Isolated cases of severe hypotension and heart failure have been seen in patients taking
beta blockers with
nifedipine or
nisoldipine. Patients with impaired left ventricular function (which is a caution for the use of nifedipine) and/or those taking high-dose
beta blockers are most at risk. Note that all cases of an interaction involved short-acting
nifedipine (which is now considered unsuitable in angina or hyperten- sion) or when extended-release
nifedipine was crushed.
Monitor the outcome of concurrent use for additive haemodynamic effects (e.g. hypotension or heart failure).