If (Funny Current) Inhibitor

Ivabradine

Brand names: Procoralan

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

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses 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.

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. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways