Moderate
enalapril × metoprolol
Angiotensin-converting enzyme inhibitors (ACEi)×Selective β1-adrenoceptor blockers
Mechanism
A target combination in HFrEF and hypertension – synergistic BP and pre/afterload reduction. In older patients with hypovolemia or CKD, symptomatic hypotension and bradycardia can occur.
Management
Start both at low doses and titrate slowly. Check BP, heart rate, creatinine, and potassium at 1–2 weeks and with each dose increase.
Sources
- Lexicomp: Lexicomp Drug Interactions (2024)— Wolters Kluwer Clinical Drug Information, Inc. Lexi-Interact Online, 2024
- Pharmaceutical Press: Stockley's Drug Interactions, 12th edition (2024)— Preston CL (ed.). Stockley's Drug Interactions. 12th ed. London: Pharmaceutical Press; 2024