Drug General Information (ID: DDIGL7SCEI)
Drug Name			Pilocarpine		Drug Info		Ozanimod		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Cholinergic Agents				Selective Immunosuppressants
Structure

Mechanism of Pilocarpine-Ozanimod Interaction (Severity Level: Moderate)
Increased risk of atrioventricular block Click to Show/Hide Mechanism Graph
Drug Name		Pilocarpine				Ozanimod
Mechanism 1		Delay atrioventricular conduction				Delay atrioventricular conduction
Key Mechanism Factor 1
		Factor Name		Atrioventricular block
		Factor Description		Atrioventricular block is a type of cardiac conduction block that occurs when the electrical signal from the atria to the ventricles is impaired. In an Atrioventricular block, this electrical signal is either delayed or completely blocked. When the signal is completely blocked, the ventricles produce their own electrical signal to control the heart rate. The heart rate produced by the ventricles is much slower than that produced by the sinus node.
Mechanism Description		Increased risk of atrioventricular block by the combination of Pilocarpine and Ozanimod
Increased risk of bradycardia Click to Show/Hide Mechanism Graph
Drug Name		Pilocarpine				Ozanimod
Mechanism 2		Bradycardia				Bradycardia
Key Mechanism Factor 2
		Factor Name		Bradycardia
		Factor Description		Bradycardia is a slow heart rate in which the heart beats less than 60 times per minute. If the heart rate is very slow and the heart is not pumping enough oxygen-rich blood to the body, and you may feel dizzy, very tired or weak, and short of breath.
Mechanism Description		Increased risk of bradycardia by the combination of Pilocarpine and Ozanimod

Recommended Action
Management		Ozanimod has not been adequately studied in patients receiving concomitant therapy with drugs that decrease heart rate. In addition, advice from a cardiologist should be sought if coadministration of ozanimod is considered in patients with significant QT prolongation (QTcF greater than 450 msec in males or 470 msec in females), patients with arrhythmias requiring treatment with Class 1a or Class III antiarrhythmic agents, patients with ischemic heart disease, heart failure, history of cardiac arrest or myocardial infarction, cerebrovascular disease, or uncontrolled hypertension. Use of ozanimod in patients with a history of second-degree Mobitz type II or higher AV block, sick-sinus syndrome, or sinoatrial heart block is considered contraindicated unless the patient has a functioning pacemaker.

References
1	Product Information. Zeposia (ozanimod). Celgene Corporation, Summit, NJ.