Metoprolol; Propranolol/Cimetidine Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Moderate. These medicines may cause some risk when taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, your body may not process your heart medicine properly.

What might happen:

An increase in the beneficial and toxic effects of your heart medicine may occur.

What you should do about this interaction:

If you experience slow heart rate, weakness, fatigue, or dizziness, contact your doctor. Your doctor may adjust the dose of your heart medicine or change your cimetidine to another medicine.Your healthcare professionals (e.g. doctor or pharmacist) may already be aware of this drug interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

View Reference
  • 1.Feely J, Wilkinson GR, Wood AJ. Reduction of liver blood flow and propranolol metabolism by cimetidine. N Engl J Med 1981 Mar 19; 304(12):692-5.
  • 2.Donovan MA, Heagerty AM, Patel L, Castleden M, Pohl JE. Cimetidine and bioavailability of propranolol. Lancet 1981 Jan 17;1(8212):164.
  • 3.Heagerty AM, Donovan MA, Castleden CM, Pohl JF, Patel L, Hedges A. Influence of cimetidine on pharmacokinetics of propranolol. Br Med J (Clin Res Ed) 1981 Jun 13;282(6280):1917-9.
  • 4.Duchin KL, Stern MA, Willard DA, McKinstry DN. Kinetic interactions of nadolol and propranolol with cimetidine. Br J Clin Pharmacol 1984 Apr; 17(4):486-7.
  • 5.Duchin KL, Stern MA, Willard DA, McKinstry DN. Comparison of kinetic interactions of nadolol and propranolol with cimetidine. Am Heart J 1984 Oct;108(4 Pt 2):1084-6.
  • 6.Reimann IW, Klotz U, Siems B, Frolich J. Cimetidine increases steady state plasma levels of propranolol. Br J Clin Pharmacol 1981 Dec;12(6):785-90.
  • 7.Reimann IW, Klotz U, Frolich JC. Effects of cimetidine and ranitidine on steady-state propranolol kinetics and dynamics. Clin Pharmacol Ther 1982 Dec;32(6):749-57.
  • 8.Donn KH, Powell JR, Rogers JF, Eshelman FN. The influence of H2-receptor antagonists on steady-state concentrations of propranolol and 4-hydroxypropranolol. J Clin Pharmacol 1984 Nov-Dec;24(11-12):500-8.
  • 9.Kirch W, Spahn H, Kohler H, Ohnhaus EE, Mutschler E. Interaction of metoprolol, propranolol and atenolol with concurrent administration of cimetidine. Klin Wochenschr 1982 Nov 15;60(22):1401-7.
  • 10.Kirch W, Spahn H, Kohler H, Mutschler E. Accumulation and adverse effects of metoprolol and propranolol after concurrent administration of cimetidine. Arch Toxicol Suppl 1983;6:379-83.
  • 11.Mutschler E, Spahn H, Kirch W. The interaction between H2-receptor antagonists and beta-adrenoceptor blockers. Br J Clin Pharmacol 1984;17 Suppl 1:51S-57S.
  • 12.Spahn H, Kirch W, Mutschler E. The interaction of cimetidine with metoprolol, atenolol, propranolol, pindolol and penbutolol. Br J Clin Pharmacol 1983 Apr;15(4):500-1.
  • 13.Kirch W, Kohler H, Spahn H, Mutschler E. Interaction of cimetidine with metoprolol, propranolol, or atenolol. Lancet 1981 Sep 05;2(8245):531-2.
  • 14.Houtzagers JJ, Streurman O, Regardh CG. The effect of pretreatment with cimetidine on the bioavailability and disposition of atenolol and metoprolol. Br J Clin Pharmacol 1982 Jul;14(1):67-72.
  • 15.Kirch W, Ramsch K, Janisch HD, Ohnhaus EE. The influence of two histamine H2-receptor antagonists, cimetidine and ranitidine, on the plasma levels and clinical effect of nifedipine and metoprolol. Arch Toxicol Suppl 1984;7:256-9.
  • 16.Toon S, Davidson EM, Garstang FM, Batra H, Bowes RJ, Rowland M. The racemic metoprolol H2-antagonist interaction. Clin Pharmacol Ther 1988 Mar;43(3):283-9.
  • 17.Heagerty AM, Castleden CM, Patel L. Failure of ranitidine to interact with propranolol. Br Med J (Clin Res Ed) 1982 May 1;284(6325):1304.
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  • 19.Kelly JG, Salem SA, Kinney CD, Shanks RG, McDevitt DG. Effects of ranitidine on the disposition of metoprolol. Br J Clin Pharmacol 1985 Feb;19(2):219-24.
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