Ivabradine Clydesdale Pharma (Ivabradine)

• Ivabradine acts on the cardiac If current to manage specific cardiovascular conditions.
• Chronic stable angina: lowers heart rate to relieve angina symptoms and improve exercise tolerance.
• Heart failure with reduced ejection fraction: reduces heart rate to improve ventricular filling and decrease hospitalisation risk.

• Ivabradine selectively inhibits the funny (If) current in the sinoatrial node, which slows depolarisation of pacemaker cells. This reduction in automaticity lowers heart rate without affecting myocardial contractility or blood pressure, thereby decreasing myocardial oxygen demand while preserving cardiac output.

Ivabradine is generally well tolerated, but several adverse reactions have been reported.

Common Side Effects

• Bradycardia: heart rate falls below the intended therapeutic range.
• Visual disturbances (phosphenes): transient luminous phenomena.
• Headache: mild to moderate intensity.
• Dizziness or vertigo: especially on standing.
• Fatigue: reduced energy levels.
• Blurred vision: occasional visual acuity changes.

Serious or Rare Side Effects

• Severe bradycardia requiring medical intervention.
• Symptomatic hypotension: low blood pressure with dizziness.
• Atrial fibrillation: irregular heart rhythm episodes.
• QT interval prolongation: potential arrhythmogenic risk.
• Allergic reactions: rash, pruritus, or angioedema.
• Hepatic dysfunction: elevated liver enzymes in rare cases.

• Before initiating therapy, clinicians should evaluate patient-specific factors and monitor for safety.
• Monitor heart rate: ensure resting rate remains above 50 bpm.
• Avoid in severe hepatic impairment: reduced metabolism may increase exposure.
• Use caution in sick‑sinus syndrome: risk of excessive bradycardia.
• Do not combine with strong CYP3A4 inhibitors: may raise plasma levels.
• Pregnancy and lactation: safety unknown; avoid unless benefits outweigh risks.
• Store at below 25°C: keep in the original pack, protect from moisture.

Ivabradine may interact with other medicines that influence heart rate or its metabolism.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): can markedly increase ivabradine levels.
• Concomitant use with other bradycardic agents (e.g., beta‑blockers, digoxin): may cause severe bradycardia.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., diltiazem, verapamil): require dose adjustment.
• Drugs that prolong the QT interval (e.g., certain antiarrhythmics): increase arrhythmia risk.
• Rifampicin: may reduce ivabradine exposure, diminishing efficacy.