OBJECT DRUGS

• Ivabradine (Corlanor)

PRECIPITANT DRUGS

Enzyme Inducers:

• Barbiturates
• Bosentan (Tracleer)
• Carbamazepine (Tegretol, etc.)
• Dabrafenib (Tafinlar)
• Dexamethasone (Decadron, etc.)
• Efavirenz (Sustiva)
• Lumacaftor (Orkambi)
• Oxcarbazepine (Trileptal, etc.)
• Phenytoin (Dilantin, etc.)
• Primidone (Mysoline)
• Rifabutin (Mycobutin)
• Rifampin (Rifadin, etc.)
• Rifapentine (Priftin)
• St. John's wort

Comment:

Ivabradine is metabolized by CYP3A4 and concurrent administration with CYP3A4 inducers has been shown to markedly reduce ivabradine plasma concentrations. Carbamazepine, for example, reduced ivabradine bioavailability by about 80%. Reduced efficacy is likely to occur during coadministered with CYP3A4 inducers.

Class 2: Use Only If Benefit Felt to Outweigh Risk

• Use Alternative: If possible, avoid using enzyme inducers in patients receiving ivabradine, since ivabradine plasma concentrations are likely to be subtherapeutic. The product information states that ivabradine should not be used with CYP3A4 inducers.
• Monitor: If concurrent use of ivabradine and enzyme inducers is deemed to be necessary, monitor for altered response when the CYP3A4 inducer is initiated, discontinued, or changed in dosage. Much larger than normal ivabradine dosage is likely to be required to achieve therapeutic ivabradine plasma concentrations.