Ivabradine

Cardiac Therapy · Sinus node II inhibitor

Indications

Chronic stable angina, in coronary artery disease in patients with normal sinus rhythm who have a contraindication or intolerance to ß-Blockers when monotherapy is inadequate and heart rate > 60 beats per minute. Stable chronic heart failure (NYHA II-IV) with systolic dysfunction in patients in sinus rhythm with heart rate = 75 beats per minute in combination with standard therapy, including a ß-Blockers, or when ß-Blockers contraindicated, or not tolerated.

Dosage

Adults: Angina and Heart Failure: Initially 5 mg twice daily with morning and evening meals. Adjust dose according to response and heart rate, range 2.5-7.5 mg twice daily. Heart rate at rest should not be allowed to fall below 50 beats/min. Elderly: Initially 2.5 mg twice daily, heart rate at rest should not be allowed to fall below 50 beats/min. Children: Not recommended.

Adverse Effects

Luminous Phenomena, blurred vision, bradycardia, 1st degree AV block, ventricular extra systole, blood pressure changes, atrial fibrillation, headache and dizziness.

Risk Factor (Pregnancy/Lactation)

Pregnancy: Contraindicated in pregnancy. Lactation: Contraindicated or not recommended. Contraindications: Pretreatment resting heart rate < 60 beats per minute. Persistent symptoms of bradycardia or if heart rate persistently < 50 beats per minute. Cardiogenic shock, acute MI, severe hypotension (< 90/50 mm Hg), sick sinus syndrome, sino-atrial block, unstable or acute heart failure, pacemaker dependent, unstable angina, 2nd or 3rd degree AV block, cardiac arrhythmias, severe hepatic impairment, immediately after stroke. Precautions: Mild to moderate hypotension, renal insufficiency (Cr Cl < 15 mL/min), moderate hepatic impairment. Monitor regularly for atrial fibrillation, QT syndrome or QT prolongation. Intraventricular conduction defects and ventricular dyssynchrony; monitor closely. Monitor BP after any treatment changes. Heart failure (NYHA IV). Retinitis pigmentosa. Elderly = 75…

Interactions

CYP3A4 inducers and inhibitors, thiazides, loop diuretics, Ca Channel blockers, drugs that prolong the QT interval, grapefruit juice.

Advice to Patient

Take with meals. Avoid excessive intake of grapefruit juice. Inform prescriber before starting the medication if any surgery is due.

Pharmacokinetics

Metabolism: Extensively intestinal and hepatic. Bioavailability: Approx. 40%. Half-life elimination: Distribution: 2 hrs. Effective: Approx. 6 hrs. Time to peak, plasma: Fasting: Approx. 1 hr. With food: Approx. 2 hrs. Excretion: Urine.

Compiled by Healify Pharmacy from published drug references. How we compile it →

Always consult a pharmacist or doctor.