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Ivabradine

Molecule Description

Ivabradine is used to lower the heart rate and chest pain in patients who do not tolerate regular medications, and whose pumping efficiency of the heart is low.

Uses of Ivabradine

Prolonged standing chest pain which has a definite pattern of the same intensity and is aggravated by the same factors (chronic stable angina) in patients who are not tolerating regular medicines (Ivabradine can also be used in combination with other medicines used for the same condition). Decreased pumping efficiency of the heart for long term, with a heart rate ≥ 75 beats per minute (chronic heart failure).
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Contraindications of Ivabradine

When should one not use Ivabradine

  • Allergy to Ivabradine or any of its components
  • If your heart rate (at rest) before treatment is slow (less than 70 beats per minute)
  • Low blood pressure due to impaired pumping ability of the heart (cardiogenic shock)
  • Abnormal heart rhythms
  • Low blood pressure, prone to heart attacks
  • Sudden, severe irregular chest pain with no definite pattern (unstable angina)
  • If you have an artificial pacemaker
  • Severe liver disease (under treatment)

Side effects of Ivabradine

Common side effects of this drug are:

  • Visual disturbances (alternating between normal and increased brightness, a condition known as luminous visual phenomena)
  • Slowing down of heart rate
  • Rapid, irregular heartbeats, heavy heartbeats (palpitations - you can feel the pulse), high blood pressure, headache, feeling dizzy, spinning of the head (vertigo), blurry vision
  • Feeling sick, difficulty in breathing, loose motions, constipation, stomach pain, muscle cramps, vision problems, double vision
  • High levels of uric acid, eosinophils (white blood cells increased in allergy), creatinine in the blood
  • Skin rashes, swollen face, tongue, throat, and difficulty in breathing (angioedema)
  • Low blood pressure, feeling tired and weak, abnormal ECG
  • Red, itchy, skin rashes due to allergy (urticaria or hives), feeling sick

Precautions and Warnings of Ivabradine

Pregnancy

Q:
Can I take Ivabradine during pregnancy?
A:
Ivabradine can cause harm to the unborn baby and is not recommended during pregnancy or if you are planning to become pregnant.

Breast Feeding

Q:
Can I take Ivabradine while breastfeeding?
A:
As Ivabraine is secreted in breast milk and has the potential to cause harm to the newborn baby, so the medicine is not recommended if you are breastfeeding.

Driving

Q:
Can I drive if I have consumed Ivabradine?
A:
Ivabradine may cause visual disturbances and strict caution is advised especially at nights. But if you have experienced any such symptoms or dizziness or lightheadedness, it is recommended to avoid driving.

Alcohol

Q:
Can I consume alcohol with Ivabradine?
A:
Both alcohol and Ivabradine reduce your heart rate and blood pressure and hence alcohol consumption is not recommended as it may cause any unwanted effects.

Other General Warnings

Talk to your doctor if
  • Irregular heartbeats (atrial fibrillation) and heart rhythm, chest pain, abnormal ECG
  • Heart symptoms such as difficulty in breathing, feeling tired or dizzy
  • High pulse rate at rest (over 110 beats per minute)
  • Recent brain stroke (high blood pressure causing rupture of blood vessels in the brain)
  • Uncontrolled blood pressure (high or low)
  • Reduced pumping efficiency of the heart due to defective signaling (bundle branch block)
  • Eye, liver or kidney problems

Mode of Action of Ivabradine

How Does It Work?

The sinoatrial node or the SA node is a specialized structure in the heart which is known as the natural pacemaker because it controls and regulates the heart rate. Ivabradine works by a unique mechanism of reducing the activity of the pacemaker and thus controlling the heart rate.
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Interactions of Ivabradine

Interactions with other medicines

  • Rifampicin (used to treat TB)
  • Fluconazole (antifungal)
  • Medicines used to treat seizure, anxiety (Phenytoin, Barbiturates)
  • Anti-psychotic/ anti-depressant medicines (Pimozide, Ziprasidone, Sertindole, St. John’s wort)
  • Medicines used to treat heart rhythm abnormalities (Quinidine, Disopyramide, Ibutilide, Sotalol, Amiodarone)
  • Anti-malarial medicines (Mefloquine, Halofantrine)
  • Bepridil (used to treat chest pain, high blood pressure)
  • Cisapride (increases motility of the intestines)
  • Certain medicines used to high blood pressure and associated swelling (Diuretics - Furosemide, Hydrochlorthiazide, Indapamide)
  • Antifungals (Ketoconazole, Itraconazole)
  • Certain antibiotics when given orally (Clarithromycin, Erythromycin, Telithromycin, Josamycin)
  • Medicines used to treat HIV/ AIDS (Nelfinavir, Ritonavir)
  • Nefazodone (anti-depressant)
  • Diltiazem, Verapamil (used to treat high blood pressure or chest pain)

Interactions with food items

Food slightly increases the efficacy of Ivabradine and hence is advised to be taken with meals.

Dietary Restrictions of Ivabradine

Grapefruit juice should be avoided as it can increase the levels of Ivabradine and therefore reduce your heart rate.

Dosage of Ivabradine

Overdose

The overdose of Ivabradine will slow down the heart rate significantly and hence caution is advised. If you experience any symptoms such as feeling dizzy, head spinning, fainting or low pulse or heart rate, seek medical attention. Speak to your doctor in case of a small accidental overdose.
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Missed a Dose

If you forget the dose of Ivabradine, skip the missed dose and continue with the regular schedule. Do not take a double dose to compensate for a missed dose.

Content Details

WRITTEN BY
doctor

Dr. Arpit Verma

MBBS, MD (Pharmacology)

REVIEWED BY
doctor

Dr. Ritu Budania

MBBS, MD (Pharmacology)

Frequently Asked Questions (FAQs)

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Q: How is Ivabradine different from other regular heart medicines?

A: Ivabradine has a unique mechanism of action and should not be used in all patients. It acts on a specialized muscle that regulates the heart rate in our body (called the pacemaker) and reduces the heart rate. If you have to use Ivabradine, the heart should be in normal rhythm called the sinus rhythm (which means you should not have any irregular heartbeats or abnormal rhythms), your heart rate should not be abnormally low (not less than 70 beats per minute), and your heart is pumping lesser blood than what is safe (ejection fraction ≤ 35%).

Q: Is there anything else I need to know while taking Ivabradine?

A: While using Ivabradine, you may experience bright visions for brief moments (called luminous visual phenomena). This may be accompanied by colored flashes, multiple images, bright circles (halo), etc. These symptoms mostly occur when you start treatment with Ivabradine and will resolve in the first two months. Hence you are advised not to discontinue the medicine if you experience any visual symptoms within the first two months and inform your doctor if they persist beyond two months. Ivabradine has to be stopped if there is no improvement in symptoms within 3 months of starting this medicine. Inform your doctor if this applies to you. The dose of Ivabradine has to be reduced if your heart rate falls below 50 beats per minute. If it remains low and does not improve after decreasing the dose, the medicine may have to be discontinued.
Last Updated on: 05 Oct 2020 | 10:47 PM (IST)

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Disclaimer
The information provided herein is accurate, updated and complete as per the best practices of the Company. Please note that this information should not be treated as a replacement for physical medical consultation or advice. We do not guarantee the accuracy and the completeness of the information so provided. The absence of any information and/or warning to any drug shall not be considered and assumed as an implied assurance of the Company. We do not take any responsibility for the consequences arising out of the aforementioned information and strongly recommend you for a physical consultation in case of any queries or doubts. Please click here for detailed T&C.
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