Cookie policy: This site uses cookies (small files stored on your computer) to simplify and improve your experience of this website. Cookies are small text files stored on the device you are using to access this website. For more information please take a look at our terms and conditions. Some parts of the site may not work properly if you choose not to accept cookies.

Join

Subscribe or Register

Existing user? Login

Prescribing advice

BNF updates advice on dual blockade and ivabradine use

Avoid combination therapy with drugs that affect the renin-angiotensin system and monitor patients taking ivabradine.

ECG monitoring machine

Source: Zayacskz / Dreamstime.com

Patients taking ivabradine should be monitored for bradycardia (a resting heart rate below 60 beats per minute)

Warnings on “dual blockade” — the concomitant use of drugs that affect the renin-angiotensin system (RAS) — and on a cardiovascular risk associated with ivabradine are highlighted in the August 2014 update from the British National Formulary (BNF).

The BNF advice on combining drugs affecting the RAS — the hormone system that regulates blood pressure and water balance — recommends avoidance of combination therapy with two drugs that affect the RAS system (ACE [angiotensin converting enzyme] inhibitors, angiotensin II receptor agonists and aliskiren). Compared with the use of a single drug, there is an increased risk of hyperkalaemia, hypotension and renal impairment when two drugs are used.

The advice has been updated in the light of new guidance from the Medicines and Healthcare products Regulatory Agency (MHRA), which is itself the product of a European review.

The update points out there is evidence that the benefits of combined use of an ACE inhibitor with candesartan or valdesartan may outweigh the risks for some heart failure patients for whom other treatments are not suitable. But the use of this combination at the same time as an aldosterone agonist or a potassium-sparing diuretic is not recommended.

The need for continued review of patients who are currently taking combination therapy is also highlighted.

Patients taking ivabradine should be monitored for bradycardia

The BNF update draws attention to an increased cardiovascular risk with ivabradine, which is prescribed for patients with long-term stable angina or long-term heart failure. It warns that patients taking the drug should be monitored for bradycardia (a resting heart rate below 60 beats per minute), after results from the Signify trial showed a small increased risk of cardiovascular events that may be associated with the condition.

Advice on new TB and hepatitis C drugs

The update includes advice about the new antimycobacterial drug delamanid (Deltyba; Otsuka), which has been licensed, in combination with other drugs, for the treatment of multiple drug resistant pulmonary tuberculosis.

The update also contains information about simeprevir (Olysio; Janssen/Medivir), a new protease inhibitor that has been licensed for use in combination with ribavirin and peginterferon alfa for the treatment of chronic hepatitis C infection of genotypes 1 or 4. Simeprevir may also be used in combination with sofosbuvir, with or without ribavirin, for urgent treatment of the infection only when peginterferon cannot be used owing to intolerance or contraindications, and simeprevir monotherapy is not recommended.

 

 

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.20066216

Have your say

For commenting, please login or register as a user and agree to our Community Guidelines. You will be re-directed back to this page where you will have the ability to comment.

Recommended from Pharmaceutical Press

  • Patient Care in Community Practice

    Patient Care in Community Practice

    Patient Care in Community Practice is a unique, practical guide for healthcare professionals or carers. Covers a range of non-medicinal products suitable for use at home.

    £22.00Buy now
  • Pharmacy OSCEs

    Pharmacy OSCEs

    The only pharmacy-specific OSCE revision guide. This easy-to-use book covers the key competencies that will be tested in your exams.

    £25.00Buy now
  • Physicochemical Principles of Pharmacy

    Physicochemical Principles of Pharmacy

    This established textbook covers every aspect of drug properties from the design of dosage forms to their delivery by all routes to sites of action in the body.

    £48.00Buy now
  • Introduction to Renal Therapeutics

    Introduction to Renal Therapeutics

    Introduction to Renal Therapeutics covers all aspects of drug use in renal failure. Shows the role of the pharmacist in patient care for chronic kidney disease.

    £38.00Buy now
  • Handbook of Pharmaceutical Excipients

    Handbook of Pharmaceutical Excipients

    The Handbook of Pharmaceutical Excipients contains essential data on the physical properties of excipients, their safe use and potential toxicity.

    £415.00Buy now

Search an extensive range of the world’s most trusted resources

Powered by MedicinesComplete
  • Print
  • Share
  • Comment
  • Save
  • Print Friendly Version of this pagePrint Get a PDF version of this webpagePDF

Newsletter Sign-up

Want to keep up with the latest news, comment and CPD articles in pharmacy and science? Subscribe to our free alerts.