ivabradine: clinical use

Prescribing considerations

• Confirm sinus rhythm and establish resting heart rate using serial measurements, ECG or ambulatory monitoring where appropriate.
• For angina, use is for symptom control; cardiovascular outcome benefit has not been demonstrated.
• Initiate heart-failure treatment only when the condition is stable and within the licensed systolic heart-failure population.
• Use caution with moderate hepatic impairment, severe renal impairment, mild-to-moderate hypotension, conduction defects, congenital long-QT syndrome and retinal disease.
• Reconsider treatment if atrial fibrillation or unexpected deterioration in visual function develops.

Contraindications and cautions

• Resting heart rate below the product’s licensed initiation threshold
• Cardiogenic shock, acute myocardial infarction, unstable angina or acute or unstable heart failure
• Severe hypotension or severe hepatic impairment
• Sick sinus syndrome, sinoatrial block, third-degree AV block or pacemaker dependence
• Concurrent verapamil, diltiazem or a strong CYP3A4 inhibitor
• Pregnancy, breastfeeding, or childbearing potential without effective contraception
• Hypersensitivity to ivabradine or product excipients

Monitoring

• Resting heart rate and symptoms of bradycardia
• Rhythm and symptoms suggesting atrial fibrillation; obtain an ECG when clinically indicated
• Blood pressure, particularly after changes to antihypertensive treatment
• Electrolytes and cardiac rhythm when potassium depletion or QT prolongation is a concern
• Visual symptoms, especially unexpected deterioration

Clinical pharmacology

Ivabradine selectively inhibits the sinus-node If current. It is metabolised through CYP3A4 and has an active N-desmethyl metabolite; inhibitors increase exposure and inducers reduce it.

Formulation and product differences

• The selected product is a film-coated tablet containing lactose.
• Do not assume that the selected tablet is divisible; scoring and approved divisibility vary between products.
• Products may differ in salt form, excipients, appearance and tablet scoring, so consult the specific product information and pack leaflet.

Tablet

Route: Oral

Strengths: 5 mg, 7.5 mg