Clarithromycin and Ivabradine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clarithromycin
Ivabradine
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased ivabradine exposure, an increased risk of ivabradine-related adverse effects and an increased risk of QT prolongation
Interaction Deep Dive
The concomitant use of ivabradine (a CYP3A4 substrate) with strong CYP3A4 inhibitors that also prolong the QT interval is contraindicated due to the potential for increased ivabradine exposure, an increased ivabradine-related adverse effects [like bradycardia and conduction disturbances] and additive QT prolongation. In a pharmacokinetic study, the coadministration of ketoconazole (200 mg once daily) increased the ivabradine Cmax by almost 4-fold and the AUC by almost 8-fold relative to ivabradine given alone1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of ivabradine; additive QT interval prolongation
Common questions
Can I take Clarithromycin and Ivabradine together?
Increased ivabradine exposure, an increased risk of ivabradine-related adverse effects and an increased risk of QT prolongation Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clarithromycin and Ivabradine interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Clarithromycin or Ivabradine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: CORLANOR(R) oral tablets, oral solution, ivabradine oral tablets, oral solution. Amgen Inc (per FDA), Thousand Oaks, CA, 2021. DailyMed
Keep reading about Clarithromycin
Keep reading about Ivabradine
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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