Moderate
Probable
설명
Carvedilol combined with diltiazem increases the risk of bradycardia, hypotension, and AV block through additive cardiac depressant effects and pharmacokinetic interaction.
기전
Diltiazem inhibits CYP2D6 (a pathway for carvedilol metabolism), increasing carvedilol exposure; diltiazem also inhibits AV nodal conduction via calcium channel blockade, adding to carvedilol's beta-blocking effects.
임상적 중요성
Symptomatic bradycardia and hypotension requiring treatment have been reported; risk is highest in patients with systolic heart failure.
관리 방법
Start carvedilol at minimal dose; monitor heart rate and blood pressure closely when combining; perform ECG if symptomatic bradycardia suspected.