Generic

Ivabradine

Indications

Symptomatic therapy of chronic stable angina pectoris in individuals with coronary artery disease and normal sinus rhythm. Ivabradine is prescribed for the following conditions:

• In people who are unable to tolerate beta-blockers or have a contraindication to their usage,
• In conjunction with beta-blockers in individuals who are not effectively managed with an optimum beta-blocker dose and have a heart rate of more than 60 beats per minute.

Pharmacology

Ivabradine is a pure heart rate reducer. It works by inhibiting the cardiac pacemaker I f current, which controls spontaneous diastolic depolarization in the sinus node and regulates heart rhythm. Ivabradine reduces cardiac strain and hence oxygen consumption by lowering heart rate. Ivabradine also prolongs diastole, allowing for greater perfusion of coronary arteries and oxygen delivery to the heart. The cardiac effects are restricted to the sinus node and have no influence on intra-atrial, atrioventricular, or intraventricular conduction times, myocardial contractility, or ventricular repolarization.

Dosage & Administration

Adult: The usual recommended starting dose of Ivabradine is 5 mg twice daily which may be increased after 3-4 weeks of treatment to 7.5 mg twice daily, depending on therapeutic response. Usual dose is 1 tablet in the morning and 1 tablet in the evening during meals. If the heart rate decreases persistently below 50 bpm at rest or if symptoms related to bradycardia, the dose must be adjusted downwards to 2.5 mg twice daily (one half of the 5 mg tablet twice daily). Treatment must be discontinued if heart rate remains below 50 bpm or symptoms of bradycardia persist.

Elderly: Consider a lower starting dose (2.5 mg twice daily i.e. one half 5 mg tablet twice daily).

Interaction

The use of QT wave prolonging medications is not advised. Medications that extend the QT wave in the heart (e.g. quinidine, disopyramide, bepridil, sotalol, ibutilide, amiodarone). Non-cardiovascular QT wave lengthening pharmaceuticals (e.g. pimozide, ziprasidone, sertindole, mefloquine, halofantrine, pentamidine, cisapride, intravenous erythromycin). Concurrent use of cardiovascular and noncardiovascular QT wave prolonging medications with ivabradine should be avoided since QT wave prolonged can be worsened by a decrease in heart rate. Close cardiac monitoring is required if the combination appears to be essential.

Contraindications

Resting heart rate less than 60 beats per minute prior to therapy, cardiogenic shock, acute myocardial infarction, severe hypotension (90/50 mmHg), severe hepatic insufficiency, sick sinus syndrome, sino-atrial block, heart failure, pacemaker dependent, unstable angina, 3rd degree AV block, in conjunction with potent cytochrome P-450 3A4 inhibitors (such as azole antifungals, macrolide antibiotics, HIV protease inhibitors).

Side Effects

Visual symptoms, blurred vision, bradycardia, first degree AV block, ventricular extrasystoles, headaches, and dizziness are all possible.

Pregnancy & Lactation

In rat studies, there was no influence on male or female fertility. There is no or little data on the usage of ivabradine in pregnant women. As a result, ivabradine is not recommended during pregnancy. According to animal research, ivabradine is secreted in milk. As a result, ivabradine is not recommended during breast-feeding.

Precautions & Warnings

Mild to moderate hypotension, atrial fibrillation, congenital QT syndrome, or treatment with QT wave lengthening medications Hepatic insufficiency is moderate, while renal insufficiency is severe.

Therapeutic Class

Other anti-anginal and anti-ischaemic medications

Storage Conditions

Keep below 30°C and away from light and moisture. Keep out of children's reach.

Pharmaceutical Name