Ivabradine ๐
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โน๏ธ About
Always check the BNF link here ๐ for the most up-to-date guidance.
โ๏ธ Mode of Action
- Selective โfunny currentโ (If) channel blocker at the sinoatrial (SA) node
- Slows pacemaker activity without affecting contractility or blood pressure.
๐ Indications & Dose
- Chronic stable angina in sinus rhythm, LVEF <35%, or intolerance to ฮฒ-blockers.
- Chronic heart failure (NYHA class IIโIV) symptomatic HFrEF, LVEF โค35%, sinus rhythm, resting HR โฅ75 bpm despite optimised beta-blocker therapy or beta-blocker intolerance; specialist initiation..
๐ Dose Range (check BNF for details)
| Name | Dose | Frequency | Route |
| Ivabradine | 2.5โ5 mg | BD | PO |
โ ๏ธ Interactions
- See BNF - avoid with potent CYP3A4 inhibitors, diltiazem, verapamil.
๐ Cautions
- Avoid if resting HR <60 bpm, or HR <75 bpm in heart failure.
- Contraindicated with diltiazem/verapamil (risk of profound bradycardia).
- Use caution in heart block, long QT syndrome, recent MI, or cardiogenic shock.
๐ซ Contraindications
- See BNF - sinus bradycardia, severe hypotension, sick sinus syndrome, acute decompensated heart failure, pacemaker dependence.
โ Side Effects
- Bradycardia (dose-dependent) ๐
- Atrial fibrillation โก
- Visual phenomena (โphosphenesโ - transient enhanced brightness) ๐
- Dizziness, headache, fatigue (less common).
๐ References
๐ Revisions