Drug interactions
Ivabradine + St john's wort
Severity: Major
Ivabradine and St john's wort: major 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
St John's wort induces CYP3A4 and reduces ivabradine plasma concentrations. This can lessen the heart rate effect and reduce clinical benefit.
What this interaction means in plain words
Ivabradine and St john's wort 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
Hyperforin in St John's wort activates PXR, inducing CYP3A4 and increasing ivabradine metabolism.
What to do
Avoid the combination and counsel patients not to use St John's wort. If it is stopped, monitor for increased ivabradine effect and bradycardia as induction wanes.
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
Frequently asked questions
Can I take Ivabradine with St john's wort?
MediHelp rates the interaction as major. Ivabradine and St john's wort 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. St John's wort induces CYP3A4 and reduces ivabradine plasma concentrations. This can lessen the heart rate effect and reduce clinical benefit.
How serious is the interaction between Ivabradine and St john's wort?
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 and counsel patients not to use St John's wort. If it is stopped, monitor for increased ivabradine effect and bradycardia as induction wanes.
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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