2.6.3 Ivabradine


Choice	Drug	Dosage
Reserve [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.