Management: Ruxolitinib Canadian product labeling recommends avoiding use with bradycardia-causing agents to the extent possible.Siponimod: Bradycardia-Causing Agents may enhance the bradycardic effect of Siponimod.

Among patients treated with Metoprolol, there were comparable reductions in 3 month mortality for those treated early (≤ 8 hours) and those in whom treatment was started later.
This preferential ... following initial intravenous therapy were also observed with Lopressor and were independent of the interval between onset of symptoms and initiation of therapy. NIFEdipine may enhance the negative inotropic effect of Beta-Blockers.Nitroprusside: Blood Pressure Lowering Agents may enhance the hypotensive effect of Nitroprusside. Metoprolol is available as two different salts: metoprolol tartrate and metoprolol succinate. The COMET trial evaluated carvedilol and metoprolol tartrate in patients with chronic heart failure (NYHA class II to IV) and demonstrated a significantly lower all-cause mortality for carvedilol compared to metoprolol tartrate (34% vs. 40%, HR 0.83, 95% CI 0.74 to 0.93, p = 0.0017); however, COMET … Several serious adverse reactions have been reported in association with the administration of brimonidine to infants in the age range of 28 days to 3 months (see Adverse Effects).Although brimonidine had minimal effect on blood pressure and heart rate of patients in clinical studies, caution should be exercised in treating patients with severe cardiovascular disease.Brimonidine has not been studied in patients with hepatic or renal impairment; caution should be exercised in treating such patients.Brimonidine should be used with caution in patients with depression, cerebral or coronary insufficiency, Raynaud’s phenomenon, orthostatic hypotension or thromboangiitis obliterans.Brimonidine did not have clinically significant effects on pulse and blood pressure in chronic clinical studies. Headache, nightmares, and insomnia have also been reported.Shortness of breath and bradycardia have occurred in approximately 3 of 100 patients. Protect from moisture.Acetylcholinesterase Inhibitors: May enhance the bradycardic effect of Beta-Blockers.Ajmaline: May increase the serum concentration of CYP2D6 Substrates (High risk with Inhibitors).Alfuzosin: May enhance the hypotensive effect of Blood Pressure Lowering Agents.Alpha1-Blockers: Beta-Blockers may enhance the orthostatic hypotensive effect of Alpha1-Blockers. 1205736-overview Clinical Pharmacology. These oral doses are approximately 830 and 330 times greater, respectively, than the maximum recommended human daily ophthalmic dosage for brimonidine (0.003 mg base/kg/day) based on a 60 kg human.Brimonidine was not mutagenic or cytogenic in a series of in vitro and in vivo studies including the Ames test, host-mediated assay, chromosomal aberration assay in Chinese Hamster Ovary (CHO) cells, cytogenic studies in mice and dominant lethal assay.Pregnancy: Teratogenicity studies showed no adverse effects in rats and rabbits when oral doses (1.65 mg base/kg/day and 3.33 mg base/kg/day) were administered at approximately 550 and 1 110 times, respectively, the maximum recommended human daily ophthalmic dosage for brimonidine (based on a 60 kg human).There are no studies of brimonidine in pregnant women; however, in animal studies, brimonidine crossed the placenta and entered into the fetal circulation to a limited extent (ratio of drug-related material in fetal:maternal blood = 0.1 to 0.3).