Ivabradine: functions, dosage, side effects, how to use

What Drug Ivabradine?

What is ivabradine for?

Ivabradine is a drug used to treat chronic heart failure and symptoms of stable angina pectoris. This drug works by affecting the electrical activity of the heart so that the heart will beat more slowly.

Doctors usually prescribe this medication for adults who are unsuitable or unable to take medication beta blockers. Even so, this drug can also be used by children who experience heart failure due to an enlarged heart (dilated cardiomyopathy).

Heart failure itself is a condition when the heart cannot pump blood around the body optimally. As a result, the heart muscle will weaken and cannot work effectively. Heart failure is considered a chronic disease that requires lifelong treatment.

This drug can also be combined with drugs beta blockers in the optimal dose beta blockers- still lacking.

How is ivabradine used?

Ivabradine tablets are taken regularly. So as not to forget, take this medicine at the same time every day.

If at any time you forget to take this medicine and the next interval for consumption is still far away, it is advisable to do so as soon as you remember. Meanwhile, if the time lag is near, ignore it and don't try to double the dose.

Usually this drug is recommended to be taken twice a day at meal times (at breakfast and dinner). Take this medication with a glass of water and do not increase or decrease the dose of the drug without the doctor's knowledge.

The dose prescribed depends on the condition being treated and how well it is controlled. Follow the instructions given by your doctor. Instructions will be written on the label provided by your pharmacist on the package of the medicine.

While taking this drug, try to avoid grapefruit juice. Grapefruit juice can affect the effectiveness of the drug and may increase side effects.

Do not give this medicine to other people even if they have symptoms similar to yours. As mentioned earlier, the dosage is adjusted according to the patient's health condition and how their body responds to treatment.

Finally, do not hesitate to seek medical attention immediately if your condition does not improve or is getting worse. If you have any questions, you should also immediately consult a doctor.

How is ivabradine stored?

This medication is best stored at room temperature, away from direct light and damp places. Don't keep it in the bathroom. Don't freeze it. Other brands of this drug may have different storage rules. Observe the storage instructions on the product package or ask your pharmacist. Keep all medicines away from children and pets.

Do not flush medicines down the toilet or down the drain unless instructed to do so. Discard this product when it has expired or when it is no longer needed. Consult your pharmacist or local waste disposal company about how to safely dispose of your product.

Ivabradine dosage

The information provided is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist before starting treatment.

What is the ivabradine dosage for adults?

Coronary arteries

The initial dose of 5 mg is taken 2 times a day. If needed, the dose can be increased to 7.5 mg orally 2 times a day after 3-4 weeks.

In certain cases, the dose of the drug can also be reduced to 2.5 mg orally 2 times a day. This reduction in dosage usually occurs when the patient's resting heart rate is less than 50 beats / minute or the patient develops symptoms of bradycardia such as dizziness, fatigue and hypotension.

Heart failure

The recommended dose is 5 mg orally 2 times a day. After 2 weeks, adjust dosage until you reach a resting heart rate of between 50-60 beats / minute. The maximum dose that can be given is 7.5 mg orally 2 times a day.

In principle, each person may get a different dose. This is because doctors will usually provide drug doses based on age, overall health condition, and patient response to treatment. Please ask your doctor directly to find out the exact dose that is suitable for your condition

What is the dose of ivabradine for children?

The dosage for children has not been established. Consult your doctor for more information.

In what dosage is ivabradine available?

This drug is available in tablet form.

Ivabradine side effects

What side effects can I experience due to ivabradine?

Every drug in principle has the potential to cause side effects, including this drug. Some of the most common side effects that patients complain about on this medicine include:

• Visual disturbances such as being very sensitive to light
• Blurred vision
• Slow heart rate (bradycardia)
• Slower conduction of electrical impulses between the chambers of the heart (first-degree atrioventricular obstruction)
• Headache (generally in the first month of treatment)
• Dizzy
• Uncontrolled blood pressure

While some of the uncommon side effects of using this drug include:

• The body feels weak, lethargic, and weak
• Low blood pressure
• Palpitations, aka heart palpitations
• Abnormal heart rhythm, seen on ECG as a 'prolonged QT interval'
• Short or shallow breath
• Vertigo
• Digestive disorders such as nausea, constipation, diarrhea, and pain in the stomach
• Red rash on the skin
• Allergic reaction characterized by swelling of the face, tongue, or throat (angioedema)
• Muscle cramp
• An increase in the number of white blood cells called eosinophils (eosinophilia)
• Increase in blood creatinine
• high levels of uric acid in the blood (hyperuricaemia)
• Problems with vision, such as double vision
• Fainting

Not everyone experiences the above side effects. There may be some side effects not listed above. If you have concerns about certain side effects, consult your doctor or pharmacist.

Ivabradine Drug Warnings and Cautions

What should be known before using ivabradine?

Before using Ivabradine, tell your doctor if you have:

• History of chronic or acute heart failure.
• Very low blood pressure (below 90/50 mmHg).
• Liver and kidney disorders.
• Pregnant and breastfeeding.
• Derived galactose intolerance problems.
• Atrial fibrillation (AF).
• Arrhythmia
• Stroke.
• Severe angina that occurs with or without any activity and cannot be controlled with drugs.
• Resting heart rate slower than 70 beats per minute before starting treatment.
• Heart attack (acute myocardial infarction)
• Failure of the heart to maintain adequate blood circulation (cardiogenic shock).
• A common problem in older people, related to lack of control of heart performance (sick sinus syndrome).
• Failure of an electrical impulse that causes the heart to beat the heartbeat (sino-atrial blockage of the heart). As a result, heart function decreases.
• Serious defects in the pathway of the heart's electrical impulses resulting in decreased heart function (2nd and 3rd grade heart block).
• Install the artificial heart.

Is ivabradine safe for pregnant and lactating women?

There are no adequate studies regarding the risks of using this drug in pregnant or breastfeeding women. Always consult your doctor to weigh the potential benefits and risks before using this medication. This drug is included in the risk of pregnancy category D according to the US Food and Drug Administration (FDA) in the United States, or the equivalent of the Food and Drug Administration (BPOM) in Indonesia.

The following references the pregnancy risk categories according to the FDA:

• A = Not at risk
• B = No risk in several studies
• C = May be risky
• D = There is positive evidence of risk
• X = Contraindicated
• N = Unknown

Ivabradine Drug Interactions

What medicines may interact with ivabradine?

Although certain drugs are not recommended to be used together, in other cases two different drugs can be used together even though drug interactions may occur. In these cases, your doctor may change the dose, or other precautions need to be taken. Tell your health care provider if you are using other prescription or nonprescription drugs.

There may be an increased risk of an abnormal heart rhythm when this medicine is combined with other medicines that can prolong the QT interval on the ECG, as listed below.

• Medicines for an abnormal heart rate (antiarrhythmics) such as amiodarone, disopyramide, sotalol, quinidine, dronedarone
• Certain antidepressants, such as citalopram, escitalopram, clomipramine
• Certain antimalarials, such as mefloquine, halofantrine, riamet
• Certain antimicrobials, such as erythromycin, clarithromycin, moxifloxacin or pentamidine
• Certain antipsychotics, such as pimozide, sertindole, thioridazine, haloperidol
• Methadone
• Ranolazine
• Tolterodine
• Vardenafil
• Furosemida
• Cyclopenthiazida

The following medicines can increase the amount of Ivabradine in the blood and this can increase the risk of side effects. These medicines should not be used with ivabradine:

• Azole antifungals, such as ketoconazole or itraconazole (fluconazole can be used but the dose of ivabradine may have to be reduced if the multidose range of fluconazole is used)
• Macrolide antibiotics, such as clarithromycin, erythromycin, telithromycin
• Nefazodone
• Protease inhibitors for HIV infection, such as nelfinavir, ritonavir
• Diltiazem
• Verapamil

The following medicines can reduce the blood levels of ivabradine and reduce the effectiveness of these drugs:

• Barbiturates, such as phenobarbital
• Phenytoin
• Rifampicin

Can food or alcohol interact with ivabradine?

Certain drugs should not be used with meals or when eating certain foods because drug interactions can occur. Consuming alcohol or tobacco with certain drugs can also cause interactions to occur. Discuss your use of drugs with food, alcohol, or tobacco with your health care provider.

What health conditions can interact with ivabradine?

The presence of other health problems can affect the use of this drug. Tell your doctor if you have other health problems, specifically:

• Decreased liver function
• Severely decreased kidney function (creatinine excretion rate below 15 ml / min)
• Mild to moderate low blood pressure (hypotension)
• Severe heart failure
• Abnormal heart rhythm, seen on ECG as a 'prolonged QT interval'
• An eye disease called retinitis pigmentosa (overactivity of the retinal pigment cells).

Ivabradine overdose

What should I do in an emergency or overdose?

In case of an emergency or overdose, contact the emergency services provider (119) or immediately to the nearest hospital emergency department.

What should I do if I miss a dose?

If you forget a dose of this medicine, take it as soon as possible. However, when it is nearing the time of the next dose, skip the missed dose and return to the usual dosing schedule. Don't double the dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.