Drug interactions
Ivabradine + Nirmatrelvir / ritonavir
Severity: Contraindicated
Ivabradine and Nirmatrelvir / ritonavir: contraindicated interaction.
Last updated Sources: US FDA label
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
Ritonavir in this combination is a potent CYP3A4 inhibitor and will markedly raise ivabradine levels. This can cause serious bradycardia and conduction disturbances.
What this interaction means in plain words
Ivabradine and Nirmatrelvir / ritonavir are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
Ritonavir inhibits CYP3A4, greatly decreasing ivabradine clearance.
What to do
Do not use together; withhold ivabradine during the antiviral course and for a few days after, or consider an alternative COVID-19 treatment. Monitor heart rate if exposure occurs.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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References
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 Nirmatrelvir / ritonavir?
MediHelp rates the interaction as contraindicated. Ivabradine and Nirmatrelvir / ritonavir are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Ritonavir in this combination is a potent CYP3A4 inhibitor and will markedly raise ivabradine levels. This can cause serious bradycardia and conduction disturbances.
How serious is the interaction between Ivabradine and Nirmatrelvir / ritonavir?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not use together; withhold ivabradine during the antiviral course and for a few days after, or consider an alternative COVID-19 treatment. Monitor heart rate if exposure occurs.
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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