Ivabradine Grindeks (Ivabradine Hydrochloride)

Ivabradine acts on the cardiac conduction system to lower heart rate, benefiting conditions where rate control improves outcomes.

• Chronic stable angina: reduces frequency of angina attacks by lowering heart rate.
• Heart failure with reduced ejection fraction (NYHA class II–III): improves symptoms and may decrease hospitalization by decreasing myocardial oxygen demand.
• Symptomatic coronary artery disease: provides heart‑rate reduction to alleviate ischemic symptoms.

• Ivabradine selectively inhibits the funny (If) current in the sino‑atrial node. By binding to the HCN channels responsible for the pacemaker current, it slows spontaneous depolarization, producing a dose‑dependent reduction in heart rate without affecting myocardial contractility, ventricular repolarisation, or systemic blood pressure. The drug does not interfere with beta‑adrenergic signalling and therefore does not cause the typical beta‑blocker related bronchoconstriction or metabolic effects.

The most frequently reported adverse reactions with ivabradine are generally mild and related to its heart‑rate lowering action.

Common Side Effects

• Bradycardia: heart rate below 50 beats/min.
• Visual disturbances (phosphenes): transient luminous phenomena.
• Headache.
• Dizziness.

Serious or Rare Side Effects

• Severe bradycardia leading to syncope.
• Atrial fibrillation.
• Symptomatic hypotension.
• Allergic reactions (rash, angioedema).

When prescribing ivabradine, clinicians should consider several safety measures to minimise risk.

• Monitor heart rate: ensure resting rate remains above 50 beats/min before initiation and during therapy.
• Avoid in severe hepatic impairment: reduced metabolism may increase exposure.
• Caution in patients with sick sinus syndrome or atrioventricular block: may exacerbate bradyarrhythmias.
• Do not combine with strong CYP3A4 inhibitors: risk of excessive ivabradine levels.
• Use with caution in hypotensive patients: additive blood pressure effects may occur.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

Ivabradine may interact with other medicines that affect its metabolism or cardiac conduction.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, itraconazole): can markedly increase ivabradine plasma concentrations.
• Other bradycardic agents (beta‑blockers, digoxin, diltiazem, verapamil): may cause excessive heart‑rate reduction.
• Drugs causing atrioventricular block: increase risk of severe bradyarrhythmia.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., erythromycin, fluconazole): may raise ivabradine levels modestly.
• CYP3A4 inducers (e.g., rifampicin, carbamazepine): may reduce therapeutic effect.
• Antihypertensive agents (e.g., ACE inhibitors, diuretics): monitor blood pressure.
• Antidepressants affecting cardiac conduction (e.g., amiodarone): observe for rhythm changes.