Moderate
losartan × metoprolol
Angiotensin II receptor blockers (sartans)×Selective β1-adrenoceptor blockers
Mechanism
A target combination in HF and hypertension. Synergistic BP reduction. In older patients, symptomatic hypotension and bradycardia can occur. The sartan does not mask hypoglycemia (unlike the β-blocker, which can).
Management
Start at low doses. Check BP, heart rate, creatinine, and potassium at 1–2 weeks. In diabetic patients, remember that metoprolol masks tachycardia during hypoglycemia.
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