Drug interactions
Ivabradine + Netupitant / palonosetron
Severity: Major
Ivabradine and Netupitant / palonosetron: 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
Netupitant is a moderate CYP3A4 inhibitor and can raise ivabradine exposure. Higher levels increase the risk of marked bradycardia, conduction disturbances and visual phosphenes.
What this interaction means in plain words
Ivabradine and Netupitant / palonosetron 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.
Why it happens
Netupitant inhibits CYP3A4, reducing the first-pass and systemic metabolism of ivabradine.
What to do
Avoid the combination if possible, as moderate CYP3A4 inhibitors are not recommended with ivabradine. If unavoidable, monitor heart rate and ECG closely and consider a lower 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
- Ivabradine 2.5 mg film-coated Tablets - SmPC sections 4.3/4.5 (class statement: moderate CYP3A4 inhibitors; "The concomitant use of ivabradine with other moderate CYP3A4 inhibitors (e.g. fluconazole) may be considered at the starting dose of 2.5 mg twice daily") — electronic medicines compendium (UK SmPC)
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 Netupitant / palonosetron?
MediHelp rates the interaction as major. Ivabradine and Netupitant / palonosetron 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. Netupitant is a moderate CYP3A4 inhibitor and can raise ivabradine exposure. Higher levels increase the risk of marked bradycardia, conduction disturbances and visual phosphenes.
How serious is the interaction between Ivabradine and Netupitant / palonosetron?
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 the combination if possible, as moderate CYP3A4 inhibitors are not recommended with ivabradine. If unavoidable, monitor heart rate and ECG closely and consider a lower ivabradine dose.
What other medicines interact with Ivabradine?
MediHelp also lists interactions of Ivabradine with, for example, Atazanavir, Clarithromycin, Cobicistat. The full list is on the Ivabradine page.
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