<p><strong>Other &beta;-blocking Agents</strong>: Bisoprolol fumarate should not be combined with other &beta;-blocking agents.<br />
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<strong>Catecholamine-Depleting Drugs</strong>: Patients receiving catecholamine-depleting drugs, such as reserpine or guanethidine, should be monitored closely because the added &beta;-adrenergic blocking action of bisoprolol fumarate may produce excessive reduction of sympathetic activity.<br />
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<strong>Centrally Active Antihypertensive Agents</strong>: &beta;-blockers may exacerbate the rebound hypertension which can follow the withdrawal of clonidine. If the two drugs are coadministered, the &beta;-blocker should be withdrawn several days before discontinuing clonidine. If replacing clonidine by &beta;-blocker therapy, the introduction of &beta;-blockers should be delayed for several days after clonidine administration has stopped (see also prescribing information for clonidine).<br />
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<strong>Antiarrhythmic Agents</strong>: Bisoprolol fumarate should be used with care when myocardial depressants or inhibitors of A-V conduction, such as certain calcium antagonists (particularly of the phenyl alkylamine (verapamil) and benzothiazepine (diltiazem) classes), or antiarrhythmic agents, such as disopyramide, are used concurrently.<br />
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<strong>Calcium Channel Blockers</strong>: Combined use of &beta;-blockers and calcium channel blockers with negative inotropic effects can lead to prolongation of S-A and A-V conduction, particularly in patients with impaired ventricular function or conduction abnormalities. This may result in severe hypotension, bradycardia and cardiac failure.</p>