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.
Treatment with ivabradine should be discontinued if there is no improvement in symptoms of angina within 3 months.
Cautions
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.
