Drug interactions
Fluconazole + Ivabradine
Severity: Major
Fluconazole and Ivabradine: major interaction.
Last updated Sources: UK SmPC
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Fluconazole increases ivabradine exposure, which can cause excessive bradycardia, conduction block and visual phenomena. Bradycardia also adds to the risk of QT-related arrhythmia.
What this interaction means in plain words
Fluconazole and Ivabradine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Fluconazole belongs to Anti Fungals; Ivabradine belongs to Cardiovascular.
Why it happens
Inhibition of CYP3A4-mediated ivabradine metabolism.
What to do
Avoid combining with moderate CYP3A4 inhibitors per labeling, and choose an alternative antifungal. If unavoidable, monitor heart rate and ECG closely and adjust the ivabradine dose.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Fluconazole
- Dihydroergotamine intranasal + Fluconazole Contraindicated
- Dihydroergotamine + Fluconazole Contraindicated
- Dofetilide + Fluconazole Contraindicated
- Domperidone + Fluconazole Contraindicated
- Dronedarone + Fluconazole Contraindicated
- Erythromycin + Fluconazole Contraindicated
Other interactions of Ivabradine
- Atazanavir + Ivabradine Contraindicated
- Clarithromycin + Ivabradine Contraindicated
- Cobicistat + Ivabradine Contraindicated
- Conivaptan + Ivabradine Contraindicated
- Darunavir + Ivabradine Contraindicated
- Diltiazem + Ivabradine Contraindicated
Frequently asked questions
Can I take Fluconazole with Ivabradine?
MediHelp rates the interaction as major. Fluconazole and Ivabradine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Fluconazole increases ivabradine exposure, which can cause excessive bradycardia, conduction block and visual phenomena. Bradycardia also adds to the risk of QT-related arrhythmia.
How serious is the interaction between Fluconazole and Ivabradine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid combining with moderate CYP3A4 inhibitors per labeling, and choose an alternative antifungal. If unavoidable, monitor heart rate and ECG closely and adjust the ivabradine dose.
What other medicines interact with Fluconazole?
MediHelp also lists interactions of Fluconazole with, for example, Dihydroergotamine intranasal, Dihydroergotamine, Dofetilide. The full list is on the Fluconazole page.
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