Drug interactions
Ivabradine + Primidone
Severity: Major
Ivabradine and Primidone: 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
Primidone is metabolized to phenobarbital and shares its CYP3A4-inducing effect. Ivabradine concentrations may fall and its heart rate effect may be diminished.
What this interaction means in plain words
Ivabradine and Primidone 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.
Ivabradine belongs to Cardiovascular; Primidone belongs to Central Nervous System.
Why it happens
Primidone and its metabolite phenobarbital induce CYP3A4, increasing the clearance of ivabradine.
What to do
Avoid the combination if an alternative anticonvulsant is possible. Otherwise monitor heart rate and symptoms and adjust the ivabradine dose as needed.
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 Ivabradine
- Atazanavir + Ivabradine Contraindicated
- Clarithromycin + Ivabradine Contraindicated
- Cobicistat + Ivabradine Contraindicated
- Conivaptan + Ivabradine Contraindicated
- Darunavir + Ivabradine Contraindicated
- Diltiazem + Ivabradine Contraindicated
Other interactions of Primidone
- Lorlatinib + Primidone Contraindicated
- Lurasidone + Primidone Contraindicated
- Primidone + Ranolazine Contraindicated
- Primidone + Sofosbuvir-velpatasvir-voxilaprevir Contraindicated
- Primidone + Voriconazole Contraindicated
- Abiraterone + Primidone Major
Frequently asked questions
Can I take Ivabradine with Primidone?
MediHelp rates the interaction as major. Ivabradine and Primidone 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. Primidone is metabolized to phenobarbital and shares its CYP3A4-inducing effect. Ivabradine concentrations may fall and its heart rate effect may be diminished.
How serious is the interaction between Ivabradine and Primidone?
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 an alternative anticonvulsant is possible. Otherwise monitor heart rate and symptoms and adjust the ivabradine dose as needed.
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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