Ivabradine

Key facts

• Ivabradine lowers heart rate by acting on the "funny current" in the heart's natural pacemaker, the sinus node, without reducing the strength of each heartbeat.
• It is taken twice daily with food, usually alongside other heart-failure or angina medicines rather than in place of them.
• Ivabradine only works in people with normal sinus rhythm. It does not control atrial fibrillation and can trigger new atrial fibrillation, so tell your prescriber about any palpitations or an irregular pulse.
• Seek urgent care for fainting, a very slow pulse, or a pulse that feels irregular and does not settle.

What ivabradine treats

Ivabradine is used in chronic heart failure with a reduced pumping fraction, in people who remain in sinus rhythm with a resting heart rate above target despite standard heart-failure treatment, or who cannot tolerate a beta-blocker. It is also used for long-term angina, chest pain from reduced blood flow to the heart, in people whose heart rate stays too fast on other treatment. It does not relieve an angina attack already underway.

How ivabradine works

The sinus node sets your heart rate using a slow electrical current known as the funny current. Ivabradine blocks the channel that carries this current, so the sinus node fires more slowly and heart rate drops. Because it leaves the force of each contraction unchanged, it lowers heart rate without lowering blood pressure the way many other rate-control drugs do.

Before you take it

• Do not take ivabradine if your resting heart rate is under 70 beats per minute before starting, if you have unstable or acute heart failure, low blood pressure, or a pacemaker that already controls your rhythm entirely.
• Tell your prescriber about any history of atrial fibrillation or other irregular heart rhythm.
• Strong inhibitors of the liver enzyme CYP3A4, including some antifungals, some antibiotics and grapefruit juice, raise ivabradine levels and increase the risk of an excessively slow heart rate.
• Avoid it in pregnancy; effective contraception is advised during treatment.

Side effects

Common effects include visual brightness or flickering lights, headache, dizziness, and a slower heart rate than before starting.

Stop and seek urgent medical care for any of these:

• Fainting or severe dizziness.
• A pulse that feels irregular, fluttering, or unusually slow.
• New or worsening chest pain or breathlessness.

Safety essentials

• Ivabradine works only in sinus rhythm; report any palpitations or irregular pulse promptly, since it can bring on atrial fibrillation and will not control it if that happens.
• Your prescriber will check your heart rate and rhythm periodically and adjust or stop the dose if your pulse drops too low.
• Avoid grapefruit juice and check new medicines for interactions, since several common drugs raise ivabradine levels and the risk of a dangerously slow heartbeat.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.