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Angina - stable - Management
What key drug interactions should I be aware of?
- CYP3A4 enzyme inhibitors (such as azole antifungals, macrolide antibiotics, and protease inhibitors) should not be given concomitantly with ivabradine. Concomitant administration of a CYP3A4 enzyme inhibitor may increase the plasma concentration of ivabradine, increasing the risk of bradycardia.
- Drugs which prolong the QT interval (such as quinidine, amiodarone, and erythromycin) should not be given concomitantly with ivabradine. QT prolongation may be exacerbated by the heart rate reduction experienced with ivabradine.
- Grapefruit can increase the plasma concentration of ivabradine up to two-fold. People should be advised not to eat grapefruit or drink grapefruit juice whilst taking ivabradine.
- Rate-limiting calcium-channel blockers: concomitant use of ivabradine with verapamil or diltiazem is not recommended, because it can result in excessive reduction of heart rate.
[ABPI Medicines Compendium, 2010]
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