MajorAlpha and beta blocker (non-selective β + α1)×Selective serotonin reuptake inhibitors
Updated · Methodology
Mechanism
Fluoxetine is a potent CYP2D6 inhibitor, the main carvedilol metabolic route. Carvedilol plasma levels rise 2- to 3-fold. Marked hypotension and bradycardia emerge.
Symptoms
Bradycardia (heart rate below 50/min), dizziness, syncope. ECG: first- to second-degree AV block. Older patients: fall risk.
Management
Halve the carvedilol dose when combined; monitor blood pressure and pulse. Alternative beta-blockers without CYP2D6 dependence: bisoprolol or nebivolol. Alternative antidepressants without CYP2D6 inhibition: sertraline or escitalopram.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Coreg section 7 (2017)– ; DailyMed setid 07c619c6-4a0c-445e-94fa-664a54f68a39
- AEMPS: Ficha técnica: Carvedilol (nº registro 66230), sección 4.5 (2025)– AEMPS, CIMA, nº registro 66230, sección 4.5