Ivabradine Uni-Pharma (Ivabradine)

• Ivabradine acts on the cardiac pacemaker If current, making it useful in conditions where heart‑rate reduction improves outcomes.
• Chronic stable angina pectoris: improves exercise tolerance and decreases the frequency of angina episodes.
• Heart failure with reduced ejection fraction (HFrEF): lowers resting heart rate, contributing to reduced hospitalisation risk.
• Patients unsuitable for beta‑blockers: provides heart‑rate control when beta‑blockers are contraindicated or not tolerated.

• Ivabradine selectively binds to the hyperpolarisation‑activated cyclic nucleotide‑gated (HCN) channels that generate the If current in sino‑atrial node cells. By inhibiting this current, the drug slows spontaneous depolarisation, reducing heart rate without altering myocardial contractility or systemic blood pressure, thereby improving myocardial oxygen balance.

Adverse reactions are reported across a range of frequencies.

Common Side Effects

• Bradycardia: heart rate falls below the intended therapeutic range.
• Visual disturbances (phosphenes): transient luminous phenomena, especially in low‑light conditions.
• Headache: mild to moderate intensity.
• Dizziness or vertigo.
• Fatigue or general weakness.
• Blurred vision.

Serious or Rare Side Effects

• Symptomatic severe bradycardia requiring medical intervention.
• Atrial fibrillation or other significant arrhythmias.
• High‑grade atrioventricular block.
• Severe visual impairment or persistent photopsia.
• Allergic reactions such as rash, pruritus or angio‑edema.
• Hepatic dysfunction in susceptible individuals.

Careful assessment and monitoring are required before and during therapy.

• Baseline heart rate: ensure resting rate is ≥60 bpm before initiation.
• ECG monitoring: watch for excessive bradycardia or conduction abnormalities.
• Severe hepatic impairment: avoid or use with extreme caution.
• Sick sinus syndrome or AV‑block: contraindicated unless a pacemaker is present.
• Renal impairment: dose adjustment may be needed.
• Store at below 25°C: keep in the original pack, protect from moisture and light.

Ivabradine may interact with several drug classes, altering its efficacy or safety.

Major Interactions (Avoid)

• Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin): increase plasma levels.
• Concomitant bradycardic agents (beta‑blockers, digoxin): risk of excessive heart‑rate reduction.
• Drugs that affect AV‑node conduction (verapamil, diltiazem): may precipitate heart block.

Moderate Interactions (Monitor Closely)

• CYP3A4 inducers (rifampicin, carbamazepine): may reduce therapeutic effect.
• Diuretics causing electrolyte imbalance: can potentiate arrhythmic risk.
• Other anti‑anginal agents (nitrates, ranolazine): monitor for additive haemodynamic effects.