

Mechanism

Non-dihydropyridine calcium channel blocker (verapamil) + beta-blocker (carvedilol) – additive AV node blockade and negative inotropic effect. Carvedilol has additional α1-blockade, amplifying hypotension.

Symptoms

Bradycardia (heart rate below 50/min), dizziness, syncope. ECG: first- to second-degree AV block. Older patients: fall risk.

Management

Avoid the combination. For atrial fibrillation rate control, choose carvedilol + digoxin (instead of verapamil), or verapamil with carvedilol withdrawn. In heart failure, carvedilol is preferred (benefit proven in COPERNICUS and CIBIS).

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.

Open checker

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

← All interactions