Drug interactions
Ivabradine + Metronidazole
Severity: Moderate
Ivabradine and Metronidazole: moderate interaction.
Last updated
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
Ivabradine is a CYP3A4 substrate and its levels rise with CYP3A4 inhibitors, increasing bradycardia risk. Metronidazole is a weak inhibitor at most, so the effect is likely small, but bradycardia and conduction disturbances could still occur.
What this interaction means in plain words
Ivabradine and Metronidazole can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Ivabradine belongs to Cardiovascular; Metronidazole belongs to Anti Parasitic.
Why it happens
Possible weak inhibition of CYP3A4-mediated ivabradine metabolism, leading to higher ivabradine exposure and greater heart rate lowering.
What to do
Monitor heart rate and symptoms of bradycardia during the metronidazole course and reduce or stop ivabradine if the heart rate falls excessively.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Metronidazole
- Ethanol + Metronidazole Contraindicated
- Metronidazole + Pimozide Contraindicated
- Amiodarone + Metronidazole Major
- Disulfiram + Metronidazole Major
- Ergotamine + Metronidazole Major
- Lomitapide + Metronidazole Major
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 Ivabradine with Metronidazole?
MediHelp rates the interaction as moderate. Ivabradine and Metronidazole can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Ivabradine is a CYP3A4 substrate and its levels rise with CYP3A4 inhibitors, increasing bradycardia risk. Metronidazole is a weak inhibitor at most, so the effect is likely small, but bradycardia and conduction disturbances could still occur.
How serious is the interaction between Ivabradine and Metronidazole?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor heart rate and symptoms of bradycardia during the metronidazole course and reduce or stop ivabradine if the heart rate falls excessively.
What other medicines interact with Metronidazole?
MediHelp also lists interactions of Metronidazole with, for example, Ethanol, Pimozide, Amiodarone. The full list is on the Metronidazole page.
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