Multaq interactions: Alcohol, medications, and other factors

Before you start treatment with Multaq, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Multaq interacts with supplements, herbs, or vitamins, see the “Multaq and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Multaq. Keep in mind that this table doesn’t include all drugs that may interact with Multaq. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For details about this interaction, see the “Drug interactions in depth” section below.
† For details about this interaction, see the “When to avoid Multaq” section below.
‡ To learn about Multaq’s side effects, see this article.

In some cases, factors or conditions could prevent your doctor from prescribing Multaq due to the risk of harm. These are known as contraindications. The contraindications of Multaq include:

Having permanent AFib or severe heart failure

Doctors typically won’t prescribe Multaq for people with permanent AFib or certain severe types of heart failure.

This is because Multaq has boxed warnings about the increased risk of death, stroke, and heart failure in people with these conditions. A boxed warning is the most serious warning from the FDA. For details, see the section about boxed warnings at the beginning of this article.

Having certain heart rhythm or heart rate problems

Doctors typically won’t prescribe Multaq for people with certain heart rhythm or heart rate problems. These include:

• second-degree heart block, third-degree heart block, or sick sinus syndrome that isn’t managed with a heart pacemaker
• a slow heart rate of fewer than 50 beats per minute

This is because Multaq may cause heart rhythm or heart rate problems as side effects. As a result, taking Multaq could worsen any heart rhythm or heart rate problems you already have. To learn about Multaq’s side effects, see this article.

If you have a heart rhythm or heart rate problem, talk with your doctor before taking Multaq. They’ll recommend whether it’s safe to take Multaq. If needed, your doctor may prescribe an alternative to Multaq for your condition.

Having severe liver disease

Doctors typically won’t prescribe Multaq for people with severe liver disease, including liver failure. It isn’t known for certain whether Multaq is safe for people with severe liver disease. This is because Multaq may cause liver damage, which can worsen severe liver disease.

If you have liver disease, talk with your doctor before taking Multaq. They’ll likely prescribe an alternative to Multaq for your condition.

Having lung or liver problems with amiodarone

Doctors typically won’t prescribe Multaq for people with lung or liver problems from past treatment with amiodarone (Nexterone, Pacerone). This is because Multaq is similar to amiodarone, so you may have a high risk of these same side effects with Multaq.

If you’ve had lung or liver problems with amiodarone, talk with your doctor before taking Multaq. They’ll likely prescribe an alternative to Multaq for your condition.

Taking certain drugs that affect the level of Multaq

Doctors typically won’t prescribe Multaq in combination with certain medications that can increase the level of Multaq in your body. This is because taking Multaq with these drugs could raise your risk of side effects from Multaq.

Below are a few examples of drugs that can increase the level of Multaq:

• certain antifungal drugs, such as itraconazole (Sporanox, Tolsura) and voriconazole (Vfend)
• certain antibiotic drugs, such as clarithromycin and erythromycin (Eryc, Ery-Tab, others)
• cyclosporine (Gengraf, Neoral, others)
• nefazodone
• ritonavir (Norvir)

Before you start treatment with Multaq, it’s important to tell your doctor about other medications you take. They’ll tell you whether it’s safe to take Multaq or recommend an alternative treatment.

Taking certain drugs that increase the risk of long QT syndrome

Doctors typically won’t prescribe Multaq in combination with certain medications that increase the risk of long QT syndrome. This is a condition that affects the heart’s rhythm and electrical activity. Taking Multaq with these drugs could raise your risk of long QT syndrome as a side effect of Multaq.

Below are a few examples of drugs that may increase the risk of long QT syndrome:

• tricyclic antidepressants, such as amitriptyline and nortriptyline (Pamelor)
• certain antipsychotic drugs, such as fluphenazine, perphenazine, trifluoperazine
• certain antibiotic drugs, such as azithromycin (Zithromax) and erythromycin (Eryc, Ery-Tab, others)
• certain irregular heart rhythm drugs, such as propafenone and dofetilide (Tikosyn)

Before you start treatment with Multaq, tell your doctor about other medications you take. They’ll help determine whether it’s safe to take Multaq or recommend an alternative treatment.

Having had an allergic reaction to Multaq or any of its ingredients

If you have had an allergic reaction to Multaq or any of its ingredients, your doctor will likely not prescribe Multaq. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Multaq, it’s important to tell your doctor if any of these contraindications apply to you. They can determine whether to prescribe Multaq.

There aren’t any known interactions between Multaq and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during Multaq treatment.

This is because consuming large amounts of alcohol can cause liver damage. Multaq may also cause liver damage as a side effect.* This means that drinking alcohol during Multaq treatment may increase the risk of liver problems.

If you have questions about drinking alcohol while taking Multaq, talk with your doctor or pharmacist.

* For details about Multaq’s side effects, see this article.

Here’s a closer look at certain drug interactions of Multaq.

Certain blood thinners

Blood thinners are prescribed to help prevent or treat blood clots in certain situations.

Interaction result: Taking Multaq with certain blood thinners may increase the risk of serious bleeding with blood thinners.

Interaction explained: Taking Multaq with certain blood thinners can cause your body to break down the blood thinner more slowly. This may raise the level of the blood thinner in your body, increasing your risk of bleeding as a side effect.

Examples of blood thinner drugs: Here are some blood thinners that may interact with Multaq:

• rivaroxaban (Xarelto)
• dabigatran (Pradaxa)
• warfarin

Steps you or your doctor may take: Before starting Multaq treatment, tell your doctor if you’re taking a blood thinner. They can advise whether it’s safe to take these medications together.

If they determine that it’s safe, your doctor may lower the dosage of your blood thinner in certain situations. Doing so may help reduce the risk of bleeding.

If you have questions about taking Multaq and certain blood thinners, talk with your doctor or pharmacist.

Certain calcium channel blockers

Calcium channel blockers (CCBs) are prescribed to treat high blood pressure and certain heart conditions.

Interaction result: Taking Multaq with certain CCBs may increase the risk of side effects from either drug. To learn about Multaq’s side effects, see this article.

Interaction explained: Taking Multaq with certain CCBs can cause your body to break down the CCB more slowly than it should. This may lead to a high level of the CCB in your system, increasing your risk of side effects from the CCB.

In addition, taking Multaq and CCBs may cause problems with the electrical activity in your heart. This can occur when either drug is taken individually, and the risk may be greater when they’re taken together.

Examples of CCB drugs: Here are some CCBs that may interact with Multaq:

• diltiazem (Cardizem, Tiazac, others)
• verapamil (Verelan, Verelan PM)
• amlodipine (Katerzia, Norvasc, others)
• felodipine
• isradipine

Steps you or your doctor may take: Before taking Multaq, be sure your doctor knows if you’re taking a CCB. They can advise you on whether it’s safe to take these medications together. If your doctor says it’s safe, they may prescribe a lower dosage of the CCB. This may help reduce the risk of side effects.

If you have other questions about Multaq and certain CCBs, talk with your doctor or pharmacist.

Beta-blockers

Beta-blockers are prescribed for high blood pressure, angina (a type of chest pain), and certain other heart conditions.

Interaction result: Taking Multaq with beta-blockers can increase the risk of a slow heart rate as a side effect of either drug.

Interaction explained: When taken individually, Multaq and beta-blockers may slow your heart rate. Taking these medications together further increases this risk.

Examples of beta-blocker drugs: Here are some beta blockers that may interact with Multaq:

• atenolol (Tenormin)
• bisoprolol
• carvedilol (Coreg, Coreg CR)
• metoprolol (Lopressor, Toprol XL, others)
• propranolol (Hemangeol, Inderal LA, others)

Steps you or your doctor may take: Before you start Multaq treatment, be sure your doctor knows if you’re taking a beta-blocker. They can tell you whether these medications are safe together.

If your doctor prescribes Multaq with a beta-blocker, they may prescribe a lower dosage of the beta-blocker. Doing so may help lower the risk of having a slow heart rate.

To learn more about Multaq and beta-blockers, talk with your doctor or pharmacist.

Multaq may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Multaq.

Multaq interactions with supplements

Before you start treatment with Multaq, tell your doctor and pharmacist about supplements, herbs, or vitamins you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Multaq interactions with herbs

Doctors will typically recommend you avoid taking St. John’s wort with Multaq. St. John’s wort is an herbal supplement that people may take for depression and other conditions.

St. John’s wort may cause Multaq to break down more quickly in your body. This may lead to a low level of Multaq in your system. If the level of Multaq in your system is too low, the drug may not work as well for your condition.

You can talk with your doctor about alternatives to St. John’s wort that may be safe for you while taking Multaq.

Multaq and vitamins

There are no specific reports of vitamins interacting with Multaq. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Multaq.

Multaq interactions with food

Grapefruit products can interact with Multaq. Specifically, grapefruit and grapefruit juice can stop your body from breaking down Multaq. This raises the level of Multaq in your system, which increases your risk of side effects from the drug.* Due to this risk, your doctor may recommend avoiding grapefruit products while taking Multaq.

* For details about Multaq’s side effects, see this article.

Multaq and vaccines

There aren’t any known interactions between Multaq and vaccines. Talk with your doctor or pharmacist to determine whether you’re due for any vaccines.

Multaq and lab tests

Multaq isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

MULTAQ INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Multaq.

The effect of cannabis products on Multaq can vary from person to person. For example, cannabis products may raise or lower the level of Multaq in your body. An increased level of Multaq can raise your risk of side effects from Multaq. A reduced level of Multaq may cause the drug to be less effective at treating your condition.

Before you start treatment with Multaq, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Multaq. Before you take this drug, be sure to talk with your doctor about your health history. Multaq may not be the right treatment option for you if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Multaq include:

• Permanent AFib or severe heart failure: Doctors typically won’t prescribe Multaq for people with permanent AFib or certain severe types of heart failure. This is because Multaq has boxed warnings about the increased risk of death, stroke, and heart failure in people with these conditions. This is the most serious warning from the FDA. A boxed warning alerts doctors and patients about drug effects that may be dangerous. For details, see the boxed warning section at the top of this article.
• Certain heart rhythm or heart rate problems: Doctors typically won’t prescribe Multaq for people with certain heart rhythm or heart rate problems. To learn more, see the “When to avoid Multaq” section above.
• Severe liver disease: Doctors typically won’t prescribe Multaq for people with severe liver disease. To learn more, see the “When to avoid Multaq” section above.
• Lung or liver problems with amiodarone: Doctors typically won’t prescribe Multaq for people who’ve had lung or liver problems with amiodarone. To learn more, see the “When to avoid Multaq” section above.
• Allergic reaction: If you’ve had an allergic reaction to Multaq or any of its ingredients, your doctor will likely not prescribe Multaq. Taking the drug again could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
• Breastfeeding: It may not be safe to take Multaq while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Multaq may have on a child who is breastfed. However, to be safe, your doctor may advise you not to breastfeed during Multaq treatment. If you’re breastfeeding or planning to, talk with your doctor before taking Multaq. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: It may not be safe to take Multaq while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth defects). However, it’s important to note that animal studies don’t always indicate what may happen in humans. If you’re pregnant or planning to become pregnant, tell your doctor before starting Multaq. They can advise you on the right treatment plan for you.

Here are some answers to frequently asked questions about Multaq and possible interactions.

Is there a Multaq and Eliquis interaction?

No, there are no specific reports of Multaq interacting with Eliquis (apixaban). Eliquis is a blood thinner that’s prescribed to help prevent or treat blood clots in certain situations.

However, Multaq may interact with other blood thinners, such as Xarelto (rivaroxaban). For details about this interaction, see the “Drug interactions in depth” section above.

If you’re interested in taking Eliquis with Multaq, talk with your doctor. They’ll determine whether it’s safe to take these medications together.

Is it safe to have Multaq and caffeine together?

In general, yes, it’s safe to take Multaq with caffeine. There aren’t reports of these medications interacting with each other.

However, the American Heart Association advises people with AFib to avoid consuming large amounts of caffeine. (Multaq is prescribed to help reduce the risk of hospitalization in certain people with AFib.) For this reason, your doctor may recommend that you limit caffeine consumption during your Multaq treatment.

Examples of foods and beverages that contain caffeine include:

• chocolate
• coffee
• energy drinks
• tea

Before consuming caffeine with Multaq, talk with your doctor or pharmacist. They can suggest an amount of caffeine that’s safe for you.

You can take certain steps to help prevent interactions with Multaq. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Multaq label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

IfMultaq doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Multaq by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Multaq. These resources might help:

• Overview of Multaq. For a general overview of Multaq, you can see this article.
• Side effects. If you’re interested in the side effects of Multaq, see this article. Another option is to refer to the Multaq prescribing information.
• Dosage specifics. To learn about the dosage of Multaq, see this article.
• Cost. If you’d like to learn about Multaq and cost, see this article.
• Facts about AFib. To learn more about your condition, see our list of AFib articles.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.