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.
Restart post-operatively as soon as next dose is due.
Interaction(s) with Common Anaesthetic Agents
Ivabradine can increase the risk of bradycardia when used concomitantly with the following1: -
Interaction(s) with other Common Medicines used in the Perioperative Period
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.