Discussions that mention timolol

Panic Disorders board


Quote from Punchy:
My doctor has prescribed Zoloft and Inderal. After doing some OCD research on the interaction between the two, I noticed that they do conflict (or there have been reported cases). When I started to take them together I was getting panic attacks worrying about the interactions. I was on strictly Zoloft about 2 years ago and that was the last time I can remember feeling 'normal' or 'happy'. I would like to get back there. Then they found that I have a little bit of HBP (140/90) and doc put me on the Inderal, but I had stopped taking Zoloft for about 1.5 years. Now my medical is covered again, but I want to know if there is a good combination with Zoloft and any other HBP meds that people are using and having good success with. I will be taking the Zoloft in the morning, in case that matters. I see the doc today and will be requesting a possible change. He told me not to worry about the interaction (easier said then done).
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Dear Punchy,
First buy a wrist monitor an keep track of your blood pressure to make sure that you do not have white coat syndrome, which means it is only high at the doctors office or during an attack. Mine is always high at the doctors office no matter what. I do not have high blood pressure. Here is the interaction between zoloft and Inderal and then between zoloft and Lotensin. You should only be on about 10mg a day lotensin at most to start, 140/90 is not that high.

The Interaction between Zoloft - Inderal
Limited clinical data suggest that selective serotonin reuptake inhibitors (SSRIs) may potentiate the pharmacologic effects of some beta-blockers. There have been case reports of patients stabilized on beta-blocker therapy who developed bradycardia, hypotension, and complete heart block following the addition of a SSRI, subsequently requiring discontinuation of one or both agents and/or institution of a permanent pacemaker. The interaction is also corroborated by data from in vitro and clinical studies involving paroxetine and metoprolol conducted by one group of investigators. The proposed mechanism is SSRI inhibition (competitive and/or noncompetitive) of CYP450 2D6, the isoenzyme responsible for the metabolic clearance of beta-blockers such as carvedilol, labetalol, metoprolol, propranolol, and timolol. Paroxetine and norfluoxetine (the active metabolite of fluoxetine), in particular, are potent inhibitors of CYP450 2D6 and may be more likely than other SSRIs to cause the interaction. On the other hand, fluvoxamine is a potent inhibitor of CYP450 1A2 and may significantly interact with propranolol, which is a substrate of both CYP450 2D6 and 1A2.MANAGEMENT: During concomitant therapy with SSRIs, a lower initial dosage and more cautious titration of the beta-blocker may be appropriate. Cardiac function should be closely monitored and the beta-blocker dosage adjusted accordingly, particularly following initiation, discontinuation or change of dosage of SSRI in patients who are stabilized on their beta-blocker regimen. Due to the long half-life of fluoxetine and its active metabolite, norfluoxetine, the risk of an interaction may exist for an extended period (up to several weeks) after discontinuation of fluoxetine. To avoid the interaction, use of beta-blockers that are primarily eliminated by the kidney (e.g., atenolol, acebutolol, betaxolol, carteolol, nadolol) may be considered.

Lotensin (high blood pressure medication)
Food Interaction for Lotensin
Moderate-to-high dietary intake of potassium can cause hyperkalemia in some patients who are using angiotensin converting enzyme (ACE) inhibitors. In some cases, affected patients were using a potassium-rich salt substitute. ACE inhibitors can promote hyperkalemia through inhibition of the renin-aldosterone-angiotensin (RAA) system. MANAGEMENT: It is recommended that patients who are taking ACE inhibitors be advised to avoid moderately high or high potassium dietary intake. Particular attention should be paid to the potassium content of salt substitutes.

Food Interaction for Zoloft
Grapefruit juice may increase the plasma concentrations of some orally administered drugs which are substrates of the CYP450 3A4 isoenzyme. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. The extent and clinical significance are unknown. Moreover, pharmacokinetic alterations associated with interactions involving grapefruit juice are often subject to a high degree of interpatient variability.MANAGEMENT: Patients who regularly consume grapefruits and grapefruit juice should be monitored for adverse effects and altered plasma concentrations of drugs that are metabolized by CYP450 3A4. Grapefruits and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact with these drugs.

No drug interaction found. Good luck, I took this one with an srri and had no problem except I did not have high blood pressure which was easy to determine with a wrist tester. Do not take toporol or metatoporol. You need a blood pressure lowing drug not a hypertesion medication or strong beta blocker which is what you are taking now.

Sincerely,

Sickman :)