[For information only, not a NI Formulary Choice]
|Ivabradine▼ (Procoralan®) tablets f/c 5mg, 7.5mg [Consultant initiation only]||Dose:|
Heart failure, initially 5mg twice daily, increased if necessary after 2 weeks to 7.5mg twice daily (if not tolerated reduce dose to 2.5mg twice daily)
initially 2.5mg twice daily in the elderly
Angina, Initially 2.5-5mg twice daily, increased if necessary after 3-4 weeks to 7.5mg twice daily (if not tolerated reduce dose to 2.5-5mg twice daily); initially 2.5mg twice daily in the elderly
- NICE recommend that ivabradine▼, in combination with standard therapy including a beta-blocker (unless contraindicated or not tolerated), an ACE inhibitor, and an aldosterone antagonist, is an option for treating mild to severe stable heart failure in patients who
- Have a left ventricular ejection fraction of ≤ 35% and
- Are in sinus rhythm with a heart rate of ≥ 75 beats/min
- Ivabradine▼ should be initiated only by a heart failure specialist after 4 weeks of stable optimal standard therapy; monitoring and dose titration should be carried out by heart failure specialist, or a GP with a specialist interest in heart failure, or by a heart failure specialist nurse.
- Ivabradine▼ should only be initiated by specialists for angina. Refer to NICE CG 126 ‘Management of Stable Angina’ for further details.
- Treatment with ivabradine should be discontinued if there is no improvement in symptoms of angina within 3 months.
- Ivabradine▼ may be associated with the risks of bradycardia, atrial fibrillation, and other cardiovascular risks. Only start ivabradine▼ if the resting heart rate is at least 70 beats per minute. Do not prescribe ivabradine▼ with verapamil, diltiazem or strong CYP3A4 inhibitors. See Drug Safety Update Dec 2014 for further details.