If (Funny Current) Inhibitor Pregnancy: Contraindicated

Ivabradine

Brand names: Procoralan

Adult dose

Dose: Starting: 5 mg BD. Titrate to 7.5 mg BD after 3–4 weeks if heart rate >60 bpm

Route: Oral

Frequency: Twice daily with meals

Max: 7.5 mg BD

SHIFT trial. Indicated in chronic HFrEF (LVEF ≤35%) with HR ≥70 bpm in sinus rhythm on maximally tolerated beta-blocker.

Paediatric dose

Route: Oral

Frequency: BD

Max: Not licensed for heart failure in children

Licensed for stable angina in paediatric patients ≥1 month under specialist supervision only

Dose adjustments

Renal

No dose adjustment required; caution if eGFR <15

Hepatic

Contraindicated in severe hepatic impairment. Caution in moderate impairment.

Clinical pearls

Only works in sinus rhythm — no benefit (and harm) in AF
SHIFT trial: reduced CV death + HF hospitalisation in HFrEF with HR ≥70
Phosphenes (visual brightness) are reversible and benign; warn patients
Monitor ECG for AF — stop if develops (increases AF risk)

Contraindications

Resting HR <60 bpm before treatment
Cardiogenic shock
Sick sinus syndrome
SA block
3rd degree AV block
AF/flutter (no benefit)
Severe hepatic impairment
Pregnancy

Side effects

Luminous phenomena (phosphenes, visual brightness — 14%)
Bradycardia
Dizziness
Headache
AF (increased risk)
Blurred vision

Interactions

QT-prolonging drugs — increased risk
Strong CYP3A4 inhibitors (ketoconazole, clarithromycin) — avoid
Diltiazem/verapamil — additive HR reduction, avoid
Grapefruit juice — increased levels

Monitoring

Resting heart rate (target 50–60 bpm)
ECG for AF
Blood pressure
Vision symptoms

Reference: BNFc; SHIFT Trial (Swedberg et al, Lancet 2010); NICE TA267; BNF. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways