ModerateSelective β1-adrenoceptor blockers×Methylxanthine
Updated · Methodology
Mechanism
Metoprolol is cardioselective but at high doses antagonises theophylline's bronchodilator effect. In bronchial asthma, control may worsen.
Symptoms
Exertional dyspnoea, wheezing, more frequent asthma attacks. In COPD: symptom exacerbation.
Management
In asthma and COPD with atrial fibrillation or hypertension, metoprolol is preferred at cardioselective doses (up to 100 mg/day) under pulmonary function monitoring. In severe asthma, consider alternatives — diltiazem or verapamil for rate control in atrial fibrillation. Theophylline is second-line in COPD; consider switching to long-acting beta-2 agonists (formoterol).
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Sources
- FDA: Theo-24 (theophylline) prescribing information (2012)– ; DailyMed setid 7a108fa0-c230-475f-be93-6f864b98a410