nebivolol/valsartan (Rx)

Dosage Forms & Strengths

nebivolol/valsartan

tablet

• 5mg/80mg

Hypertension

Indicated for hypertension, to lower blood pressure and reduce the risk of fatal and nonfatal cardiovascular events, primarily strokes and myocardial infarction

May be used as initial therapy (if not controlled on valsartan 80 mg or ≤10 mg nebivolol) or be substituted for its components in patients already receiving nebivolol 5 mg and valsartan 80 mg

1 tablet (ie, 5 mg/80 mg) PO qDay

Dosage Modifications

Hepatic impairment

• Mild (Child-Pugh A): No dosage adjustment required
• Moderate (Child-Pugh B): Not recommended as initial treatment because recommended starting dose for these patients is nebivolol 2.5 mg/day
• Severe (Child-Pugh C): Contraindicated

Renal impairment

• Mild or moderate (CrCl >60 mL/min): No dosage adjustment required
• Moderate and severe: Not studied

Safety and efficacy not established

Contraindicated (1)

• aliskiren

  valsartan decreases effects of aliskiren by Other (see comment). Contraindicated. Comment: Aliskiren use contraindicated with ARBs in patients with diabetes; avoid coadministration with ARBs if GFR. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of ARBS with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.

Serious - Use Alternative (44)

• acebutolol

  acebutolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  artemether/lumefantrine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• atenolol

  atenolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• baricitinib

  valsartan will increase the level or effect of baricitinib by decreasing elimination. Avoid or Use Alternate Drug. Coadministration of baricitinib with strong organic anion transporter 3 (OAT3) inhibitors is not recommended.

• benazepril

  valsartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• betaxolol

  betaxolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• bisoprolol

  bisoprolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• captopril

  valsartan, captopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• carvedilol

  carvedilol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• celiprolol

  celiprolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• clonidine

  clonidine, nebivolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• dacomitinib

  dacomitinib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• digoxin

  digoxin, nebivolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• diltiazem

  diltiazem, nebivolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• eluxadoline

  valsartan increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

• enalapril

  valsartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• esmolol

  esmolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• fexinidazole

  fexinidazole, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to induce bradycardia. .

• fluoxetine

  fluoxetine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• fosinopril

  valsartan, fosinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• givosiran

  givosiran will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• labetalol

  labetalol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• lisinopril

  valsartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• lithium

  valsartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

• lofexidine

  lofexidine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
  
  lofexidine, valsartan. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

• lumefantrine

  lumefantrine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• moexipril

  valsartan, moexipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• mavacamten

  nebivolol, mavacamten. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Expect additive negative inotropic effects of mavacamten and other drugs that reduce cardiac contractility.

• metoprolol

  metoprolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• nadolol

  nadolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• paroxetine

  paroxetine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• penbutolol

  nebivolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• perindopril

  valsartan, perindopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• pindolol

  nebivolol and pindolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• potassium phosphates, IV

  valsartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.

• propranolol

  nebivolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• quinapril

  valsartan, quinapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• quinidine

  quinidine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Monitor blood pressure. Reduced doses of nebivolol may be necessary.

• ramipril

  valsartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• rivastigmine

  nebivolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

• sotalol

  nebivolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• timolol

  nebivolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• trandolapril

  valsartan, trandolapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• verapamil

  verapamil, nebivolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

Monitor Closely (293)

• abiraterone

  abiraterone increases levels of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• acebutolol

  acebutolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and acebutolol both increase serum potassium. Use Caution/Monitor.
  
  acebutolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• aceclofenac

  valsartan and aceclofenac both increase serum potassium. Use Caution/Monitor.
  
  aceclofenac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and aceclofenac both increase serum potassium. Use Caution/Monitor.

• acemetacin

  nebivolol and acemetacin both increase serum potassium. Use Caution/Monitor.
  
  acemetacin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and acemetacin both increase serum potassium. Use Caution/Monitor.

• albiglutide

  valsartan increases effects of albiglutide by Other (see comment). Use Caution/Monitor. Comment: Angiotensin II receptor antagonists may enhance hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Monitor patients for changes in glycemic control.

• albuterol

  nebivolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.

• aldesleukin

  aldesleukin increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
  
  aldesleukin increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• alfuzosin

  alfuzosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• amifostine

  amifostine, valsartan. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

• aluminum hydroxide

  aluminum hydroxide decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• amifostine

  amifostine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

• amiloride

  nebivolol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.
  
  valsartan and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.

• amiodarone

  amiodarone will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Monitor cardiac function carefully and observe for signs of bradycardia or heart block when amiodarone and a beta adrenergic blocker are coadministered. Amiodarone should be used with caution in patients receiving a beta adrenergic blocker, particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
  
  amiodarone, nebivolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.

• apalutamide

  apalutamide will decrease the level or effect of valsartan by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces OATP1B1 and may decrease systemic exposure of drugs that are OATP1B1 substrates.

• amlodipine

  nebivolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• amobarbital

  amobarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• arformoterol

  nebivolol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor.

• asenapine

  asenapine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  asenapine and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• aspirin

  nebivolol and aspirin both increase serum potassium. Use Caution/Monitor.
  
  aspirin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, aspirin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and aspirin both increase serum potassium. Use Caution/Monitor.
  
  aspirin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• aspirin rectal

  aspirin rectal decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• aspirin/citric acid/sodium bicarbonate

  valsartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• atazanavir

  atazanavir increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension, bradycardia, AV block, and prolonged PR interval. Consider lowering beta blocker dose.

• atenolol

  valsartan and atenolol both increase serum potassium. Use Caution/Monitor.
  
  atenolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• atenolol

  atenolol and nebivolol both increase serum potassium. Use Caution/Monitor.

• atorvastatin

  atorvastatin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure
  
  valsartan increases toxicity of atorvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• avanafil

  avanafil increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
  
  avanafil increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• bendroflumethiazide

  valsartan increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• betaxolol

  betaxolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  betaxolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and betaxolol both increase serum potassium. Use Caution/Monitor.

• bismuth subsalicylate

  bismuth subsalicylate, nebivolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.

• bisoprolol

  valsartan and bisoprolol both increase serum potassium. Use Caution/Monitor.
  
  bisoprolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• bisoprolol

  bisoprolol and nebivolol both increase serum potassium. Use Caution/Monitor.

• bretylium

  nebivolol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.
  
  valsartan, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

• brimonidine

  brimonidine increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.

• bumetanide

  nebivolol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bumetanide

  valsartan increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bupropion

  bupropion will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• butabarbital

  butabarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• butalbital

  butalbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• calcium acetate

  calcium acetate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• calcium carbonate

  calcium carbonate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.
  
  calcium carbonate decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• calcium chloride

  calcium chloride decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• calcium citrate

  calcium citrate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• calcium gluconate

  calcium gluconate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• canagliflozin

  valsartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

• candesartan

  candesartan and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• carbamazepine

  carbamazepine will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• carbenoxolone

  nebivolol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbidopa

  carbidopa increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

• carvedilol

  valsartan and carvedilol both increase serum potassium. Use Caution/Monitor.
  
  carvedilol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• carvedilol

  carvedilol and nebivolol both increase serum potassium. Use Caution/Monitor.

• caspofungin

  caspofungin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• celecoxib

  nebivolol and celecoxib both increase serum potassium. Use Caution/Monitor.
  
  celecoxib decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  celecoxib decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and celecoxib both increase serum potassium. Use Caution/Monitor.
  
  valsartan, celecoxib. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  celecoxib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• celiprolol

  valsartan and celiprolol both increase serum potassium. Use Caution/Monitor.
  
  celiprolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  celiprolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• chloroquine

  chloroquine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• chlorothiazide

  valsartan increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorothiazide

  nebivolol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorthalidone

  nebivolol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• choline magnesium trisalicylate

  nebivolol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.
  
  choline magnesium trisalicylate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan, choline magnesium trisalicylate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  choline magnesium trisalicylate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.

• cimetidine

  cimetidine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• clarithromycin

  clarithromycin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• clevidipine

  nebivolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• clonidine

  nebivolol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.
  
  clonidine, nebivolol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive sympatholytic action may worsen sinus node dysfunction and atrioventricular (AV) block.

• cyclopenthiazide

  nebivolol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cyclosporine

  cyclosporine and valsartan both increase Other (see comment). Use Caution/Monitor. Cyclosporine and valsartan both increase the risk of hyperkalemia and nephrotoxicity.

• darifenacin

  darifenacin will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• dalteparin

  dalteparin increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

• dasiglucagon

  nebivolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

• desflurane

  desflurane, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• desvenlafaxine

  desvenlafaxine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

• diclofenac

  valsartan and diclofenac both increase serum potassium. Use Caution/Monitor.
  
  diclofenac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and diclofenac both increase serum potassium. Use Caution/Monitor.
  
  diclofenac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, diclofenac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• diflunisal

  diflunisal decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and diflunisal both increase serum potassium. Use Caution/Monitor.
  
  diflunisal decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, diflunisal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and diflunisal both increase serum potassium. Use Caution/Monitor.

• digoxin

  nebivolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  nebivolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  valsartan will increase the level or effect of digoxin by decreasing renal clearance. Use Caution/Monitor. Monitor digoxin levels closely when coadministered with drugs that may decrease glomerular filtration or tubular secretion.

• diltiazem

  nebivolol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• dobutamine

  valsartan increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• dobutamine

  nebivolol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor.

• dopexamine

  nebivolol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  valsartan increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxazosin

  doxazosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• drospirenone

  valsartan and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.

• dronedarone

  dronedarone will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• drospirenone

  nebivolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.

• duloxetine

  duloxetine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• eliglustat

  eliglustat increases levels of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

• eltrombopag

  eltrombopag will decrease the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  encorafenib will increase the level or effect of valsartan by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a OATP1B1 and OATP1B3 inhibitor) may increase the concentration and toxicities of OATP1B1 and OATP1B3 substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.

• enoxaparin

  enoxaparin increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

• ephedrine

  nebivolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.

• epinephrine

  nebivolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

• epinephrine racemic

  nebivolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor.

• eplerenone

  valsartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

• eprosartan

  eprosartan and valsartan both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  eprosartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• erythromycin base

  erythromycin base will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• esmolol

  esmolol and nebivolol both increase serum potassium. Use Caution/Monitor.

• erythromycin ethylsuccinate

  erythromycin ethylsuccinate will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• erythromycin lactobionate

  erythromycin lactobionate will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• erythromycin stearate

  erythromycin stearate will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• esmolol

  valsartan and esmolol both increase serum potassium. Use Caution/Monitor.
  
  esmolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• ethacrynic acid

  nebivolol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ether

  nebivolol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.

• etodolac

  valsartan and etodolac both increase serum potassium. Use Caution/Monitor.
  
  etodolac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan, etodolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• etodolac

  nebivolol and etodolac both increase serum potassium. Use Caution/Monitor.
  
  etodolac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• etomidate

  etomidate, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• exenatide injectable solution

  valsartan increases effects of exenatide injectable solution by Other (see comment). Use Caution/Monitor. Comment: Angiotensin II receptor antagonists may enhance hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Monitor patients for changes in glycemic control.

• exenatide injectable suspension

  valsartan increases effects of exenatide injectable suspension by Other (see comment). Use Caution/Monitor. Comment: Angiotensin II receptor antagonists may enhance hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Monitor patients for changes in glycemic control.

• fedratinib

  fedratinib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• felodipine

  nebivolol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• fenbufen

  nebivolol and fenbufen both increase serum potassium. Use Caution/Monitor.
  
  valsartan and fenbufen both increase serum potassium. Use Caution/Monitor.

• fenoprofen

  fenoprofen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  fenoprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and fenoprofen both increase serum potassium. Use Caution/Monitor.
  
  valsartan, fenoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and fenoprofen both increase serum potassium. Use Caution/Monitor.

• fingolimod

  nebivolol increases effects of fingolimod by pharmacodynamic synergism. Use Caution/Monitor. Both medications decrease heart rate. Monitor patients on concomitant therapy, particularly in the first 6 hours after fingolimod is initiated or after a treatment interruption of at least two weeks, for bradycardia and atrioventricular block. To identify underlying risk factors of bradycardia and AV block, obtain a new or recent ECG in patients using beta-blockers prior to starting fingolimod.

• flurbiprofen

  valsartan and flurbiprofen both increase serum potassium. Use Caution/Monitor.
  
  flurbiprofen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan, flurbiprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• flurbiprofen

  nebivolol and flurbiprofen both increase serum potassium. Use Caution/Monitor.
  
  flurbiprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• fluvastatin

  valsartan increases toxicity of fluvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• formoterol

  nebivolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.

• fostemsavir

  fostemsavir will increase the level or effect of valsartan by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.

• furosemide

  nebivolol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• gemfibrozil

  gemfibrozil will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• gentamicin

  nebivolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• gentamicin

  valsartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• glucagon

  glucagon decreases toxicity of nebivolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

• glucagon intranasal

  glucagon intranasal decreases toxicity of nebivolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

• glyburide

  glyburide will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• haloperidol

  haloperidol will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• heparin

  heparin increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

• hydralazine

  hydralazine increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

• hydrochlorothiazide

  nebivolol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibuprofen

  valsartan and ibuprofen both increase serum potassium. Use Caution/Monitor.
  
  valsartan, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and ibuprofen both increase serum potassium. Use Caution/Monitor.
  
  ibuprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  ibuprofen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• ibuprofen IV

  ibuprofen IV decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and ibuprofen IV both increase serum potassium. Use Caution/Monitor.
  
  ibuprofen IV decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and ibuprofen IV both increase serum potassium. Use Caution/Monitor.
  
  valsartan, ibuprofen IV. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• imatinib

  imatinib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• indapamide

  valsartan increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• indacaterol, inhaled

  indacaterol, inhaled, nebivolol. Other (see comment). Use Caution/Monitor. Comment: Beta-blockers and indacaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

• indapamide

  nebivolol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• indinavir

  indinavir will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• indomethacin

  valsartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and indomethacin both increase serum potassium. Use Caution/Monitor.
  
  indomethacin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  indomethacin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and indomethacin both increase serum potassium. Use Caution/Monitor.

• insulin aspart

  valsartan increases effects of insulin aspart by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin degludec

  nebivolol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

• insulin aspart protamine/insulin aspart

  valsartan increases effects of insulin aspart protamine/insulin aspart by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin degludec

  valsartan, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
  
  valsartan increases effects of insulin degludec by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin degludec/insulin aspart

  valsartan, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
  
  nebivolol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

• insulin detemir

  valsartan increases effects of insulin detemir by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin inhaled

  nebivolol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

• insulin glargine

  valsartan increases effects of insulin glargine by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin glulisine

  valsartan increases effects of insulin glulisine by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin inhaled

  valsartan, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
  
  valsartan increases effects of insulin inhaled by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin isophane human/insulin regular human

  valsartan increases effects of insulin isophane human/insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin lispro

  valsartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin lispro protamine/insulin lispro

  valsartan increases effects of insulin lispro protamine/insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin NPH

  valsartan increases effects of insulin NPH by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin regular human

  valsartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• iodixanol

  nebivolol increases toxicity of iodixanol by unspecified interaction mechanism. Use Caution/Monitor. Use of beta-blockers lowers the threshold for and increases the severity of contrast reactions, and reduces the responsiveness of treatment of hypersensitivity reactions with epinephrine. .

• irbesartan

  irbesartan and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• isoproterenol

  nebivolol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

• isradipine

  nebivolol, isradipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• ivabradine

  ivabradine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

• ketamine

  ketamine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• ketoconazole

  ketoconazole will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• ketoprofen

  ketoprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and ketoprofen both increase serum potassium. Use Caution/Monitor.
  
  valsartan, ketoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and ketoprofen both increase serum potassium. Use Caution/Monitor.
  
  ketoprofen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• ketorolac

  nebivolol and ketorolac both increase serum potassium. Use Caution/Monitor.
  
  valsartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  ketorolac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and ketorolac both increase serum potassium. Use Caution/Monitor.
  
  ketorolac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• ketorolac intranasal

  valsartan, ketorolac intranasal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  ketorolac intranasal decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.
  
  valsartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.
  
  ketorolac intranasal decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• labetalol

  labetalol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  labetalol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and labetalol both increase serum potassium. Use Caution/Monitor.

• lasmiditan

  nebivolol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.

• letermovir

  valsartan increases levels of letermovir by decreasing metabolism. Use Caution/Monitor. Coadminstration of letermovir, an OATP1B1/3 substrate, with OATP1B1/3 inhibitors may increase letermovir plasma concentrations.
  
  letermovir increases levels of valsartan by Other (see comment). Use Caution/Monitor. Comment: Letermovir, an OATP1B1/3 inhibitor may increase plasma concentrations of coadministered OATP1B1/3 substrates.

• levalbuterol

  nebivolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

• levodopa

  levodopa increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
  
  levodopa increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

• levoketoconazole

  levoketoconazole will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• lorcaserin

  lorcaserin will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• liraglutide

  valsartan increases effects of liraglutide by Other (see comment). Use Caution/Monitor. Comment: Angiotensin II receptor antagonists may enhance hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Monitor patients for changes in glycemic control.

• lornoxicam

  nebivolol and lornoxicam both increase serum potassium. Use Caution/Monitor.
  
  lornoxicam decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and lornoxicam both increase serum potassium. Use Caution/Monitor.

• losartan

  losartan and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• lovastatin

  lovastatin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• lurasidone

  lurasidone increases effects of nebivolol by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
  
  lurasidone increases effects of valsartan by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

• maitake

  maitake increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.

• maraviroc

  maraviroc will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• maraviroc

  maraviroc, valsartan. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.

• marijuana

  marijuana will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• meclofenamate

  meclofenamate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and meclofenamate both increase serum potassium. Use Caution/Monitor.
  
  meclofenamate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan, meclofenamate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and meclofenamate both increase serum potassium. Use Caution/Monitor.

• mefenamic acid

  valsartan and mefenamic acid both increase serum potassium. Use Caution/Monitor.
  
  valsartan, mefenamic acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and mefenamic acid both increase serum potassium. Use Caution/Monitor.
  
  mefenamic acid decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  mefenamic acid decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• mefloquine

  mefloquine increases levels of nebivolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

• meloxicam

  valsartan and meloxicam both increase serum potassium. Use Caution/Monitor.
  
  meloxicam decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• meloxicam

  nebivolol and meloxicam both increase serum potassium. Use Caution/Monitor.
  
  meloxicam decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• metaproterenol

  nebivolol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor.

• methyclothiazide

  valsartan increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
  
  nebivolol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• methylphenidate

  methylphenidate will decrease the level or effect of valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

• metolazone

  nebivolol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylphenidate transdermal

  methylphenidate transdermal decreases effects of valsartan by anti-hypertensive channel blocking. Use Caution/Monitor.

• metolazone

  valsartan increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metoprolol

  metoprolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  metoprolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and metoprolol both increase serum potassium. Use Caution/Monitor.

• metyrapone

  metyrapone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• mirabegron

  mirabegron will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mifepristone

  mifepristone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• moxisylyte

  moxisylyte and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• nabumetone

  nabumetone decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and nabumetone both increase serum potassium. Use Caution/Monitor.
  
  nabumetone decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and nabumetone both increase serum potassium. Use Caution/Monitor.
  
  valsartan, nabumetone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• nadolol

  nadolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  nadolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and nadolol both increase serum potassium. Use Caution/Monitor.

• naproxen

  nebivolol and naproxen both increase serum potassium. Use Caution/Monitor.
  
  naproxen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  naproxen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and naproxen both increase serum potassium. Use Caution/Monitor.
  
  valsartan, naproxen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• nebivolol

  valsartan and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• nicardipine

  nebivolol, nicardipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• nelfinavir

  nelfinavir will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• nifedipine

  nebivolol, nifedipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• nilotinib

  nilotinib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• nimodipine

  nebivolol, nimodipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• nisoldipine

  nebivolol, nisoldipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• nitroglycerin rectal

  nitroglycerin rectal, valsartan. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .
  
  nitroglycerin rectal, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.

• norepinephrine

  nebivolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. May inhibit organic anion transporter polypeptides; decrease dose of angiotensin receptor blockers and monitor patients for signs and symptoms of hypotension and/or worsening renal function; if such events occur, consider further dose reduction of angiotensin receptor blocker or switching to alternative to angiotensin receptor blocker

• olmesartan

  olmesartan and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• oxaprozin

  nebivolol and oxaprozin both increase serum potassium. Use Caution/Monitor.
  
  oxaprozin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  oxaprozin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and oxaprozin both increase serum potassium. Use Caution/Monitor.
  
  valsartan, oxaprozin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• oxymetazoline topical

  oxymetazoline topical increases and nebivolol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• paclitaxel

  paclitaxel will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• paclitaxel protein bound

  paclitaxel protein bound will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• panobinostat

  panobinostat will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Panobinostat can increase the levels and effects of sensitive CYP2D6 substrates or those with a narrow therapeutic index CYP2D6.

• parecoxib

  parecoxib decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and parecoxib both increase serum potassium. Use Caution/Monitor.
  
  parecoxib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  valsartan and parecoxib both increase serum potassium. Use Caution/Monitor.

• pazopanib

  pazopanib will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• penbutolol

  nebivolol and penbutolol both increase serum potassium. Use Caution/Monitor.

• penbutolol

  valsartan and penbutolol both increase serum potassium. Use Caution/Monitor.
  
  penbutolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• pentobarbital

  pentobarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• perphenazine

  perphenazine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• phenobarbital

  phenobarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• phenoxybenzamine

  phenoxybenzamine and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• phentolamine

  phentolamine and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• pindolol

  valsartan and pindolol both increase serum potassium. Use Caution/Monitor.
  
  pindolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  nebivolol and pindolol both increase serum potassium. Use Caution/Monitor.

• pioglitazone

  pioglitazone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• pirbuterol

  nebivolol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor.

• piroxicam

  piroxicam decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and piroxicam both increase serum potassium. Use Caution/Monitor.
  
  valsartan, piroxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and piroxicam both increase serum potassium. Use Caution/Monitor.
  
  piroxicam decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• pitavastatin

  valsartan increases toxicity of pitavastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• ponesimod

  ponesimod and nebivolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• potassium acid phosphate

  valsartan and potassium acid phosphate both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium chloride

  nebivolol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.
  
  valsartan and potassium chloride both increase serum potassium. Use Caution/Monitor.

• potassium citrate

  nebivolol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.
  
  valsartan and potassium citrate both increase serum potassium. Use Caution/Monitor.

• potassium citrate/citric acid

  valsartan and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

• prazosin

  prazosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• potassium iodide

  potassium iodide and valsartan both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ARBs; the effect may be the result of aldosterone suppression in patients receiving ARBs.

• pravastatin

  pravastatin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure
  
  valsartan increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• primidone

  primidone decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• propafenone

  propafenone will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced doses of nebivolol may be necessary.

• propofol

  propofol, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• propranolol

  nebivolol and propranolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and propranolol both increase serum potassium. Use Caution/Monitor.
  
  propranolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• quinacrine

  quinacrine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• repaglinide

  repaglinide will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• ranolazine

  ranolazine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• rifampin

  rifampin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• ritonavir

  ritonavir will increase the level or effect of valsartan by Mechanism: decreasing hepatic clearance. Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic efflux transporter MRP2; coadministration of inhibitors of the efflux transporter may increase the systemic exposure to valsartan
  
  ritonavir will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  ritonavir will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• rolapitant

  rolapitant will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• rosiglitazone

  rosiglitazone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• sacubitril/valsartan

  sacubitril/valsartan and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• salicylates (non-asa)

  valsartan and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.
  
  salicylates (non-asa) decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

• salmeterol

  nebivolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.

• salsalate

  valsartan and salsalate both increase serum potassium. Use Caution/Monitor.
  
  salsalate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan, salsalate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• salsalate

  nebivolol and salsalate both increase serum potassium. Use Caution/Monitor.
  
  salsalate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• saquinavir

  saquinavir, nebivolol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of PR prolongation and cardiac arrhythmias.
  
  saquinavir will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• secobarbital

  secobarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• simvastatin

  simvastatin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• sertraline

  sertraline will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• sevoflurane

  sevoflurane, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• sildenafil

  nebivolol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.

• silodosin

  silodosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• siponimod

  siponimod, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.

• sodium bicarbonate

  sodium bicarbonate decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• sodium citrate/citric acid

  sodium citrate/citric acid decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sofosbuvir/velpatasvir

  sofosbuvir/velpatasvir increases levels of valsartan by Other (see comment). Use Caution/Monitor. Comment: Velpatasvir inhibits OATP1B1, OATP1B3, and OATP2B1 transporters. .

• sotalol

  nebivolol and sotalol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and sotalol both increase serum potassium. Use Caution/Monitor.
  
  sotalol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• spironolactone

  valsartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.
  
  nebivolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

• succinylcholine

  nebivolol and succinylcholine both increase serum potassium. Use Caution/Monitor.

• sulfasalazine

  valsartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.
  
  sulfasalazine decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• sulfasalazine

  nebivolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
  
  sulfasalazine decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• sulindac

  nebivolol and sulindac both increase serum potassium. Use Caution/Monitor.
  
  sulindac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, sulindac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and sulindac both increase serum potassium. Use Caution/Monitor.
  
  sulindac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• synthetic human angiotensin II

  valsartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.

• tadalafil

  tadalafil increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• tadalafil

  tadalafil increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• telmisartan

  telmisartan and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• terazosin

  terazosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• terbinafine

  terbinafine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  nebivolol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor.
  
  valsartan increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• theophylline

  nebivolol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.

• timolol

  valsartan and timolol both increase serum potassium. Use Caution/Monitor.
  
  timolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• thioridazine

  thioridazine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• timolol

  nebivolol and timolol both increase serum potassium. Use Caution/Monitor.

• tipranavir

  tipranavir will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tizanidine

  tizanidine increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• tolfenamic acid

  valsartan and tolfenamic acid both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.
  
  tolfenamic acid decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• tolmetin

  valsartan and tolmetin both increase serum potassium. Use Caution/Monitor.
  
  valsartan, tolmetin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and tolmetin both increase serum potassium. Use Caution/Monitor.
  
  tolmetin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  tolmetin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• tolvaptan

  valsartan and tolvaptan both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and tolvaptan both increase serum potassium. Use Caution/Monitor.

• torsemide

  valsartan increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• treprostinil

  treprostinil increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.

• triamterene

  nebivolol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.

• triamterene

  valsartan and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.

• trimethoprim

  valsartan and trimethoprim both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.

• valsartan

  valsartan and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.

• venlafaxine

  venlafaxine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• verapamil

  nebivolol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• voclosporin

  voclosporin and valsartan both increase serum potassium. Use Caution/Monitor.
  
  voclosporin, valsartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.

• xipamide

  xipamide increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.
  
  xipamide increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor.

Minor (36)

• adenosine

  nebivolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

• agrimony

  agrimony increases effects of valsartan by pharmacodynamic synergism. Minor/Significance Unknown.
  
  agrimony increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• brimonidine

  brimonidine increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• cornsilk

  cornsilk increases effects of valsartan by pharmacodynamic synergism. Minor/Significance Unknown.

• cevimeline

  cevimeline increases effects of nebivolol by unspecified interaction mechanism. Minor/Significance Unknown.

• ciprofloxacin

  ciprofloxacin increases levels of nebivolol by decreasing metabolism. Minor/Significance Unknown.

• cocaine topical

  nebivolol increases effects of cocaine topical by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.

• cornsilk

  cornsilk increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• dihydroergotamine

  dihydroergotamine, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

• dihydroergotamine intranasal

  dihydroergotamine intranasal, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

• dipyridamole

  dipyridamole, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• entecavir

  valsartan, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

• escitalopram

  escitalopram increases levels of nebivolol by decreasing metabolism. Minor/Significance Unknown.

• fenoldopam

  fenoldopam increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

• food

  food decreases levels of valsartan by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• forskolin

  forskolin increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• guanfacine

  nebivolol, guanfacine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

• imaging agents (gadolinium)

  nebivolol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.

• levobetaxolol

  levobetaxolol increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• maitake

  maitake increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• melatonin

  melatonin decreases toxicity of nebivolol by pharmacodynamic antagonism. Minor/Significance Unknown. Melatonin may correct beta blocker induced sleep disturbances.

• metipranolol ophthalmic

  metipranolol ophthalmic increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• neostigmine

  nebivolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

• nirmatrelvir/ritonavir

  nirmatrelvir/ritonavir will increase the level or effect of valsartan by Other (see comment). Minor/Significance Unknown. Valsartan is a substrate of the hepatic uptake transporters OATP1B1 and MRP2. Ritonavir inhibits these transporters. No dosage modification needed since induction reaches maximal effect after several days and the short duration of nirmatrelvir/ritonavir treatment.

• noni juice

  nebivolol and noni juice both increase serum potassium. Minor/Significance Unknown.
  
  valsartan and noni juice both increase serum potassium. Minor/Significance Unknown.

• octacosanol

  octacosanol increases effects of valsartan by pharmacodynamic synergism. Minor/Significance Unknown.
  
  octacosanol increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of valsartan by decreasing elimination. Minor/Significance Unknown. May inhibit hepatic efflux transporter MRP2; decrease dose of angiotensin receptor blockers and monitor patients for signs and symptoms of hypotension and/or worsening renal function; if such events occur, consider further dose reduction of angiotensin receptor blocker or switching to alternative to angiotensin receptor blocker

• physostigmine

  nebivolol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

• pilocarpine

  pilocarpine increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• reishi

  reishi increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.
  
  reishi increases effects of valsartan by pharmacodynamic synergism. Minor/Significance Unknown.

• shepherd's purse

  shepherd's purse, nebivolol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.
  
  shepherd's purse, valsartan. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

• simvastatin

  valsartan increases toxicity of simvastatin by Other (see comment). Minor/Significance Unknown. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• tizanidine

  tizanidine increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

• treprostinil

  treprostinil increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• voclosporin

  voclosporin will increase the level or effect of valsartan by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

• yohimbe

  nebivolol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.

• abiraterone

  Monitor Closely (1)abiraterone increases levels of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.

• acebutolol

  Monitor Closely (3)acebutolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and acebutolol both increase serum potassium. Use Caution/Monitor.
  
  acebutolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.Serious - Use Alternative (1)acebutolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• aceclofenac

  Monitor Closely (3)valsartan and aceclofenac both increase serum potassium. Use Caution/Monitor.
  
  aceclofenac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and aceclofenac both increase serum potassium. Use Caution/Monitor.

• acemetacin

  Monitor Closely (3)nebivolol and acemetacin both increase serum potassium. Use Caution/Monitor.
  
  acemetacin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and acemetacin both increase serum potassium. Use Caution/Monitor.

• adenosine

  Minor (1)nebivolol, adenosine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Bradycardia.

• agrimony

  Minor (2)agrimony increases effects of valsartan by pharmacodynamic synergism. Minor/Significance Unknown.
  
  agrimony increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• albiglutide

  Monitor Closely (1)valsartan increases effects of albiglutide by Other (see comment). Use Caution/Monitor. Comment: Angiotensin II receptor antagonists may enhance hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Monitor patients for changes in glycemic control.

• albuterol

  Monitor Closely (2)nebivolol decreases effects of albuterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and albuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• aldesleukin

  Monitor Closely (2)aldesleukin increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
  
  aldesleukin increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• alfuzosin

  Monitor Closely (1)alfuzosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• aliskiren

  Contraindicated (1)valsartan decreases effects of aliskiren by Other (see comment). Contraindicated. Comment: Aliskiren use contraindicated with ARBs in patients with diabetes; avoid coadministration with ARBs if GFR. In patients who are elderly, volume-depleted (including those on diuretic therapy), or with compromised renal function, coadministration of ARBS with drugs that affect RAAS may increase the risk of renal impairment (including acute renal failure) and cause loss of antihypertensive effect. Monitor renal function periodically.

• aluminum hydroxide

  Monitor Closely (1)aluminum hydroxide decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• amifostine

  Monitor Closely (2)amifostine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.
  
  amifostine, valsartan. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration with blood pressure lowering agents may increase the risk and severity of hypotension associated with amifostine. When amifostine is used at chemotherapeutic doses, withhold blood pressure lowering medications for 24 hr prior to amifostine; if blood pressure lowering medication cannot be withheld, do not administer amifostine.

• amiloride

  Monitor Closely (2)nebivolol and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.
  
  valsartan and amiloride both increase serum potassium. Modify Therapy/Monitor Closely.

• amiodarone

  Monitor Closely (2)amiodarone will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Monitor cardiac function carefully and observe for signs of bradycardia or heart block when amiodarone and a beta adrenergic blocker are coadministered. Amiodarone should be used with caution in patients receiving a beta adrenergic blocker, particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
  
  amiodarone, nebivolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of cardiotoxicity with bradycardia.

• amlodipine

  Monitor Closely (1)nebivolol, amlodipine. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• amobarbital

  Monitor Closely (1)amobarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of amobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• apalutamide

  Monitor Closely (1)apalutamide will decrease the level or effect of valsartan by increasing elimination. Use Caution/Monitor. Apalutamide weakly induces OATP1B1 and may decrease systemic exposure of drugs that are OATP1B1 substrates.

• arformoterol

  Monitor Closely (2)nebivolol decreases effects of arformoterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and arformoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• artemether/lumefantrine

  Serious - Use Alternative (1)artemether/lumefantrine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• asenapine

  Monitor Closely (2)asenapine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  asenapine and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• aspirin

  Monitor Closely (5)aspirin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and aspirin both increase serum potassium. Use Caution/Monitor.
  
  valsartan, aspirin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and aspirin both increase serum potassium. Use Caution/Monitor.
  
  aspirin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• aspirin rectal

  Monitor Closely (3)aspirin rectal decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and aspirin rectal both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and aspirin rectal both increase serum potassium. Use Caution/Monitor.

• aspirin/citric acid/sodium bicarbonate

  Monitor Closely (5)valsartan and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and aspirin/citric acid/sodium bicarbonate both increase serum potassium. Use Caution/Monitor.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  aspirin/citric acid/sodium bicarbonate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, aspirin/citric acid/sodium bicarbonate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• atazanavir

  Monitor Closely (1)atazanavir increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of hypotension, bradycardia, AV block, and prolonged PR interval. Consider lowering beta blocker dose.

• atenolol

  Monitor Closely (3)atenolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  atenolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and atenolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)atenolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• atorvastatin

  Monitor Closely (2)atorvastatin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure
  
  valsartan increases toxicity of atorvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• avanafil

  Monitor Closely (2)avanafil increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
  
  avanafil increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• baricitinib

  Serious - Use Alternative (1)valsartan will increase the level or effect of baricitinib by decreasing elimination. Avoid or Use Alternate Drug. Coadministration of baricitinib with strong organic anion transporter 3 (OAT3) inhibitors is not recommended.

• benazepril

  Serious - Use Alternative (1)valsartan, benazepril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• bendroflumethiazide

  Monitor Closely (2)valsartan increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol increases and bendroflumethiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• betaxolol

  Monitor Closely (3)betaxolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  betaxolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and betaxolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)betaxolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• bismuth subsalicylate

  Monitor Closely (1)bismuth subsalicylate, nebivolol. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Blockage of renal prostaglandin synthesis; may cause severe hypertension.

• bisoprolol

  Monitor Closely (3)bisoprolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  valsartan and bisoprolol both increase serum potassium. Use Caution/Monitor.
  
  bisoprolol and nebivolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)bisoprolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• bretylium

  Monitor Closely (2)nebivolol, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.
  
  valsartan, bretylium. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Each drug may cause hypotension.

• brimonidine

  Monitor Closely (1)brimonidine increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.Minor (1)brimonidine increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• bumetanide

  Monitor Closely (2)nebivolol increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and bumetanide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• bupropion

  Monitor Closely (1)bupropion will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• butabarbital

  Monitor Closely (1)butabarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butabarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• butalbital

  Monitor Closely (1)butalbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of butalbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• calcium acetate

  Monitor Closely (1)calcium acetate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• calcium carbonate

  Monitor Closely (2)calcium carbonate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.
  
  calcium carbonate decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• calcium chloride

  Monitor Closely (1)calcium chloride decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• calcium citrate

  Monitor Closely (1)calcium citrate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• calcium gluconate

  Monitor Closely (1)calcium gluconate decreases effects of nebivolol by unspecified interaction mechanism. Use Caution/Monitor.

• canagliflozin

  Monitor Closely (1)valsartan and canagliflozin both increase serum potassium. Use Caution/Monitor.

• candesartan

  Monitor Closely (2)nebivolol, candesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  candesartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• captopril

  Serious - Use Alternative (1)valsartan, captopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• carbamazepine

  Monitor Closely (1)carbamazepine will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• carbenoxolone

  Monitor Closely (2)nebivolol increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and carbenoxolone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbidopa

  Monitor Closely (1)carbidopa increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Therapy with carbidopa, given with or without levodopa or carbidopa-levodopa combination products, is started, dosage adjustment of the antihypertensive drug may be required.

• carvedilol

  Monitor Closely (3)carvedilol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  carvedilol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  valsartan and carvedilol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)carvedilol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• caspofungin

  Monitor Closely (1)caspofungin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• celecoxib

  Monitor Closely (6)celecoxib decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and celecoxib both increase serum potassium. Use Caution/Monitor.
  
  valsartan, celecoxib. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and celecoxib both increase serum potassium. Use Caution/Monitor.
  
  celecoxib decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  celecoxib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• celiprolol

  Monitor Closely (3)valsartan and celiprolol both increase serum potassium. Use Caution/Monitor.
  
  celiprolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  celiprolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.Serious - Use Alternative (1)celiprolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• cevimeline

  Minor (1)cevimeline increases effects of nebivolol by unspecified interaction mechanism. Minor/Significance Unknown.

• chloroquine

  Monitor Closely (1)chloroquine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• chlorothiazide

  Monitor Closely (2)valsartan increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol increases and chlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• chlorthalidone

  Monitor Closely (2)nebivolol increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and chlorthalidone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• choline magnesium trisalicylate

  Monitor Closely (5)nebivolol and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.
  
  choline magnesium trisalicylate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan, choline magnesium trisalicylate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  choline magnesium trisalicylate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and choline magnesium trisalicylate both increase serum potassium. Use Caution/Monitor.

• cimetidine

  Monitor Closely (1)cimetidine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• ciprofloxacin

  Minor (1)ciprofloxacin increases levels of nebivolol by decreasing metabolism. Minor/Significance Unknown.

• clarithromycin

  Monitor Closely (1)clarithromycin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• clevidipine

  Monitor Closely (1)nebivolol, clevidipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• clonidine

  Monitor Closely (2)clonidine, nebivolol. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive sympatholytic action may worsen sinus node dysfunction and atrioventricular (AV) block.
  
  nebivolol, clonidine. Mechanism: pharmacodynamic synergism. Modify Therapy/Monitor Closely. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.Serious - Use Alternative (1)clonidine, nebivolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• cocaine topical

  Minor (1)nebivolol increases effects of cocaine topical by pharmacodynamic synergism. Minor/Significance Unknown. Risk of angina.

• cornsilk

  Minor (2)cornsilk increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.
  
  cornsilk increases effects of valsartan by pharmacodynamic synergism. Minor/Significance Unknown.

• cyclopenthiazide

  Monitor Closely (2)nebivolol increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and cyclopenthiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• cyclosporine

  Monitor Closely (1)cyclosporine and valsartan both increase Other (see comment). Use Caution/Monitor. Cyclosporine and valsartan both increase the risk of hyperkalemia and nephrotoxicity.

• dacomitinib

  Serious - Use Alternative (1)dacomitinib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.

• dalteparin

  Monitor Closely (1)dalteparin increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

• darifenacin

  Monitor Closely (1)darifenacin will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• dasiglucagon

  Monitor Closely (1)nebivolol decreases effects of dasiglucagon by unknown mechanism. Use Caution/Monitor. Dasiglucagon may stimulate catecholamine release; whereas beta blockers may inhibit catecholamines released in response to dasiglucagon. Coadministration may also transiently increase pulse and BP.

• desflurane

  Monitor Closely (1)desflurane, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• desvenlafaxine

  Monitor Closely (1)desvenlafaxine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg

• diclofenac

  Monitor Closely (5)valsartan and diclofenac both increase serum potassium. Use Caution/Monitor.
  
  diclofenac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  diclofenac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and diclofenac both increase serum potassium. Use Caution/Monitor.
  
  valsartan, diclofenac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• diflunisal

  Monitor Closely (5)diflunisal decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and diflunisal both increase serum potassium. Use Caution/Monitor.
  
  diflunisal decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, diflunisal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and diflunisal both increase serum potassium. Use Caution/Monitor.

• digoxin

  Monitor Closely (3)nebivolol and digoxin both increase serum potassium. Use Caution/Monitor.
  
  nebivolol increases effects of digoxin by pharmacodynamic synergism. Use Caution/Monitor. Enhanced bradycardia.
  
  valsartan will increase the level or effect of digoxin by decreasing renal clearance. Use Caution/Monitor. Monitor digoxin levels closely when coadministered with drugs that may decrease glomerular filtration or tubular secretion.Serious - Use Alternative (1)digoxin, nebivolol. Either decreases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• dihydroergotamine

  Minor (1)dihydroergotamine, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

• dihydroergotamine intranasal

  Minor (1)dihydroergotamine intranasal, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Additive vasospasm.

• diltiazem

  Monitor Closely (1)nebivolol and diltiazem both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)diltiazem, nebivolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• diphenhydramine

  Monitor Closely (1)diphenhydramine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• dipyridamole

  Minor (1)dipyridamole, nebivolol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of bradycardia.

• dobutamine

  Monitor Closely (3)nebivolol increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and dobutamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of dobutamine by pharmacodynamic antagonism. Use Caution/Monitor.

• dopexamine

  Monitor Closely (3)nebivolol increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of dopexamine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  valsartan increases and dopexamine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxazosin

  Monitor Closely (1)doxazosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• dronedarone

  Monitor Closely (1)dronedarone will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• drospirenone

  Monitor Closely (2)valsartan and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.
  
  nebivolol and drospirenone both increase serum potassium. Modify Therapy/Monitor Closely.

• duloxetine

  Monitor Closely (1)duloxetine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• eliglustat

  Monitor Closely (1)eliglustat increases levels of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.

• eltrombopag

  Monitor Closely (1)eltrombopag will decrease the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• eluxadoline

  Serious - Use Alternative (1)valsartan increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP2D6 inhibitor; caution with CYP2D6 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• enalapril

  Serious - Use Alternative (1)valsartan, enalapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• encorafenib

  Monitor Closely (1)encorafenib will increase the level or effect of valsartan by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a OATP1B1 and OATP1B3 inhibitor) may increase the concentration and toxicities of OATP1B1 and OATP1B3 substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.

• enoxaparin

  Monitor Closely (1)enoxaparin increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

• entecavir

  Minor (1)valsartan, entecavir. Either increases effects of the other by decreasing renal clearance. Minor/Significance Unknown. Coadministration with drugs that reduce renal function or compete for active tubular secretion may increase serum concentrations of either entecavir or the coadministered drug.

• ephedrine

  Monitor Closely (2)nebivolol decreases effects of ephedrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and ephedrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  Monitor Closely (2)nebivolol decreases effects of epinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and epinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  Monitor Closely (2)nebivolol decreases effects of epinephrine racemic by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and epinephrine racemic decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• eplerenone

  Monitor Closely (1)valsartan, eplerenone. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of hyperkalemia.

• eprosartan

  Monitor Closely (3)eprosartan and valsartan both increase serum potassium. Use Caution/Monitor.
  
  nebivolol, eprosartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  eprosartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• erythromycin base

  Monitor Closely (1)erythromycin base will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• erythromycin ethylsuccinate

  Monitor Closely (1)erythromycin ethylsuccinate will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• erythromycin lactobionate

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• erythromycin stearate

  Monitor Closely (1)erythromycin stearate will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• escitalopram

  Minor (1)escitalopram increases levels of nebivolol by decreasing metabolism. Minor/Significance Unknown.

• esmolol

  Monitor Closely (3)esmolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  esmolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  valsartan and esmolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)esmolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• ethacrynic acid

  Monitor Closely (2)nebivolol increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and ethacrynic acid decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ether

  Monitor Closely (1)nebivolol, ether. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both beta blockers and ether depress the myocardium; consider lowering beta blocker dose if ether used for anesthesia.

• etodolac

  Monitor Closely (5)etodolac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and etodolac both increase serum potassium. Use Caution/Monitor.
  
  etodolac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, etodolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and etodolac both increase serum potassium. Use Caution/Monitor.

• etomidate

  Monitor Closely (1)etomidate, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• exenatide injectable solution

  Monitor Closely (1)valsartan increases effects of exenatide injectable solution by Other (see comment). Use Caution/Monitor. Comment: Angiotensin II receptor antagonists may enhance hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Monitor patients for changes in glycemic control.

• exenatide injectable suspension

  Monitor Closely (1)valsartan increases effects of exenatide injectable suspension by Other (see comment). Use Caution/Monitor. Comment: Angiotensin II receptor antagonists may enhance hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Monitor patients for changes in glycemic control.

• fedratinib

  Monitor Closely (1)fedratinib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.

• felodipine

  Monitor Closely (1)nebivolol and felodipine both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• fenbufen

  Monitor Closely (2)nebivolol and fenbufen both increase serum potassium. Use Caution/Monitor.
  
  valsartan and fenbufen both increase serum potassium. Use Caution/Monitor.

• fenoldopam

  Minor (1)fenoldopam increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown. Additive hypotensive effects.

• fenoprofen

  Monitor Closely (5)fenoprofen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  fenoprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and fenoprofen both increase serum potassium. Use Caution/Monitor.
  
  valsartan, fenoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and fenoprofen both increase serum potassium. Use Caution/Monitor.

• fexinidazole

  Serious - Use Alternative (1)fexinidazole, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to induce bradycardia. .

• fingolimod

  Monitor Closely (1)nebivolol increases effects of fingolimod by pharmacodynamic synergism. Use Caution/Monitor. Both medications decrease heart rate. Monitor patients on concomitant therapy, particularly in the first 6 hours after fingolimod is initiated or after a treatment interruption of at least two weeks, for bradycardia and atrioventricular block. To identify underlying risk factors of bradycardia and AV block, obtain a new or recent ECG in patients using beta-blockers prior to starting fingolimod.

• fluoxetine

  Serious - Use Alternative (1)fluoxetine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• flurbiprofen

  Monitor Closely (5)flurbiprofen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and flurbiprofen both increase serum potassium. Use Caution/Monitor.
  
  valsartan, flurbiprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and flurbiprofen both increase serum potassium. Use Caution/Monitor.
  
  flurbiprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• fluvastatin

  Monitor Closely (1)valsartan increases toxicity of fluvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• food

  Minor (1)food decreases levels of valsartan by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• formoterol

  Monitor Closely (2)nebivolol decreases effects of formoterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and formoterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• forskolin

  Minor (1)forskolin increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• fosinopril

  Serious - Use Alternative (1)valsartan, fosinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• fostemsavir

  Monitor Closely (1)fostemsavir will increase the level or effect of valsartan by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.

• furosemide

  Monitor Closely (2)nebivolol increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and furosemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• gemfibrozil

  Monitor Closely (1)gemfibrozil will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• gentamicin

  Monitor Closely (2)nebivolol increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and gentamicin decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• givosiran

  Serious - Use Alternative (1)givosiran will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.

• glucagon

  Monitor Closely (1)glucagon decreases toxicity of nebivolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

• glucagon intranasal

  Monitor Closely (1)glucagon intranasal decreases toxicity of nebivolol by sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Use Caution/Monitor. Coadministration of glucagon with beta-blockers may have transiently increased pulse and blood pressure.

• glyburide

  Monitor Closely (1)glyburide will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• guanfacine

  Minor (1)nebivolol, guanfacine. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Selective beta blocker administration during withdrawal from centrally acting alpha agonists may result in rebound hypertension.

• haloperidol

  Monitor Closely (1)haloperidol will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• heparin

  Monitor Closely (1)heparin increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Low molecular weight heparins may suppress adrenal aldosterone secretion, which can potentially cause hyperkalemia.

• hydralazine

  Monitor Closely (1)hydralazine increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Additive hypotensive effects.

• hydrochlorothiazide

  Monitor Closely (2)nebivolol increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  valsartan increases and hydrochlorothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ibuprofen

  Monitor Closely (5)valsartan and ibuprofen both increase serum potassium. Use Caution/Monitor.
  
  valsartan, ibuprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  ibuprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and ibuprofen both increase serum potassium. Use Caution/Monitor.
  
  ibuprofen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• ibuprofen IV

  Monitor Closely (5)ibuprofen IV decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and ibuprofen IV both increase serum potassium. Use Caution/Monitor.
  
  ibuprofen IV decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and ibuprofen IV both increase serum potassium. Use Caution/Monitor.
  
  valsartan, ibuprofen IV. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• imaging agents (gadolinium)

  Minor (1)nebivolol, imaging agents (gadolinium). Mechanism: unknown. Minor/Significance Unknown. Increased risk of anaphylaxis from contrast media.

• imatinib

  Monitor Closely (1)imatinib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• indacaterol, inhaled

  Monitor Closely (1)indacaterol, inhaled, nebivolol. Other (see comment). Use Caution/Monitor. Comment: Beta-blockers and indacaterol may interfere with the effect of each other when administered concurrently. Beta-blockers may produce severe bronchospasm in COPD patients. Therefore, patients with COPD should not normally be treated with beta-blockers. However, under certain circumstances, e.g. as prophylaxis after myocardial infarction, there may be no acceptable alternatives to the use of beta-blockers in patients with COPD. In this setting, cardioselective beta-blockers could be considered, although they should be administered with caution.

• indapamide

  Monitor Closely (2)valsartan increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol increases and indapamide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• indinavir

  Monitor Closely (1)indinavir will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• indomethacin

  Monitor Closely (5)valsartan, indomethacin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and indomethacin both increase serum potassium. Use Caution/Monitor.
  
  indomethacin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  indomethacin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and indomethacin both increase serum potassium. Use Caution/Monitor.

• insulin aspart

  Monitor Closely (1)valsartan increases effects of insulin aspart by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin aspart protamine/insulin aspart

  Monitor Closely (1)valsartan increases effects of insulin aspart protamine/insulin aspart by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin degludec

  Monitor Closely (3)valsartan increases effects of insulin degludec by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
  
  valsartan, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
  
  nebivolol, insulin degludec. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

• insulin degludec/insulin aspart

  Monitor Closely (2)valsartan, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
  
  nebivolol, insulin degludec/insulin aspart. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).

• insulin detemir

  Monitor Closely (1)valsartan increases effects of insulin detemir by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin glargine

  Monitor Closely (1)valsartan increases effects of insulin glargine by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin glulisine

  Monitor Closely (1)valsartan increases effects of insulin glulisine by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin inhaled

  Monitor Closely (3)nebivolol, insulin inhaled. Other (see comment). Modify Therapy/Monitor Closely. Comment: Beta-blockers may either increase or decrease the blood glucose lowering effect of insulin; beta-blockers can prolong hypoglycemia (interference with glycogenolysis) or cause hyperglycemia (insulin secretion inhibited).
  
  valsartan increases effects of insulin inhaled by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.
  
  valsartan, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.

• insulin isophane human/insulin regular human

  Monitor Closely (1)valsartan increases effects of insulin isophane human/insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin lispro

  Monitor Closely (1)valsartan increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin lispro protamine/insulin lispro

  Monitor Closely (1)valsartan increases effects of insulin lispro protamine/insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin NPH

  Monitor Closely (1)valsartan increases effects of insulin NPH by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• insulin regular human

  Monitor Closely (1)valsartan increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and ARBs may require insulin dosage adjustment and increased glucose monitoring.

• iodixanol

  Monitor Closely (1)nebivolol increases toxicity of iodixanol by unspecified interaction mechanism. Use Caution/Monitor. Use of beta-blockers lowers the threshold for and increases the severity of contrast reactions, and reduces the responsiveness of treatment of hypersensitivity reactions with epinephrine. .

• irbesartan

  Monitor Closely (2)nebivolol, irbesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  irbesartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• isoproterenol

  Monitor Closely (2)nebivolol decreases effects of isoproterenol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and isoproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• isradipine

  Monitor Closely (1)nebivolol, isradipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• ivabradine

  Monitor Closely (1)ivabradine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Most patients receiving ivabradine will also be treated with a beta-blocker. The risk of bradycardia increases with coadministration of drugs that slow heart rate (eg, digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking ivabradine with other negative chronotropes.

• ketamine

  Monitor Closely (1)ketamine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• ketoconazole

  Monitor Closely (1)ketoconazole will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• ketoprofen

  Monitor Closely (5)valsartan and ketoprofen both increase serum potassium. Use Caution/Monitor.
  
  ketoprofen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, ketoprofen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and ketoprofen both increase serum potassium. Use Caution/Monitor.
  
  ketoprofen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• ketorolac

  Monitor Closely (5)nebivolol and ketorolac both increase serum potassium. Use Caution/Monitor.
  
  valsartan, ketorolac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  ketorolac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and ketorolac both increase serum potassium. Use Caution/Monitor.
  
  ketorolac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• ketorolac intranasal

  Monitor Closely (5)valsartan, ketorolac intranasal. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  ketorolac intranasal decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.
  
  valsartan and ketorolac intranasal both increase serum potassium. Use Caution/Monitor.
  
  ketorolac intranasal decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• labetalol

  Monitor Closely (3)labetalol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  labetalol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and labetalol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)labetalol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• lasmiditan

  Monitor Closely (1)nebivolol increases effects of lasmiditan by pharmacodynamic synergism. Use Caution/Monitor. Lasmiditan has been associated with a lowering of heart rate (HR). In a drug interaction study, addition of a single 200-mg dose of lasmiditan to propranolol decreased HR by an additional 5 bpm compared to propranolol alone, for a mean maximum of 19 bpm.

• letermovir

  Monitor Closely (2)valsartan increases levels of letermovir by decreasing metabolism. Use Caution/Monitor. Coadminstration of letermovir, an OATP1B1/3 substrate, with OATP1B1/3 inhibitors may increase letermovir plasma concentrations.
  
  letermovir increases levels of valsartan by Other (see comment). Use Caution/Monitor. Comment: Letermovir, an OATP1B1/3 inhibitor may increase plasma concentrations of coadministered OATP1B1/3 substrates.

• levalbuterol

  Monitor Closely (2)nebivolol decreases effects of levalbuterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and levalbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levobetaxolol

  Minor (1)levobetaxolol increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• levodopa

  Monitor Closely (2)levodopa increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.
  
  levodopa increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Consider decreasing dosage of antihypertensive agent.

• levoketoconazole

  Monitor Closely (1)levoketoconazole will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• liraglutide

  Monitor Closely (1)valsartan increases effects of liraglutide by Other (see comment). Use Caution/Monitor. Comment: Angiotensin II receptor antagonists may enhance hypoglycemic effects of antidiabetic agents by improving insulin sensitivity. Monitor patients for changes in glycemic control.

• lisinopril

  Serious - Use Alternative (1)valsartan, lisinopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• lithium

  Serious - Use Alternative (1)valsartan increases toxicity of lithium by decreasing renal clearance. Avoid or Use Alternate Drug.

• lofexidine

  Serious - Use Alternative (2)lofexidine, valsartan. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.
  
  lofexidine, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid coadministration with other drugs that decrease pulse or blood pressure to mitigate risk of excessive bradycardia and hypotension.

• lorcaserin

  Monitor Closely (1)lorcaserin will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• lornoxicam

  Monitor Closely (3)lornoxicam decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and lornoxicam both increase serum potassium. Use Caution/Monitor.
  
  valsartan and lornoxicam both increase serum potassium. Use Caution/Monitor.

• losartan

  Monitor Closely (2)nebivolol, losartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  losartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• lovastatin

  Monitor Closely (1)lovastatin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• lumefantrine

  Serious - Use Alternative (1)lumefantrine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• lurasidone

  Monitor Closely (2)lurasidone increases effects of valsartan by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.
  
  lurasidone increases effects of nebivolol by Other (see comment). Use Caution/Monitor. Comment: Potential for increased risk of hypotension with concurrent use. Monitor blood pressure and adjust dose of antihypertensive agent as needed.

• maitake

  Monitor Closely (1)maitake increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.Minor (1)maitake increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• maraviroc

  Monitor Closely (2)maraviroc, valsartan. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Increased risk of orthostatic hypotension.
  
  maraviroc will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• marijuana

  Monitor Closely (1)marijuana will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• mavacamten

  Serious - Use Alternative (1)nebivolol, mavacamten. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Expect additive negative inotropic effects of mavacamten and other drugs that reduce cardiac contractility.

• meclofenamate

  Monitor Closely (5)meclofenamate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, meclofenamate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  meclofenamate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and meclofenamate both increase serum potassium. Use Caution/Monitor.
  
  valsartan and meclofenamate both increase serum potassium. Use Caution/Monitor.

• mefenamic acid

  Monitor Closely (5)valsartan and mefenamic acid both increase serum potassium. Use Caution/Monitor.
  
  valsartan, mefenamic acid. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  mefenamic acid decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and mefenamic acid both increase serum potassium. Use Caution/Monitor.
  
  mefenamic acid decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• mefloquine

  Monitor Closely (1)mefloquine increases levels of nebivolol by decreasing metabolism. Use Caution/Monitor. Risk of arrhythmia.

• melatonin

  Minor (1)melatonin decreases toxicity of nebivolol by pharmacodynamic antagonism. Minor/Significance Unknown. Melatonin may correct beta blocker induced sleep disturbances.

• meloxicam

  Monitor Closely (5)valsartan, meloxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and meloxicam both increase serum potassium. Use Caution/Monitor.
  
  meloxicam decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  meloxicam decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and meloxicam both increase serum potassium. Use Caution/Monitor.

• metaproterenol

  Monitor Closely (2)nebivolol decreases effects of metaproterenol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and metaproterenol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methyclothiazide

  Monitor Closely (2)valsartan increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .
  
  nebivolol increases and methyclothiazide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• methylphenidate

  Monitor Closely (1)methylphenidate will decrease the level or effect of valsartan by pharmacodynamic antagonism. Use Caution/Monitor. Methylphenidate may diminish antihypertensive effects. Monitor BP.

• methylphenidate transdermal

  Monitor Closely (1)methylphenidate transdermal decreases effects of valsartan by anti-hypertensive channel blocking. Use Caution/Monitor.

• metipranolol ophthalmic

  Minor (1)metipranolol ophthalmic increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• metolazone

  Monitor Closely (2)valsartan increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol increases and metolazone decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metoprolol

  Monitor Closely (3)metoprolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  metoprolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and metoprolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)metoprolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• metyrapone

  Monitor Closely (1)metyrapone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• mifepristone

  Monitor Closely (1)mifepristone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• mirabegron

  Monitor Closely (1)mirabegron will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• moexipril

  Serious - Use Alternative (1)valsartan, moexipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• moxisylyte

  Monitor Closely (1)moxisylyte and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• nabumetone

  Monitor Closely (5)nabumetone decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and nabumetone both increase serum potassium. Use Caution/Monitor.
  
  nabumetone decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, nabumetone. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and nabumetone both increase serum potassium. Use Caution/Monitor.

• nadolol

  Monitor Closely (3)nadolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  nadolol and nebivolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and nadolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)nadolol and nebivolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• naproxen

  Monitor Closely (5)nebivolol and naproxen both increase serum potassium. Use Caution/Monitor.
  
  naproxen decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  naproxen decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan and naproxen both increase serum potassium. Use Caution/Monitor.
  
  valsartan, naproxen. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• nebivolol

  Monitor Closely (2)nebivolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  valsartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• nelfinavir

  Monitor Closely (1)nelfinavir will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• neostigmine

  Minor (1)nebivolol, neostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

• nicardipine

  Monitor Closely (1)nebivolol, nicardipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• nifedipine

  Monitor Closely (1)nebivolol, nifedipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• nilotinib

  Monitor Closely (1)nilotinib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• nimodipine

  Monitor Closely (1)nebivolol, nimodipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• nirmatrelvir/ritonavir

  Minor (1)nirmatrelvir/ritonavir will increase the level or effect of valsartan by Other (see comment). Minor/Significance Unknown. Valsartan is a substrate of the hepatic uptake transporters OATP1B1 and MRP2. Ritonavir inhibits these transporters. No dosage modification needed since induction reaches maximal effect after several days and the short duration of nirmatrelvir/ritonavir treatment.

• nisoldipine

  Monitor Closely (1)nebivolol, nisoldipine. Either decreases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs lower blood pressure.

• nitroglycerin rectal

  Monitor Closely (2)nitroglycerin rectal, valsartan. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Observe for possible additive hypotensive effects during concomitant use. .
  
  nitroglycerin rectal, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers blunt the reflex tachycardia produced by nitroglycerin without preventing its hypotensive effects. If beta-blockers are used with nitroglycerin in patients with angina pectoris, additional hypotensive effects may occur.

• noni juice

  Minor (2)nebivolol and noni juice both increase serum potassium. Minor/Significance Unknown.
  
  valsartan and noni juice both increase serum potassium. Minor/Significance Unknown.

• norepinephrine

  Monitor Closely (2)nebivolol decreases effects of norepinephrine by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and norepinephrine decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• octacosanol

  Minor (2)octacosanol increases effects of valsartan by pharmacodynamic synergism. Minor/Significance Unknown.
  
  octacosanol increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• olmesartan

  Monitor Closely (2)nebivolol, olmesartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  olmesartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)

  Monitor Closely (1)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. May inhibit organic anion transporter polypeptides; decrease dose of angiotensin receptor blockers and monitor patients for signs and symptoms of hypotension and/or worsening renal function; if such events occur, consider further dose reduction of angiotensin receptor blocker or switching to alternative to angiotensin receptor blocker Minor (1)ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of valsartan by decreasing elimination. Minor/Significance Unknown. May inhibit hepatic efflux transporter MRP2; decrease dose of angiotensin receptor blockers and monitor patients for signs and symptoms of hypotension and/or worsening renal function; if such events occur, consider further dose reduction of angiotensin receptor blocker or switching to alternative to angiotensin receptor blocker

• oxaprozin

  Monitor Closely (5)oxaprozin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and oxaprozin both increase serum potassium. Use Caution/Monitor.
  
  oxaprozin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and oxaprozin both increase serum potassium. Use Caution/Monitor.
  
  valsartan, oxaprozin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.

• oxymetazoline topical

  Monitor Closely (1)oxymetazoline topical increases and nebivolol decreases sympathetic (adrenergic) effects, including increased blood pressure and heart rate. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• paclitaxel

  Monitor Closely (1)paclitaxel will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• paclitaxel protein bound

  Monitor Closely (1)paclitaxel protein bound will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• panobinostat

  Monitor Closely (1)panobinostat will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Panobinostat can increase the levels and effects of sensitive CYP2D6 substrates or those with a narrow therapeutic index CYP2D6.

• parecoxib

  Monitor Closely (4)parecoxib decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and parecoxib both increase serum potassium. Use Caution/Monitor.
  
  parecoxib will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  valsartan and parecoxib both increase serum potassium. Use Caution/Monitor.

• paroxetine

  Serious - Use Alternative (1)paroxetine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.

• pazopanib

  Monitor Closely (1)pazopanib will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• penbutolol

  Monitor Closely (3)valsartan and penbutolol both increase serum potassium. Use Caution/Monitor.
  
  penbutolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  nebivolol and penbutolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)nebivolol and penbutolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• pentobarbital

  Monitor Closely (1)pentobarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of pentobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• perindopril

  Serious - Use Alternative (1)valsartan, perindopril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• perphenazine

  Monitor Closely (1)perphenazine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• phenobarbital

  Monitor Closely (1)phenobarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of phenobarbital. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• phenoxybenzamine

  Monitor Closely (1)phenoxybenzamine and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• phentolamine

  Monitor Closely (1)phentolamine and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• physostigmine

  Minor (1)nebivolol, physostigmine. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive bradycardia.

• pilocarpine

  Minor (1)pilocarpine increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• pindolol

  Monitor Closely (3)pindolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  valsartan and pindolol both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and pindolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)nebivolol and pindolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• pioglitazone

  Monitor Closely (1)pioglitazone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• pirbuterol

  Monitor Closely (2)nebivolol decreases effects of pirbuterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and pirbuterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• piroxicam

  Monitor Closely (5)piroxicam decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and piroxicam both increase serum potassium. Use Caution/Monitor.
  
  valsartan, piroxicam. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and piroxicam both increase serum potassium. Use Caution/Monitor.
  
  piroxicam decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• pitavastatin

  Monitor Closely (1)valsartan increases toxicity of pitavastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• ponesimod

  Monitor Closely (1)ponesimod and nebivolol both increase pharmacodynamic synergism. Use Caution/Monitor. Beta-blockers may have additive effects on lowering HR. Consider resting HR before initiating ponesimod in patients on stable dose of beta-blocker. Refer to the ponesimod prescribing information for more dosing information.

• potassium acid phosphate

  Monitor Closely (2)valsartan and potassium acid phosphate both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and potassium acid phosphate both increase serum potassium. Modify Therapy/Monitor Closely.

• potassium chloride

  Monitor Closely (2)nebivolol and potassium chloride both increase serum potassium. Modify Therapy/Monitor Closely.
  
  valsartan and potassium chloride both increase serum potassium. Use Caution/Monitor.

• potassium citrate

  Monitor Closely (2)nebivolol and potassium citrate both increase serum potassium. Modify Therapy/Monitor Closely.
  
  valsartan and potassium citrate both increase serum potassium. Use Caution/Monitor.

• potassium citrate/citric acid

  Monitor Closely (1)valsartan and potassium citrate/citric acid both increase serum potassium. Use Caution/Monitor.

• potassium iodide

  Monitor Closely (1)potassium iodide and valsartan both increase serum potassium. Use Caution/Monitor. Potassium salts may increase the hyperkalemic effects of ARBs; the effect may be the result of aldosterone suppression in patients receiving ARBs.

• potassium phosphates, IV

  Serious - Use Alternative (1)valsartan and potassium phosphates, IV both increase serum potassium. Avoid or Use Alternate Drug.

• pravastatin

  Monitor Closely (2)pravastatin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure
  
  valsartan increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• prazosin

  Monitor Closely (1)prazosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• primidone

  Monitor Closely (1)primidone decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Consider a higher beta-blocker dose during coadministration of secobarbital. Consider a higher beta-blocker dose during coadministration of primidone. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• propafenone

  Monitor Closely (1)propafenone will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced doses of nebivolol may be necessary.

• propofol

  Monitor Closely (1)propofol, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• propranolol

  Monitor Closely (3)nebivolol and propranolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and propranolol both increase serum potassium. Use Caution/Monitor.
  
  propranolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.Serious - Use Alternative (1)nebivolol and propranolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• quinacrine

  Monitor Closely (1)quinacrine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• quinapril

  Serious - Use Alternative (1)valsartan, quinapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• quinidine

  Serious - Use Alternative (1)quinidine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Monitor blood pressure. Reduced doses of nebivolol may be necessary.

• ramipril

  Serious - Use Alternative (1)valsartan, ramipril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• ranolazine

  Monitor Closely (1)ranolazine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• reishi

  Minor (2)reishi increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.
  
  reishi increases effects of valsartan by pharmacodynamic synergism. Minor/Significance Unknown.

• repaglinide

  Monitor Closely (1)repaglinide will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• rifampin

  Monitor Closely (1)rifampin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• ritonavir

  Monitor Closely (3)ritonavir will increase the level or effect of valsartan by Mechanism: decreasing hepatic clearance. Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic efflux transporter MRP2; coadministration of inhibitors of the efflux transporter may increase the systemic exposure to valsartan
  
  ritonavir will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
  
  ritonavir will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• rivastigmine

  Serious - Use Alternative (1)nebivolol increases toxicity of rivastigmine by pharmacodynamic synergism. Avoid or Use Alternate Drug. Additive bradycardia effect may result in syncope.

• rolapitant

  Monitor Closely (1)rolapitant will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.

• rosiglitazone

  Monitor Closely (1)rosiglitazone will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• sacubitril/valsartan

  Monitor Closely (2)nebivolol, sacubitril/valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  sacubitril/valsartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• salicylates (non-asa)

  Monitor Closely (3)valsartan and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.
  
  salicylates (non-asa) decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and salicylates (non-asa) both increase serum potassium. Use Caution/Monitor.

• salmeterol

  Monitor Closely (2)nebivolol decreases effects of salmeterol by pharmacodynamic antagonism. Use Caution/Monitor.
  
  nebivolol increases and salmeterol decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  Monitor Closely (5)salsalate decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  valsartan and salsalate both increase serum potassium. Use Caution/Monitor.
  
  salsalate decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, salsalate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  nebivolol and salsalate both increase serum potassium. Use Caution/Monitor.

• saquinavir

  Monitor Closely (2)saquinavir, nebivolol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Use alternatives if available. Increased risk of PR prolongation and cardiac arrhythmias.
  
  saquinavir will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• secobarbital

  Monitor Closely (1)secobarbital decreases levels of nebivolol by increasing metabolism. Use Caution/Monitor. Atenolol, sotalol, nadolol less likely to be affected than other beta blockers.

• sertraline

  Monitor Closely (1)sertraline will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• sevoflurane

  Monitor Closely (1)sevoflurane, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• shepherd's purse

  Minor (2)shepherd's purse, nebivolol. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.
  
  shepherd's purse, valsartan. Other (see comment). Minor/Significance Unknown. Comment: Theoretically, shepherd's purse may interfere with BP control.

• sildenafil

  Monitor Closely (1)nebivolol increases effects of sildenafil by additive vasodilation. Use Caution/Monitor. Sildenafil has systemic vasodilatory properties and may further lower blood pressure in patients taking antihypertensive medications. Monitor blood pressure response to sildenafil in patients receiving concurrent blood pressure lowering therapy.

• silodosin

  Monitor Closely (1)silodosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• simvastatin

  Monitor Closely (1)simvastatin will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposureMinor (1)valsartan increases toxicity of simvastatin by Other (see comment). Minor/Significance Unknown. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• siponimod

  Monitor Closely (1)siponimod, nebivolol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Caution when siponimod is initiated in patients receiving beta-blocker treatment because of additive effects on lowering heart rate. Temporary interruption of beta-blocker may be needed before initiating siponimod. Beta-blocker treatment can be initiated in patients receiving stable doses of siponimod.

• sodium bicarbonate

  Monitor Closely (1)sodium bicarbonate decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• sodium citrate/citric acid

  Monitor Closely (1)sodium citrate/citric acid decreases levels of nebivolol by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor. Separate by 2 hours.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of valsartan by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sofosbuvir/velpatasvir

  Monitor Closely (1)sofosbuvir/velpatasvir increases levels of valsartan by Other (see comment). Use Caution/Monitor. Comment: Velpatasvir inhibits OATP1B1, OATP1B3, and OATP2B1 transporters. .

• sotalol

  Monitor Closely (3)nebivolol and sotalol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and sotalol both increase serum potassium. Use Caution/Monitor.
  
  sotalol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.Serious - Use Alternative (1)nebivolol and sotalol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• spironolactone

  Monitor Closely (2)valsartan and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.
  
  nebivolol and spironolactone both increase serum potassium. Modify Therapy/Monitor Closely.

• succinylcholine

  Monitor Closely (1)nebivolol and succinylcholine both increase serum potassium. Use Caution/Monitor.

• sulfasalazine

  Monitor Closely (5)sulfasalazine decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.
  
  nebivolol and sulfasalazine both increase serum potassium. Use Caution/Monitor.
  
  sulfasalazine decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  valsartan, sulfasalazine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and sulfasalazine both increase serum potassium. Use Caution/Monitor.

• sulindac

  Monitor Closely (5)sulindac decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and sulindac both increase serum potassium. Use Caution/Monitor.
  
  valsartan, sulindac. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  valsartan and sulindac both increase serum potassium. Use Caution/Monitor.
  
  sulindac decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• synthetic human angiotensin II

  Monitor Closely (1)valsartan decreases effects of synthetic human angiotensin II by pharmacodynamic antagonism. Use Caution/Monitor.

• tadalafil

  Monitor Closely (2)tadalafil increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.
  
  tadalafil increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.

• telmisartan

  Monitor Closely (2)nebivolol, telmisartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  telmisartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• terazosin

  Monitor Closely (1)terazosin and nebivolol both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.

• terbinafine

  Monitor Closely (1)terbinafine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.

• terbutaline

  Monitor Closely (3)nebivolol increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol decreases effects of terbutaline by pharmacodynamic antagonism. Use Caution/Monitor.
  
  valsartan increases and terbutaline decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• theophylline

  Monitor Closely (1)nebivolol, theophylline. Other (see comment). Use Caution/Monitor. Comment: Beta blockers (esp. non selective) antagonize theophylline effects, while at the same time increasing theophylline levels and toxicity (mechanism: decreased theophylline metabolism). Smoking increases risk of interaction.

• thioridazine

  Monitor Closely (1)thioridazine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• timolol

  Monitor Closely (3)timolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  nebivolol and timolol both increase serum potassium. Use Caution/Monitor.
  
  valsartan and timolol both increase serum potassium. Use Caution/Monitor.Serious - Use Alternative (1)nebivolol and timolol both increase anti-hypertensive channel blocking. Avoid or Use Alternate Drug.

• tipranavir

  Monitor Closely (1)tipranavir will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• tizanidine

  Monitor Closely (1)tizanidine increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor. Risk of hypotension.Minor (1)tizanidine increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension.

• tolfenamic acid

  Monitor Closely (3)valsartan and tolfenamic acid both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and tolfenamic acid both increase serum potassium. Use Caution/Monitor.
  
  tolfenamic acid decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.

• tolmetin

  Monitor Closely (5)valsartan and tolmetin both increase serum potassium. Use Caution/Monitor.
  
  valsartan, tolmetin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals.
  
  tolmetin decreases effects of nebivolol by pharmacodynamic antagonism. Use Caution/Monitor. Long term (>1 wk) NSAID use. NSAIDs decrease prostaglandin synthesis.
  
  nebivolol and tolmetin both increase serum potassium. Use Caution/Monitor.
  
  tolmetin decreases effects of valsartan by pharmacodynamic antagonism. Modify Therapy/Monitor Closely. NSAIDs decrease synthesis of vasodilating renal prostaglandins, and thus affect fluid homeostasis and may diminish antihypertensive effect.

• tolvaptan

  Monitor Closely (2)valsartan and tolvaptan both increase serum potassium. Use Caution/Monitor.
  
  nebivolol and tolvaptan both increase serum potassium. Use Caution/Monitor.

• torsemide

  Monitor Closely (2)valsartan increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.
  
  nebivolol increases and torsemide decreases serum potassium. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• trandolapril

  Serious - Use Alternative (1)valsartan, trandolapril. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Dual blockade of renin-angiotensin system increases risks of hypotension, hyperkalemia, and renal impairment.

• treprostinil

  Monitor Closely (1)treprostinil increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.Minor (1)treprostinil increases effects of nebivolol by pharmacodynamic synergism. Minor/Significance Unknown.

• triamterene

  Monitor Closely (2)valsartan and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.
  
  nebivolol and triamterene both increase serum potassium. Modify Therapy/Monitor Closely.

• trimethoprim

  Monitor Closely (1)valsartan and trimethoprim both increase serum potassium. Use Caution/Monitor. Trimethoprim decreases urinary potassium excretion. May cause hyperkalemia, particularly with high doses, renal insufficiency, or when combined with other drugs that cause hyperkalemia.

• valsartan

  Monitor Closely (2)nebivolol, valsartan. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of fetal compromise if given during pregnancy.
  
  valsartan and nebivolol both increase serum potassium. Use Caution/Monitor.

• venlafaxine

  Monitor Closely (1)venlafaxine will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

• verapamil

  Monitor Closely (1)nebivolol and verapamil both increase anti-hypertensive channel blocking. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)verapamil, nebivolol. Either increases toxicity of the other by unspecified interaction mechanism. Avoid or Use Alternate Drug. Can increase risk of bradycardia.

• voclosporin

  Monitor Closely (2)voclosporin and valsartan both increase serum potassium. Use Caution/Monitor.
  
  voclosporin, valsartan. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Coadministration with drugs associated with nephrotoxicity may increase the risk for acute and/or chronic nephrotoxicity.Minor (1)voclosporin will increase the level or effect of valsartan by Other (see comment). Minor/Significance Unknown. Information suggests voclosporin (an OATP1B1 inhibitor) may increase in the concentration of OATP1B1 substrates is possible. Monitor for adverse reactions of OATP1B1 substrates when coadministered with voclosporin.

• xipamide

  Monitor Closely (2)xipamide increases effects of valsartan by pharmacodynamic synergism. Use Caution/Monitor.
  
  xipamide increases effects of nebivolol by pharmacodynamic synergism. Use Caution/Monitor.

• yohimbe

  Minor (1)nebivolol decreases toxicity of yohimbe by pharmacodynamic antagonism. Minor/Significance Unknown.