Drug interactions between fingolimod and Inderide
| Results for the following 2 drugs: |
|---|
| fingolimod |
| Inderide (hydrochlorothiazide/propranolol) |
Interactions between your selected drugs
propranolol ↔ fingolimod
Applies to:Inderide (hydrochlorothiazide/propranolol) and fingolimod
MONITOR: The risk of bradycardia and atrioventricular (AV) block may be increased during initiation of fingolimod treatment in patients receiving beta-blockers or calcium channel blockers due to additive effects on heart rate. 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. Patients who experienced bradycardia were generally asymptomatic, but some experienced mild to moderate dizziness, fatigue, palpitations, and chest pain that resolved within the first 24 hours on treatment. 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. The conduction abnormalities were usually transient and asymptomatic, and resolved within the first 24 hours on treatment, but they occasionally required treatment with atropine or isoproterenol.
MANAGEMENT: Fingolimod has not been adequately studied in patients receiving beta-blockers or calcium channel blockers. Close monitoring is recommended during initiation of fingolimod treatment in patients treated with these agents. Patients should be observed for a period of six hours after the first dose for signs and symptoms of bradycardia. Should postdose bradyarrhythmia-related symptoms occur, initiate appropriate management and continue observation until the symptoms have resolved. To identify underlying risk factors for bradycardia and AV block, 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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