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Atenolol + Chlorthalidone + Lidocaine Hydrochloride (Spray)

Moderate 10 published sources

This interaction is documented in this data source.

Atenolol + Chlorthalidone
Checked as Atenolol + Chlorthalidone
Lidocaine Hydrochloride (Spray)
Checked as Lidocaine

2 documented mechanisms

This source documents more than one distinct mechanism for this pair. Each is shown with its own effect, advice and sources rather than merged into one.

  1. Mechanism 1: Synergy · Metabolism

    Moderate

    via Atenolol and Lidocaine

    What happens

    Some beta-blockers may increase lidocaine levels and risk of toxicity. The proposed mechanism is enzyme inhibition and/or decreased cardiac output and hepatic blood flow resulting in decreased hepatic metabolism of lidocaine. In addition beta-blockers and lidocaine may also have additive negative inotropic effects on the heart.

    What to do

    Patients receiving concurrent therapy should be monitored for drowsiness, mental status changes, bradycardia, and hypotension. Lidocaine levels should be obtained when clinically necessary. If toxicity is suspected, the lidocaine infusion should be decreased, as possible.

    10 sources

    1. Ochs HR, Carstens G, Greenblatt DJ "Reduction in lidocaine clearance during continuous infusion and by coadministration of propranolol." N Engl J Med 303 (1980): 373-7
    2. Svendsen TL, Tango M, Waldorff S, et al "Effects of propranolol and pindolol on plasma lignocaine clearance in man." Br J Clin Pharmacol 13 (1982): s223-6
    3. Conrad KA, Byers JM, Finley PR, Burnham L "Lidocaine elimination: effects of metoprolol and of propranolol." Clin Pharmacol Ther 33 (1983): 133-8
    4. Schneck DW, Luderer JR, Davis D, Vary J "Effects of nadolol and propranolol on plasma lidocaine clearance." Clin Pharmacol Ther 36 (1984): 584-7
    5. Miners JO, Wing MH, Lillywhite KJ, Smith KJ "Failure of "therapeutic" doses of beta-adrenoceptor antagonists to alter the disposition of tolbutamide and lignocaine." Br J Clin Pharmacol 18 (1984): 853-60
    6. Jordo L, Johnsson G, Lundborg P, Regardh CG "Pharmacokinetics of lidocaine in healthy individuals pretreated with multiple doses of metoprolol." Int J Clin Pharmacol Ther Toxicol 22 (1984): 312-5
    7. Ochs HR, Skanderra D, Abernethy DR, Greenblatt DJ "Effect of penbutolol on lidocaine kinetics." Arzneimittelforschung 33 (1983): 1680-1
    8. Graham CF, Turner WM, Jones JK "Lidocaine-propranolol interactions ." N Engl J Med 304 (1981): 1301
    Show all 10 sources
    1. Bax ND, Tucker GT, Lennard MS, Woods HF "The impairment of lignocaine clearance by propranolol: major contribution from enzyme inhibition." Br J Clin Pharmacol 19 (1985): 597-603
    2. Parker G, Ene MD, Daneshmend TK, Roberts CJ "Do beta blockers differ in their effects on hepatic microsomal enzymes and liver blood flow?" J Clin Pharmacol 24 (1984): 493-9

  2. Mechanism 2: Unknown

    Listed, not described

    via Chlorthalidone and Lidocaine

    The source lists this pair here and publishes no description, mechanism or citation for it.

    No sources recorded

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