Contraindicated in:

• MI, unstable angina, stroke, transient ischemic attack, decompensated HF requiring hospitalization, or Class III or IV HF within the past 6 mo;
• History or presence of Mobitz type II 2nd- or 3rd-degree heart block, sick sinus syndrome, or sinoatrial block, unless the patient has a functioning pacemaker;
• Active infection;
• Concurrent use of moderate or strong CYP2C8 or CYP3A4 inhibitors in poor CYP2C9 metabolizers;
• Severe hepatic impairment;
• OB: Pregnancy.

Use Cautiously in:

• QT interval prolongation (>450 msec men, >470 msec women) or concurrent use of QT interval prolonging medications;
• Heart rate <50 bpm;
• Cardiac arrhythmias requiring use of class Ia or III antiarrhythmics;
• Ischemic heart disease, class I or II HF, cardiac arrest, cerebrovascular disease, or uncontrolled hypertension;
• Symptomatic bradycardia, recurrent cardiogenic syncope, or severe untreated sleep apnea;
• Mobitz type I 2nd-degree AV block, unless the patient has a functioning pacemaker;
• Immunocompromised or taking other immunosuppressant medications (↑ risk of progressive multifocal leukoencephalopathy [PML]);
• Lactation: Use while breastfeeding only if potential maternal benefit justifies potential risk to infant;
• Rep: Women of reproductive potential;
• Pedi: Safety and effectiveness not established in children.