From the Guidelines
The most significant contraindications among these medications involve potential interactions between apixaban and several other drugs, as well as the combination of metoprolol and losartan, which may cause excessive blood pressure lowering. The medications listed include furosemide, metoprolol succinate, losartan, Farxiga (dapagliflozin), bupropion, rosuvastatin, apixaban, tolterodine, fish oil, Vitamin C, B-Complex, Calcium, and garlic. Some key points to consider:
- Apixaban (a blood thinner) combined with fish oil supplements may increase bleeding risk as both reduce blood clotting 1.
- The combination of apixaban with losartan or furosemide could also enhance bleeding risk due to their effects on blood pressure and fluid balance 1.
- Metoprolol and losartan taken together may cause excessive blood pressure lowering, requiring careful monitoring 1.
- Bupropion combined with metoprolol might reduce metoprolol's effectiveness since bupropion can inhibit the enzyme that metabolizes metoprolol 1.
- Farxiga (dapagliflozin) and furosemide together could potentially cause excessive diuresis and electrolyte imbalances, as both increase urine output through different mechanisms 1.
- Additionally, rosuvastatin levels might be affected by apixaban due to shared metabolic pathways 1. These medications should be managed under medical supervision with appropriate monitoring for blood pressure, heart rate, bleeding signs, and electrolyte levels. Dosage adjustments may be necessary based on individual response and side effects. It is essential to consider the potential interactions between these medications and to monitor the patient closely to minimize the risk of adverse effects. The patient's medical history, current health status, and other medications should also be taken into account when managing these medications. Regular follow-up appointments with the healthcare provider are crucial to ensure the safe and effective use of these medications. By carefully monitoring the patient and adjusting the medications as needed, the risk of contraindications and adverse effects can be minimized, and the patient can receive the benefits of these medications while maintaining their overall health and well-being.
From the FDA Drug Label
Losartan is contraindicated: • In patients who are hypersensitive to any component of this product. • For coadministration with aliskiren in patients with diabetes.
CONTRAINDICATIONS Hypersensitivity to metoprolol and related derivatives, or to any of the excipients; hypersensitivity to other beta-blockers (cross sensitivity between beta-blockers can occur). Myocardial Infarction Metoprolol is contraindicated in patients with a heart rate < 45 beats/min; second- and third-degree heart block; significant first-degree heart block (P-R interval ≥ 0.24 sec); systolic blood pressure < 100 mmHg; or moderate-to-severe cardiac failure (see WARNINGS).
CONTRAINDICATIONS Furosemide tablets are contraindicated in patients with anuria and in patients with a history of hypersensitivity to furosemide.
The biggest contraindications between all these meds are:
- Hypersensitivity to any component of losartan, metoprolol, or furosemide
- Coadministration of losartan with aliskiren in patients with diabetes 2
- Cardiovascular conditions such as heart rate < 45 beats/min, second- and third-degree heart block, significant first-degree heart block, systolic blood pressure < 100 mmHg, or moderate-to-severe cardiac failure for metoprolol 3
- Anuria for furosemide 4
From the Research
Potential Contraindications and Interactions
The medications listed include furosemide, metoprolol succinate ER, losartan, Farxiga, buPROPion HCL XL, rosuvastatin, apixaban, tolterodine ER, Fish Oil, Vitamin C, B-Complex, Calcium 600+D Plus Minerals, and Garlic. Considering the potential interactions and contraindications among these medications:
- Furosemide and metoprolol succinate ER: No direct contraindications, but monitoring of electrolytes and blood pressure is recommended 5.
- Furosemide and losartan: No direct contraindications, but monitoring of electrolytes and blood pressure is recommended 5.
- Metoprolol succinate ER and losartan: No direct contraindications, but monitoring of blood pressure is recommended.
- Farxiga and metoprolol succinate ER: No direct contraindications, but monitoring of blood pressure and electrolytes is recommended.
- buPROPion HCL XL and metoprolol succinate ER: Potential interaction due to increased risk of seizures, but no direct contraindications 6.
- Rosuvastatin and metoprolol succinate ER: No direct contraindications.
- Apixaban and metoprolol succinate ER: No direct contraindications, but monitoring of international normalized ratio (INR) is recommended.
- Tolterodine ER and metoprolol succinate ER: Potential interaction due to increased risk of QT interval prolongation, but no direct contraindications 6.
- Fish Oil and metoprolol succinate ER: No direct contraindications.
- Vitamin C and metoprolol succinate ER: No direct contraindications.
- B-Complex and metoprolol succinate ER: No direct contraindications.
- Calcium 600+D Plus Minerals and metoprolol succinate ER: No direct contraindications.
- Garlic and metoprolol succinate ER: Potential interaction due to increased risk of bleeding, but no direct contraindications.
Polypharmacy Considerations
The patient is taking multiple medications, which increases the risk of adverse medical outcomes due to polypharmacy 7. It is essential to monitor the patient's active medication list and deprescribe any unnecessary medications to reduce pill burden, the risks of adverse drug events, and financial hardship.
Drug-Drug Interactions
Drug-drug interactions can occur when one drug affects the absorption, distribution, metabolism, or excretion of another drug 8, 6. The patient's pharmacist can be an excellent resource for determining appropriate dosages, potential for interaction, and overlapping drugs 9. Regular review of the patient's medication regimen can help identify or prevent problems and simplify the regimen.