Rifampin and Ivabradine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Rifampin
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
Decreased exposure of ivabradine
Interaction Deep Dive
Avoid concomitant use of ivabradine (CYP3A4 substrate) with a CYP3A4 inducer due to the potential for decreased ivabradine exposure. In a pharmacokinetic study, the coadministration of St John's Wort (300 mg 3 times a day) decreased the ivabradine Cmax and AUC by approximately half relative to ivabradine given alone1.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of ivabradine
Literature reports
1 report — tap to read
a) In a systematic review of studies of pharmacokinetic interactions involving St John's Wort, concomitant use with ivabradine in 1 study (N=12) resulted in a decrease in ivabradine AUC of 62% with a St John's Wort product dosage of 300 mg 3 times daily (containing hyperforin dosage of 7.5 mg/day) 2.
Common questions
Can I take Rifampin and Ivabradine together?
Decreased exposure of ivabradine Always confirm with your pharmacist or prescriber before making any change.
How serious is the Rifampin and Ivabradine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
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.
Questions for your pharmacist
- Does my dose of Rifampin 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 (2)
- Product Information: CORLANOR(R) oral tablets, ivabradine oral tablets. Amgen Inc. (per Manufacturer), Thousand Oaks, CA, 2015. DailyMed
- Chrubasik-Hausmann S, Vlachojannis J, & McLachlan AJ: Understanding drug interactions with St John's wort (Hypericum perforatum L.): impact of hyperforin content. J Pharm Pharmacol 2019; 71(1):129-138.
Keep reading about Rifampin
Keep reading about Ivabradine
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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