Products
Ivabradine is form of film-coated tablets in commerce (Procoralan). It has been approved in many countries since 2007. A fixed combination with metoprolol was registered in 2016 (Implicor). Generics are registered. A combination with carvedilol was released in 2017 (Carivalan).
Structure and properties
Ivabradine (C27H36N2O5, Mr = 468.6 g/mol)
Effects
Ivabradine (ATC C01EB17) has exclusively negative chronotropic properties. It lowers the heart rate at the sinus node, which reduces the oxygen demand of the heart. The effects are due to selective inhibition of the If current.
Indications
For symptomatic treatment of chronic stable angina in patients with coronary artery disease and sinus rhythm. Ivabradine is used in patients who cannot tolerate beta blockers or as add-on therapy to beta blockers.
Dosage
According to the SmPC. Tablets are taken in the morning and evening during meals.
Contraindications
- Hypersensitivity
- Certain cardiovascular diseases
For complete precautions, see the drug label.
Interactions
Ivabradine is metabolized by CYP3A4 and is a weak inhibitor of this isoenzyme. Corresponding drug-drug interactions are possible. It should not be co-administered with strong CYP3A4 inhibitors. Also avoided should be a combination with drugs that prolong the QT interval.
Adverse effects
The most common potential adverse effects include transient increased light intensity in a limited field of vision (phosphenes), blurred vision, and slow heart rate (bradycardia).
