Moderate
Losartan × Metoprolol
Angiotensin II receptor blockers (sartans)×Selective β1-adrenoceptor blockers
Mechanism
Target combination in heart failure and arterial hypertension. Synergistic blood pressure reduction. The ARB does not mask the adrenergic response to hypoglycaemia.
Symptoms
On starting, in older patients: symptomatic hypotension, dizziness. Metoprolol bradycardia is amplified as sympathetic activation drops.
Management
Start both at minimal doses with up-titration every 2 weeks to target. Check standing/sitting BP, heart rate, creatinine and potassium at 2 weeks. In diabetes, monitor for hypoglycaemia: metoprolol is cardioselective and weakly masks adrenergic symptoms.
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