If (Funny Current) Inhibitor Pregnancy: Contraindicated in pregnancy — no or limited human data; animal studies have shown reproductive toxicity with embryotoxic and teratogenic effects; potential human risk unknown. Contraindicated during breast-feeding (animal studies indicate excretion in milk) — women needing treatment should stop breast-feeding. Women of childbearing potential should use appropriate contraceptive measures during treatment. Rat studies showed no effect on fertility.

Ivabradine

Brand names: Procoralan

Ivabradine lowers heart rate in chronic heart failure and in angina, specifically for patients in sinus rhythm.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Chronic stable angina: starting dose not exceeding 5 mg twice daily (patients aged below 75 years); after 3-4 weeks, if still symptomatic, well tolerated and resting heart rate remains above 60 bpm, increase to the next higher dose. Chronic heart failure: usual recommended starting dose 5 mg twice daily; after two weeks increase to 7.5 mg twice daily if resting heart rate is persistently above 60 bpm, or decrease to 2.5 mg twice daily if resting heart rate is persistently below 50 bpm or symptoms of bradycardia occur (maintain 5 mg twice daily if heart rate is 50-60 bpm)

Route: Oral

Frequency: Twice daily — once in the morning and once in the evening, during meals

Max: Maintenance dose should not exceed 7.5 mg twice daily

Initiation/titration should take place with serial heart rate measurements, ECG or ambulatory 24-hour monitoring available. Lowest dose is 2.5 mg twice daily (one half 5 mg tablet twice daily). If resting heart rate falls below 50 bpm or the patient has bradycardia-related symptoms (dizziness, fatigue, hypotension), titrate downward and monitor heart rate after reduction; discontinue if heart rate remains below 50 bpm or bradycardia symptoms persist despite dose reduction. Angina: discontinue if no symptom improvement within 3 months; consider discontinuation if only limited symptomatic response and no clinically relevant heart-rate reduction within 3 months. Heart failure: initiate only in stable heart failure, with a physician experienced in chronic heart failure management. Elderly: in patients aged 75 years or more consider a lower starting dose of 2.5 mg twice daily before up-titration if necessary. Hepatic impairment: no adjustment in mild impairment; caution in moderate; contraindicated in severe hepatic insufficiency. Paediatric population: safety and efficacy in chronic heart failure in children below 18 years have not been established and no posology recommendation can be made; no data for symptomatic treatment of chronic stable angina.

Dose adjustments

Renal

No dose adjustment is required in patients with renal insufficiency and creatinine clearance above 15 ml/min. No data are available below 15 ml/min — use with precaution in this population.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Adult patients ● Starting dose is 2.5 (vulnerable adults) or 5 mg twice daily with food. After 2 weeks of treatment, adjust dose based on heart rate. The maximum dose is 7.5 mg twice daily. ( 2.1 ) 2.1 Adults The recommended starting dose of ivabradine tablets is 5 mg twice daily with food. Assess patient after two weeks and adjust dose to achieve a resting heart rate between 50 and 60 beats per minute (bpm) as shown in Table 1. Thereafter, adjust dose as needed based on resting heart rate and tolerability. The maximum dose is 7.5 mg twice daily. In adult patients unable to swallow tablets, Corlanor oral solution can be used [see Clinical Pharmacology (12.3) ] . In patients with a history …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-04-15. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to the active substance or any excipient
Resting heart rate below 70 beats per minute prior to treatment
Cardiogenic shock; acute myocardial infarction; unstable angina
Severe hypotension (below 90/50 mmHg)
Severe hepatic insufficiency
Sick sinus syndrome; sino-atrial block; 3rd degree AV block; pacemaker dependent (heart rate imposed exclusively by the pacemaker)
Unstable or acute heart failure
Combination with strong CYP3A4 inhibitors (azole antifungals such as ketoconazole and itraconazole; macrolides such as clarithromycin, oral erythromycin, josamycin, telithromycin; HIV protease inhibitors nelfinavir and ritonavir; nefazodone)
Combination with verapamil or diltiazem (moderate CYP3A4 inhibitors with heart-rate-reducing properties)
Pregnancy, lactation, and women of childbearing potential not using appropriate contraceptive measures

Side effects

Luminous phenomena (phosphenes) — very common (14.5%), usually within the first two months; blurred vision (common)
Bradycardia (common, 3.3%); AV 1st degree block (prolonged PQ interval), ventricular extrasystoles, atrial fibrillation (common)
Headache, generally during the first month of treatment (common)
Dizziness, possibly related to bradycardia (common)
Uncontrolled blood pressure (common); hypotension and syncope possibly related to bradycardia (uncommon)

Interactions

Strong CYP3A4 inhibitors (azole antifungals, macrolide antibiotics, HIV protease inhibitors, nefazodone) — contraindicated (§4.3)
Verapamil or diltiazem (heart-rate-reducing calcium channel blockers) — concomitant use contraindicated (§4.3, §4.4)
Amiodarone or potent class I anti-arrhythmics — atrial fibrillation has been more common with concomitant use (§4.4)

Clinical monograph

How it works

It selectively inhibits the cardiac pacemaker 'funny' current (I_f) in the sinoatrial node, slowing heart rate without reducing contractility or lowering blood pressure.

Prescribing in practice

It only works in sinus rhythm — it has no role in atrial fibrillation; in heart failure it is generally started when the resting heart rate is at least 75 bpm despite optimal beta-blockade.
Bradycardia and luminous visual phenomena (phosphenes) can occur.
Avoid with strong CYP3A4 inhibitors; it has teratogenic potential — effective contraception is needed.

Monitoring

Confirm and monitor sinus rhythm and heart rate; review symptoms.

Counselling the patient

You may notice brief flashes of brightness in your vision — these usually settle.
Report a very slow pulse, fainting or palpitations.

Evidence & guidelines

Reduces heart-failure hospitalisation in selected HFrEF patients in sinus rhythm with heart rate ≥75 bpm (SHIFT; NICE TA267).

Reference: SHIFT Trial (Swedberg et al, Lancet 2010); NICE TA267; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways