- Ivabradine is extensively metabolized by CYP3A4 and has significant pharmacokinetic interactions with lopinavir/ritonavir, making concurrent use contraindicated.
- Combining these drugs can lead to significantly increased plasma concentrations of ivabradine, potentially causing severe bradycardia.

Rutgers University

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- Anticoagulants and antiplatelet drugs
- Lipid lowering drugs
- Anti-hypertensives
- Drugs in heart failure
- Drugs in angina pectoris
- Anti-arrhythmic drugs
- Oral anti-diabetics

Drugs in Cardiovascular Disease

- Use of low molecular weight or unfractionated heparin recommended depending on the situation
- Antivitamin K and DOACs are not recommended 
- Effects of some drugs may be reduced in effect by combination with enzyme inhibitors like lopinavir

Anticoagulants and antiplatelet drugs

- Statin toxicity can be increased by additive effects in combination with lopinavir
- Monitoring is necessary and statin dosage may have to be reduced
- Pravastatin is least prone to interactions

Lipid lowering drugs

- Combining eplerenone with lopinavir/ritonavir (lopinavir/r) increases the plasma exposure of eplerenone.
- Replacing eplerenone with spironolactone is worth consideration to mitigate this drug-drug interaction.

Drugs in heart failure

- Lopinavir/r increases the exposure of quinidine and propafenone (class I AADs or sodium channel blockers) which could cause cardiac disorders
- ECG monitoring required
- Class III AADs (or potassium channel blockers) like amiodarone are contraindicated in combination with lopinavir/r due to an increased risk of torsade de pointes

Anti-arrhythmic drugs

- Lopinavir/r can cause hyperglycemia
- Hydroxychloroquine can worsen hypoglycemia
- Exposure of sulphonylureas can be reduced by ritonavir
- Exposure and concentration of gliptins can be increased by lopinavir/r
- Case by case assessment of COVID-19 patients is necessary when considering oral anti-diabetics 

Oral anti-diabetics

Anti-hypertensive drugs exhibit varying pharmacokinetic interactions with COVID-19 treatments. While sartans and diuretics are not prone to significant interactions, combining calcium channel blockers (CCBs) or beta blockers with lopinavir/ritonavir (lopinavir/r) can increase the plasma exposure of the anti-hypertensives. Furthermore, hydroxychloroquine can also increase the exposure of beta blockers. The concurrent use of the beta blocker metoprolol with lopinavir/r is contraindicated.

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