Not all ARBs are equal for cardiovascular events, and the beta-blocker–SSRI pairing to watch

The edition in brief

Today's clinical pharmacology edition opens with a scoping review in the British Journal of Clinical Pharmacology (7 October) of adverse events when beta-blockers and SSRIs are combined. Across 48 articles, bradycardia was the most reported problem, mainly with metoprolol or propranolol alongside fluoxetine, paroxetine or sertraline, and most authors proposed CYP2D6 inhibition as the mechanism. The evidence is mostly case reports and small studies. A feasibility trial in 45 adults with a BMI of 30 or more found prolonged piperacillin-tazobactam infusions reached full time above MIC in 64% versus 56% with standard infusions, a difference not statistically significant, with no safety signal. On the regulatory side, the FDA lists a Class II recall of compounded semaglutide 3 mg/mL syringes from one US compounder over lack of sterility assurance. The pearl is choosing the right weight for Cockcroft-Gault. The practice changer is a network meta-analysis of 27 randomised trials (702,584 patient-years) in people without heart failure: candesartan reduced major adverse cardiovascular events against placebo (OR 0.79) and ranked highest, with telmisartan next (OR 0.90). Most comparisons between ARBs were indirect, so this is a ranking to weigh, not a proven difference — but when starting an ARB for cardiovascular protection, the two agents with outcome data are reasonable first choices.