Ivabradine (Oral)

Ivabradine treats chest pain and lowers heart rate for patients, and it is a cardiotonic agent.

Overview

Ivabradine is a prescription medication that reduces heart rate and treats chest pain that is heart related and heart failure (that is not completely managed by the beta blockers). It lowers the chance that patients with heart failure will need to be hospitalized.

This medication is often prescribed for patients with chronic angina pectoris (stable) with regular sinus rhythm who are not able to take beta blockers. It also treats inappropriate sinus tachycardia.

For chest pain, ivabradine can be just as effective atenolol (beta blocker) and similar to amlodipine in regards to managing stable angina (chronic).

For heart failure, ivabradine is often combined with beta blockers for patients with a heart rate of more than 70 beats per minute, and who have heart failure (LVEF under 35% poorly treated by only beta blockers). For patients who cannot be treated with beta blockers, taking ivabradine can lower the possibility of having to be hospitalized for heart failure.

Ivabradine is manufactured under the US brand name Corlanor and can only be obtained with a valid prescription from your physician. It is available in tablet form.

In 2015, Ivabradine was initially approved by the US FDA; and in 2005, the European Medicines Agency approved the medication.

Conditions treated

Type of medicine

  • Cardiotonic agent

Side Effects

In addition to beneficial effects, medications may also cause side effects that may be undesired. While it is not expected for every single side effect below to take place; if any of them do occur, they could require medical care.

Consult with your physician right away if you experience any of the side effects below:

More Common Side Effects (Medical Care Required)

  • Vision blurred
  • Nervousness
  • Irregular or fast heartbeat
  • Heartbeat irregularity or slow tendencies
  • Headache
  • Fainting, dizziness, or lightheadedness
  • Fainting
  • Ear pounding
  • Dizziness
  • Chest discomfort or pain
  • Breath shortness

Additional Side Effects' Occurrence Rate Unknown (Medical Care Required)

  • Sweating
  • Hive-like, large swollen areas on the eyelids, throat, legs, sex organs, feet, hands, tongue, lips, or face
  • Faintness, lightheadedness, or dizziness when standing suddenly from a sitting or lying position
  • Confusion

Sometimes, side effects take place but these will not typically require medical care. These specific side effects may disappear throughout the course of treatment as your body becomes more adjusted to the medication. In addition, your medical care professional can likely inform you of additional methods of reducing or preventing certain side effects. Consult with your medical care professional if any of the side effects below become prolonged, troublesome, or if you have concerns or questions regarding them.

Less Common Side Effects (Medical Care Not Required)

  • Light flashes in vision

Additional Side Effects ' Occurrence Rate Unknown (Medical Care Not Required)

  • Spinning sensation
  • Skin unusually warm
  • Skin rash, itching, welts, or hives
  • Sensation of movement (constantly) of surroundings or self
  • Seeing double
  • Redness or skin flushing
  • Difficulty seeing

Additional side effects not included above could also take place for certain patients. If other side effects are experienced, consult with your physician.

Contact your medical care professional if you are seeking health advice regarding side effects of ivabradine. The FDA also accepts reports of side effects, and they can be reached by calling 1-800-FDA-1088.

Dosage

Take this medication only as instructed by your physician. Never take a dose that is more than prescribed. Do not take this medication more frequently than directed. Ivabradine should never be taken for a duration greater than the doctor instructed.

Ivabradine is distributed with a medication overview summary. Follow and read the directions carefully. Consult with your physician with any concerns or questions you may have.

This medication should be taken with food.

Do not consume grapefruit juice or grapefruit alone while taking ivabradine. The body may absorb a different amount of medication due to consumption of grapefruit or grapefruit juice.

The total dose of ivabradine will vary for different patients. Follow the instructions listed on the medication bottle. The information listed here covers only general doses of ivabradine. If you were prescribed a different dose, do not adjust your dose unless your physician has instructed you to do so.

The quantity of medication you are prescribed will depend directly on how strong the medication is. In addition, how many doses you are prescribed to take will impact your prescribed dose of ivabradine. The total duration for which you are instructed to take this medication and the time allotted between each dose will also impact your dose.

Tablet form (oral dose)
For treatment of heart failure:

  • Adults: Initially, take 5 mg (milligrams) twice per day, along with food. Your physician may alter your dose as your body requires it. However, the total dose is not typically more than 7.5 milligrams twice daily.
  • Children: Pediatrician must calculate dosage information for children.

Missed Dose

If a dose of ivabradine is accidentally missed, it should be taken as soon as the patient recognizes that a dose was skipped. However, if it is nearer to the scheduled next dose, the missed dose may remain missed and you may return to the original dosage schedule. Never take a double dose of ivabradine.

Interactions

Drug Interactions

Many prescription medications should never be combined, however in other cases two medications can be combined despite the possibility of interactions taking place. Under these circumstances, your physician may be inclined to adjust the dose, or they may prefer to take other precautions. While taking ivabradine, it is imperative that your medical professional is aware if you are on any of the following medications. The interactions below were chosen due to their potential significance. This information is not completely all-inclusive.

Doctors do not suggest taking ivabradine with medications on the following list. Your physician may choose not to prescribe ivabradine to you or they may adjust other medications you may be taking.

  • Ziprasidone
  • Voriconazole
  • Thioridazine
  • Terfenadine
  • Telithromycin
  • Telaprevir
  • Sparfloxacin
  • Saquinavir
  • Ritonavir
  • Posaconazole
  • Piperaquine
  • Pimozide
  • Nelfinavir
  • Nefazodone
  • Mesoridazine
  • Ketoconazole
  • Itraconazole
  • Indinavir
  • Idelalisib
  • Fluconazole
  • Dronedarone
  • Conivaptan
  • Cobicistat
  • Clarithromycin
  • Cisapride
  • Boceprevir
  • Bepridil
  • Amisulpride
  • Amifampridine

Taking ivabradine with any of the medications below is not typically suggested, but certain circumstances may require the combination. If both medications are prescribed at the same time, your physician may adjust the dose of frequency for either or both medication.

  • Zuclopenthixol
  • Vorinostat
  • Vinflunine
  • Vilanterol
  • Verapamil
  • Venlafaxine
  • Vemurafenib
  • Vardenafil
  • Vandetanib
  • Triptorelin
  • Trimipramine
  • Trazodone
  • Toremifene
  • Tolterodine
  • Tizanidine
  • Tetrabenazine
  • Telavancin
  • Tamoxifen
  • Tacrolimus
  • Sunitinib
  • Sulpiride
  • St John's Wort
  • Sotalol
  • Sorafenib
  • Solifenacin
  • Sodium Phosphate, Monobasic
  • Sodium Phosphate, Dibasic
  • Sodium Phosphate
  • Sevoflurane
  • Sertindole
  • Risperidone
  • Rifampin
  • Ranolazine
  • Quinine
  • Quinidine
  • Quetiapine
  • Protriptyline
  • Propafenone
  • Promethazine
  • Prochlorperazine
  • Procainamide
  • Probucol
  • Pitolisant
  • Pimavanserin
  • Phenytoin
  • Perphenazine
  • Perflutren Lipid Microsphere
  • Pentamidine
  • Pazopanib
  • Pasireotide
  • Paroxetine
  • Panobinostat
  • Paliperidone
  • Ondansetron
  • Olanzapine
  • Octreotide
  • Norfloxacin
  • Nilotinib
  • Nafarelin
  • Moxifloxacin
  • Mizolastine
  • Mitotane
  • Mifepristone
  • Metronidazole
  • Methadone
  • Mefloquine
  • Lumefantrine
  • Lumacaftor
  • Levofloxacin
  • Leuprolide
  • Lapatinib
  • Imipramine
  • Imatinib
  • Iloperidone
  • Ibutilide
  • Hydroxyzine
  • Hydroxychloroquine
  • Hydroquinidine
  • Histrelin
  • Haloperidol
  • Halofantrine
  • Granisetron
  • Goserelin
  • Gonadorelin
  • Gemifloxacin
  • Gatifloxacin
  • Galantamine
  • Fosphenytoin
  • Foscarnet
  • Fosaprepitant
  • Formoterol
  • Fluoxetine
  • Flecainide
  • Fingolimod
  • Felbamate
  • Famotidine
  • Escitalopram
  • Erythromycin
  • Eribulin
  • Enzalutamide
  • Efavirenz
  • Ebastine
  • Droperidol
  • Doxepin
  • Donepezil
  • Domperidone
  • Dolasetron
  • Dofetilide
  • Disopyramide
  • Diltiazem
  • Deslorelin
  • Desipramine
  • Delamanid
  • Degarelix
  • Dasatinib
  • Dabrafenib
  • Cyclobenzaprine
  • Crizotinib
  • Clozapine
  • Clomipramine
  • Citalopram
  • Chlorpromazine
  • Chloroquine
  • Ceritinib
  • Carbamazepine
  • Buserelin
  • Bedaquiline
  • Azithromycin
  • Atazanavir
  • Astemizole
  • Asenapine
  • Arsenic Trioxide
  • Aripiprazole
  • Aprepitant
  • Apomorphine
  • Anagrelide
  • Amitriptyline
  • Amiodarone
  • Alfuzosin

Other Interactions
Some medications should not be taken near mealtime or when eating specific kinds of food due to the chance of interaction taking place. Tobacco and alcohol can also trigger interactions when used with certain medications. The interactions below were chosen due to their possible significance. The list below is not completely all-inclusive.

Medical Interactions
Patients with other medical issues could experience impacts in the usefulness of ivabradine. Be sure to inform your physician if you have other medical issues, specifically:

  • Slow heartbeat (bradycardia)
  • Pacemaker dependence (patients with pacemaker dependence should not use)
  • Low blood pressure (hypotension)
  • Liver disease (severe)
  • Heart rhythm issues (sinus arrest, heart block) take caution; conditions could be made worse
  • Heart rhythm issues (sick sinus syndrome, sinoatrial block, AV block) with no pacemaker
  • Decompensated heart failure
  • Atrial fibrillation

Warnings

It is imperative that your physician monitors your progress regularly. Doing so will give your doctor a chance to evaluate whether or not the medication is working as it should, and to watch for undesired side effects.

Taking ivabradine while pregnant could be harmful for the unborn baby. Be sure to use a method of birth control that is effective to ensure that you will not become pregnant while on this medication. If you suspect you may have become pregnant while taking ivabradine, inform your physician immediately.

Patients who are taking any of the following medications should not take ivabradine, as unwanted side effects could take place if the medications are combined:

  • Viracept (Nelfinavir)
  • Sporanox (Itraconazole)
  • Serzone (Nefazodone)
  • Nizoral (Ketoconazole)
  • Ketek (Telithromycin)
  • Biaxin (Clarithromycin)

This medication should not be taken if you are already using any of the medications listed above. Severe undesired side effects may take place if the combination occurs.

Atril fibrillation may be increased from taking this medication. Consult with your physician immediately if you experience difficulty breathing, fainting, dizziness, irregular heartbeat, or extra fast beating of the heart.

This medication could trigger temporary brightness to occur visually, typically triggered by quick shifts in light (phosphenes or luminous phenomena). Take care when operating machinery or driving as shifts in light can occur, specifically when driving at night.

Other medications should not be taken with this medication unless previously approved by your physician. This includes nonprescription and prescription medications (including herbal remedies such as St. John's wort and vitamin supplements).

When contemplating as to whether or not a medication is right for you, compare the possible risks of the medication against the potential benefits it may provide. This decision must be made with your physician. Consider the following aspects prior to taking this medication:

Allergies

Inform your physician if you have experienced strange allergic reactions to this or other medications. Also inform your doctor if you have other kinds of allergies, including to animals, preservatives, dyes, or foods. For products that are not prescription, be sure to carefully read the package label ingredient summary cautiously.

For Pediatric Use

Current research has not yet examined whether or not ivabradine is safe for the pediatric population to take.

For Geriatric Use

Current research has not identified any issues that are specific to the elderly population that could limit the effectiveness of ivabradine for the geriatric population.

For Mothers Who Breastfeed

Current research in breastfeeding women has not been conducted to find out if there is any risk to the baby when the mother is taking ivabradine while she is breastfeeding. Mothers should compare the possible benefits against the risks prior to taking ivabradine while breastfeeding.

Storage

Always store ivabradine in a sealed container away from direct light, moisture, freezing, or hot temperatures. It should be kept at room temperature.

Always keep this medication far from children's reach.

Medicine that is expired or no longer required should be disposed of. Consult with your physician to determine proper ways to dispose of ivabradine.

Summary

This drug is often prescribed for treatment of chronic angina pectoris (stable) for patients with a normal sinus rhythm who cannot take beta-blockers. It also is prescribed for inappropriate sinus tachycardia.

For chest pain, ivabradine can work as well as atenolol (beta blocker) and is comparable to amlodipine when it comes to managing stable angina (chronic).

For heart failure, ivabradine is often used with beta-blockers for patients with a heart rate faster than 70 beats per minute, and who have heart failure (LVEF under 35% poorly treated by only beta blockers). For patients who cannot take beta-blockers, taking this medication can reduce the chance of having to be hospitalized for heart failure.