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Ivabradine interaction in bradycardia — GPhC CRA MCQ

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HardCardiovascular TherapeuticsIvabradine interaction in bradycardiaGPhC CRA

A patient with chronic heart failure takes ivabradine 5 mg twice daily and bisoprolol 5 mg daily. Resting pulse is 48 beats/min on two readings and he reports dizziness and fatigue. ECG shows sinus rhythm. What is the most appropriate recommendation?

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Correct answer: B — Reduce ivabradine to 2.5 mg twice daily and reassess the bradycardia

The ivabradine SmPC advises dose reduction when resting heart rate is persistently below 50 beats/min or symptoms related to bradycardia occur. From 5 mg twice daily, the licensed lower dose is 2.5 mg twice daily; treatment is stopped if the low rate or symptoms persist despite dose reduction. The wider heart-failure regimen still needs clinical review, but improvised once-daily or intermittent dosing is not the stated adjustment.

Reference: Ivabradine 5 mg tablets SmPC: https://www.medicines.org.uk/emc/product/101787/smpc