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
  • cisatracurium
  • neostigmine


  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 pointes1, 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 5th May 2019]
  2. Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 5th 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 5th 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]