Ivabradine Teva (Ivabradine)

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

• Chronic stable angina: reduces the frequency of angina attacks by lowering myocardial oxygen demand.
• Heart failure with reduced ejection fraction: improves exercise capacity and lowers hospitalization risk through heart‑rate reduction.
• Patients intolerant to beta‑blockers: provides a non‑beta‑blocker option for heart‑rate control in coronary disease.

• Ivabradine selectively inhibits the funny (If) current in the sinoatrial node, which slows spontaneous depolarisation. By reducing the slope of phase 4 depolarisation, the drug lowers heart rate without affecting myocardial contractility, ventricular repolarisation, or systemic blood pressure, thereby decreasing cardiac oxygen consumption.

Adverse reactions are reported across clinical use.

Common Side Effects

• Visual disturbances (phosphenes): transient luminous phenomena.
• Bradycardia: heart rate below the intended therapeutic range.
• Headache: mild to moderate intensity.
• Dizziness or vertigo: often related to reduced heart rate.
• Fatigue: general feeling of tiredness.
• Blurred vision: occasional visual acuity changes.

Serious or Rare Side Effects

• Severe bradycardia requiring medical intervention.
• Atrial fibrillation or other arrhythmias.
• Symptomatic hypotension.
• Visual loss or persistent retinal disturbances.
• Acute coronary syndrome in vulnerable patients.
• Allergic reactions such as rash or angioedema.

Before initiating therapy, clinicians should evaluate cardiovascular status and potential contraindications.

• Heart‑rate monitoring: ensure baseline rate is appropriate before dosing.
• Hepatic impairment: use caution in moderate to severe liver disease.
• Concomitant bradycardic agents: avoid combining with beta‑blockers or digoxin without supervision.
• Sick‑sinus syndrome or atrioventricular block: contraindicated unless a pacemaker is present.
• Pregnancy and lactation: safety not established; avoid unless benefits outweigh risks.
• Store below 25°C: keep in the original pack, protect from moisture.

Ivabradine may interact with several drug classes, requiring careful assessment.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): can markedly increase plasma levels.
• Other heart‑rate lowering agents (beta‑blockers, digoxin): risk of excessive bradycardia.
• Drugs that prolong QT interval: additive risk of arrhythmia.

Moderate Interactions (Monitor Closely)

• Moderate CYP3A4 inhibitors (e.g., diltiazem, verapamil): may require dose adjustment.
• Antihypertensive agents: monitor blood pressure for additive effects.
• CYP3A4 inducers (e.g., rifampicin): may reduce efficacy.
• Herbal supplements affecting CYP enzymes: assess patient use.