Ivabradine

  Issues for Surgery

For treatment of angina/heart failure – exacerbation of symptoms if omitted.

Increased risk of bradycardia if continued.

  Advice in the Perioperative period

Elective and Emergency Surgery

Continue – monitor heart rate.

Post-operative Advice

Restart post-operatively as soon as next dose is due.

  Interaction(s) with Common Anaesthetic Agents

Bradycardia

Ivabradine can increase the risk of bradycardia when used concomitantly with the following¹: -

• alfentanil, fentanyl or remifentanil
• neostigmine
• propofol
• suxamethonium

  Interaction(s) with other Common Medicines used in the Perioperative Period

Ondansetron

The risk of QT-interval prolongation with concomitant use of ondansetron might be exacerbated by bradycardia caused by ivabradine leading to increased risk of torsades de pointes^{1, 2, 3}. The manufacturer of ivabradine advises avoid the combination⁴. If unavoidable monitor cardiac effects (i.e. heart rate) closely.

  Further Information

None relevant.

  References

1. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 5^th May 2019]
2. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 5^th May 2019]
3. Ivabradine. In: Brayfield A (Ed), Martindale: The Complete Drug Reference. London: The Royal Pharmaceutical Society of Great Britain. http://www.medicinescomplete.com [Accessed 5^th May 2019] Summary of Product Characteristics – Ivabradine 2.5mg film-coated tablets. Consilient Health Ltd
4. Accessed via www.medicines.org.uk 05/05/2019 [date of revision of the text March 2019]