Drug Interaction Report

Before starting fingolimod, let your doctor know if you are currently receiving treatment with ivabradine. Using fingolimod in this situation can cause excessive slowing of your heart rate that can lead to serious or life-threatening cardiac complications. This is most likely to occur early on after you start treatment with fingolimod, especially within the first 20 hours after the first dose. On the other hand, it may be alright for you to use these medications together if you have been stable on fingolimod therapy for over a month while you start treatment with ivabradine. Talk to your doctor if you are uncertain whether you should be treated with these medications at the same time. Your first dose of fingolimod must be taken at your doctor's office or a hospital, and you will need to be observed for 6 hours or more afterwards. In the event that you restart the medication after an interruption in treatment, you may need to take the first dose again under medical observation depending on how long you were on the medication before you stopped, and how many days the interruption lasted. Contact your doctor if you develop dizziness, lightheadedness, fainting, shortness of breath, chest pain, or heart palpitations during treatment. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Do not consume grapefruit or grapefruit juice during treatment with ivabradine. Grapefruit juice can significantly increase the blood levels and effects of ivabradine, which may result in excessive slowing of heart rate or other conduction disturbances. Talk to your doctor if you have any questions or concerns. Let your doctor know if you experience significant decreases in heart rate or symptoms such as dizziness, fatigue, or low blood pressure. Also seek medical attention if you develop heart palpitations, chest pressure, or worsened shortness of breath, as these may be symptoms of atrial fibrillation caused by ivabradine. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.