Ivabradineinteractions

7. DRUG INTERACTIONS Avoid CYP3A4 inhibitors or inducers. Negative chronotropes increase risk of bradycardia; monitor heart rate.

7.1 Cytochrome P450-Based

Interactions Corlanor is primarily metabolized by CYP3A4. Concomitant use of CYP3A4 inhibitors increases ivabradine plasma concentrations and use of CYP3A4 inducers decreases them. Increased plasma concentrations may exacerbate bradycardia and conduction disturbances. The concomitant use of strong CYP3A4 inhibitors is contraindicated [ s ee Contraindications and Clinical Pharmacology ]. Examples of strong CYP3A4 inhibitors include azole antifungals (e.g., itraconazole), macrolide antibiotics (e.g., clarithromycin, telithromycin), HIV protease inhibitors (e.g., nelfinavir), and nefazodone. Avoid concomitant use of moderate CYP3A4 inhibitors when using Corlanor. Examples of moderate CYP3A4 inhibitors include diltiazem, verapamil, and grapefruit juice [ s ee Warnings and Precautions and Clinical Pharmacology ]. Avoid concomitant use of CYP3A4 inducers when using Corlanor. Examples of CYP3A4 inducers include St. John’s wort, rifampicin, barbiturates, and phenytoin [ s ee Clinical Pharmacology ].

7.2 Negative

Chronotropes Most patients receiving Corlanor will also be treated with a beta-blocker. The risk of bradycardia increases with concomitant administration of drugs that slow heart rate (e.g., digoxin, amiodarone, beta-blockers). Monitor heart rate in patients taking Corlanor with other negative chronotropes.

7.3 Pacemakers in

Adults Corlanor dosing is based on heart rate reduction, targeting a heart rate of 50 to 60 beats per minute in adults. Patients with demand pacemakers set to a rate ≥ 60 beats per minute cannot achieve a target heart rate < 60 beats per minute, and these patients were excluded from clinical trials. The use of Corlanor is not recommended in patients with demand pacemakers set to rates ≥ 60 beats per minute.