Drug interactions
Ivabradine + Quinidine
Severity: Major
Ivabradine and Quinidine: 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
Quinidine inhibits CYP3A4 and may increase ivabradine exposure, while ivabradine itself can cause bradycardia. Quinidine's QT prolongation adds to arrhythmic risk in a patient with slowed heart rate.
What this interaction means in plain words
Ivabradine and Quinidine 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; Quinidine belongs to Anti Parasitic.
Why it happens
CYP3A4 inhibition by quinidine increases ivabradine levels, plus pharmacodynamic bradycardia and QT effects.
What to do
Avoid the combination where possible, choosing an alternative antiarrhythmic. If unavoidable, monitor heart rate and ECG closely and reduce 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?
Pro+ members
Unlock the full page
Create an account and start a Pro+ trial to unlock the full management advice for Ivabradine and Quinidine, the additional notes, the evidence detail and the whole-prescription interaction checker.
- Full clinical management advice
- Additional notes
- Evidence detail
- Interaction checker for a whole prescription
Try Pro+ free for 7 days on the web. No card needed.
References
Other interactions of Quinidine
- Adagrasib + Quinidine Contraindicated
- Arsenic trioxide + Quinidine Contraindicated
- Artemether / lumefantrine + Quinidine Contraindicated
- Chloroquine + Quinidine Contraindicated
- Dofetilide + Quinidine Contraindicated
- Dronedarone + Quinidine 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 Ivabradine with Quinidine?
MediHelp rates the interaction as major. Ivabradine and Quinidine 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. Quinidine inhibits CYP3A4 and may increase ivabradine exposure, while ivabradine itself can cause bradycardia. Quinidine's QT prolongation adds to arrhythmic risk in a patient with slowed heart rate.
How serious is the interaction between Ivabradine and Quinidine?
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 where possible, choosing an alternative antiarrhythmic. If unavoidable, monitor heart rate and ECG closely and reduce the ivabradine dose.
What other medicines interact with Quinidine?
MediHelp also lists interactions of Quinidine with, for example, Adagrasib, Arsenic trioxide, Artemether / lumefantrine. The full list is on the Quinidine page.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.
