Ivabradine

Ivabradine is a medication used to lower heart rate in patients with certain heart conditions. It works by inhibiting the funny current (If) in the sinoatrial node, thereby reducing heart rate without affecting myocardial contractility or blood pressure.

Indications

-Treatment of chronic stable angina pectoris in patients with normal sinus rhythm who have contraindications or intolerance to beta-blockers. -Symptomatic treatment of chronic heart failure in patients with reduced left ventricular ejection fraction (LVEF ? 35%), in combination with standard therapy in adult patients.

Dosage

-For chronic stable angina: Typically start with 5 mg twice daily, may increase to 7.5 mg twice daily if needed. -For chronic heart failure: Start with 2.5 mg twice daily, may increase up to 7.5 mg twice daily depending on tolerability.

Contra-Indications

-Hypersensitivity to Ivabradine or any components of the formulation. -Severe liver impairment. -Pacemaker-dependent cardiac rhythm.

Special Precautions

-Regular monitoring of heart rate and clinical response is recommended. -Avoid use in patients with atrial fibrillation or flutter. -Use caution in patients with bradycardia (resting heart rate < 60 bpm), severe hypotension, or patients at risk of developing QT prolongation.

Side Effects

Common side effects include luminous phenomena (phosphenes), bradycardia, atrial fibrillation, and dizziness.

Drug Interactions

-CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) may increase Ivabradine levels. -CYP3A4 inducers (e.g., rifampicin, phenytoin) may decrease Ivabradine levels. -Use with caution with other drugs that prolong the QT interval.