Ivabradine

Uses	Heart Failure, Angina
Therapy	Anti-Anginal
Side Effects	Slow Heart Rate, Dizziness, Headache, Irregular Heartbeat and Blurred Vision

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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

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).

Contraindications

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

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

Pregnancy

Ivabradine can cause harm to the unborn baby and is not recommended during pregnancy or if you are planning to become pregnant.

Breast Feeding

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

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

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

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.

Interactions

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.

Dosage

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.

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.

Frequently Asked Questions (FAQs)

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%).

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.

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References:

EMC. Ivabradine, [Accessed on 14 Jun, 2026](Online)

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