Drug General Information (ID: DDIH54PDBS)
Drug Name			Edrophonium		Drug Info		Fingolimod		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidotes				Selective Immunosuppressants
Structure

Mechanism of Edrophonium-Fingolimod Interaction (Severity Level: Moderate)
Increased risk of atrioventricular block Click to Show/Hide Mechanism Graph
Drug Name		Edrophonium				Fingolimod
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 Edrophonium and Fingolimod
Increased risk of bradycardia Click to Show/Hide Mechanism Graph
Drug Name		Edrophonium				Fingolimod
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 Edrophonium and Fingolimod

Recommended Action
Management		Fingolimod has not been adequately studied in patients receiving other drugs that can slow the heart rate or AV conduction. Close monitoring is recommended during initiation of fingolimod treatment in these patients. The first dose should always be administered in a setting where resources to appropriately manage symptomatic bradycardia are available.

References
1	Product Information. Gilenya (fingolimod). Novartis Pharmaceuticals, East Hanover, NJ.
2	FDA. U.S. Food and Drug Administration "FDA Drug Safety Communication: Revised recommendations for cardiovascular monitoring and use of multiple sclerosis drug Gilenya (fingolimod).".