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Drug Interactions between Corlanor and dalfopristin / quinupristin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

dalfopristin ivabradine

Applies to: dalfopristin / quinupristin and Corlanor (ivabradine)

GENERALLY AVOID: Coadministration with moderate inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of ivabradine, which is primarily metabolized by the isoenzyme. According to the product labeling, administration of ivabradine with the moderate CYP450 3A4 inhibitor diltiazem (120 mg twice daily) resulted in approximately 3-fold increases in ivabradine peak plasma concentration (Cmax) and systemic exposure (AUC) compared to administration of ivabradine alone. Likewise, administration with verapamil (120 mg twice daily) increased the Cmax and AUC of ivabradine by approximately 2-fold. Grapefruit juice, another moderate CYP450 3A4 inhibitor, increased ivabradine AUC by a little over 2-fold. Elevated plasma levels of ivabradine may increase the risk of excessive bradycardia and conduction disturbances.

MANAGEMENT: Concomitant use of ivabradine with moderate CYP450 3A4 inhibitors should generally be avoided. If coadministration is required, some authorities recommend initiating ivabradine at a dosage of 2.5 mg twice daily, provided the resting heart rate is at or above 70 beats per minute and heart rate is closely monitored.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. EMEA. European Medicines Agency (2007) EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid
  3. (2015) "Product Information. Corlanor (ivabradine)." Amgen USA

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Drug and food interactions

Major

ivabradine food

Applies to: Corlanor (ivabradine)

GENERALLY AVOID: Grapefruit juice may significantly increase the plasma concentrations of ivabradine. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruit. According to the product labeling, administration with grapefruit juice (quantity unknown) resulted in an approximately twofold increase in ivabradine systemic exposure (AUC). Elevated plasma levels of ivabradine may increase the risk of excessive bradycardia and conduction disturbances.

ADJUST DOSING INTERVAL: Food delays the absorption of ivabradine by approximately 1 hour and increases plasma exposure by 20% to 40% compared to fasting conditions.

MANAGEMENT: Patients treated with ivabradine should avoid or limit consumption of grapefruit or grapefruit juice. The manufacturer recommends taking ivabradine with meals to reduce variability in exposure.

References

  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2015) "Product Information. Corlanor (ivabradine)." Amgen USA

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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