Drug interactions between fingolimod and ibutilide
| Results for the following 2 drugs: |
|---|
| fingolimod |
| ibutilide |
Interactions between your selected drugs
ibutilide ↔ fingolimod
Applies to:ibutilide and fingolimod
MONITOR: Theoretical concerns exist that initiating treatment with fingolimod may potentiate the risk of torsade de pointes arrhythmia associated with the use of class IA (e.g., disopyramide, quinidine, procainamide) and class III (e.g., amiodarone, dofetilide, ibutilide, sotalol) antiarrhythmic agents. Fingolimod can cause a decrease in heart rate during initiation of therapy that is apparent within an hour of the first dose and maximal at approximately 6 hours postdose. Further, but smaller decreases in heart rate may occur after the second dose, although heart rate eventually returns to baseline within one month of chronic treatment. The mean decrease in heart rate in patients receiving fingolimod 0.5 mg at 6 hours after the first dose was approximately 13 beats per minute (bpm). Heart rates below 40 bpm were rarely observed. In controlled clinical trials, bradycardia following the first dose was reported in 0.5% of patients receiving fingolimod 0.5 mg, compared to no patient on placebo. Initiation of fingolimod treatment has also resulted in transient AV conduction delays. First- and second-degree AV block (prolonged PR interval on ECG) following the first dose were each reported in 0.1% of patients receiving fingolimod 0.5 mg, compared to no patient on placebo. In a study of 698 patients with available 24-hour Holter monitoring data after their first dose, second degree AV blocks, usually Mobitz type I (Wenckebach), were reported in 3.7% of patients receiving fingolimod 0.5 mg and 2% of patients receiving placebo. Bradycardia and conduction abnormalities were usually transient and asymptomatic, and resolved within the first 24 hours on treatment.
MANAGEMENT: Fingolimod has not been studied in patients with arrhythmias requiring treatment with class IA or class III antiarrhythmic agents. Because bradycardia and AV block are recognized risk factors for torsade de pointes arrhythmia, close monitoring is recommended during initiation of fingolimod treatment in patients treated with these agents. Class IA and class III antiarrhythmics have been associated with cases of torsade de pointes in patients with bradycardia. Patients should have an electrocardiogram prior to starting fingolimod if a recent one (i.e., within 6 months) is not available. The same precautions are applicable if fingolimod therapy is restarted after a discontinuation of more than two weeks, since the effects on heart rate and AV conduction may recur on reintroduction of fingolimod.
See also...
Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
| 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. |
Do not stop taking any medications without consulting your healthcare provider.
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