Drug reference

Ivabradine

Hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blocker (If inhibitor) · Antihypertensive

Also known as Corlanor, Procoralan, Ivanode, Ivabrad

START

Confirm sinus rhythm, resting HR ≥70 bpm. Baseline ECG. Verify no CYP3A4 inhibitors. Counsel on phosphenes (usually mild, transient, not dangerous).

TYPICAL MAX

7.5mg BID. Do not use if HR <50 bpm at rest. If AF develops, consider discontinuing.

STOP IF

Resting HR <50 bpm or symptomatic bradycardia, new AF, second-degree AV block, severe visual disturbances, pregnancy.

WATCH

Resting HR at each visit (target 50-60 bpm). ECG if symptoms. Phosphenes are common but usually transient and harmless—reassure patients. AF risk increased by ~10%—monitor rhythm. Take WITH food (increases bioavailability).

CDSCO approvedATC C01EB17

Dose laddermg/d

Renal dose adjustmenteGFR mL/min/1.73m²

KDIGO 2024 + manufacturer label

Pharmacokineticsplasma · t hours

ONSET: 30min · Onset ~30 min
PEAK: 1h · Tmax ~1 hour
t½: 11h · Effective t½ ~11 hours
DURATION: 12h · 12 hours (BID)

EXCRETION

Fecal as metabolites (~66%)

route + CYP

INTERACTIONS

12 major

incl. contraindicated

PREGNANCY

Contraindicated in pregnancy—animal studies show embryotoxicity and teratogenicity at high doses. Effective contraception required.

FDA category + note

Top interactionssee all 12 →

LopinavirContraindicatedTextbookKDT 7e · p554
Q T Prolonging DrugsContraindicatedTextbookKDT 7e · p554
Strong Cyp3a4 InhibitorsContraindicatedDatabaseKimi deep-research + Cla
AbarelixSevereDatabaseDDInter

Available in India

86 branded formulations and 15 fixed-dose combinations. Look up specific brands in the Drugs workspace.

Mechanism

Selectively inhibits the If ('funny') current in sinoatrial node cells, slowing the rate of spontaneous diastolic depolarization and reducing heart rate without affecting myocardial contractility, blood pressure, or intracardiac conduction. Pure heart rate reduction.

Indications

Chronic stable angina (in patients with normal sinus rhythm, intolerant or contraindicated to beta-blockers)Chronic heart failure with reduced ejection fraction (HFrEF, NYHA II-IV, sinus rhythm, HR ≥70 bpm, on maximally tolerated beta-blocker)Heart failure with preserved ejection fraction (off-label, limited evidence)

Dosing

Adult: 5mg PO BID with meals initially; after 2 weeks, adjust to 7.5mg BID if resting HR >60 bpm and tolerated; reduce to 2.5mg BID if HR 50-60 bpm or bradycardia symptoms. Target resting HR 50-60 bpm.
Pediatric: Not approved in children.
Renal adjustment: No adjustment needed (hepatically metabolized).
Hepatic adjustment: Mild-moderate: no adjustment. Severe (Child-Pugh C): contraindicated.
Geriatric: Start 2.5mg BID; monitor for bradycardia and visual symptoms.
Max dose: 7.5mg BID (15mg/day)

Pharmacokinetics

Onset

Heart rate reduction within hours

Peak effect

Tmax ~1 hour (fasted); steady-state in 2-3 days

Duration

12 hours (BID dosing)

Half-life

~2 hours (parent); ~6 hours (active metabolite, S18982); effective half-life ~11 hours

Bioavailability

~40% (food increases bioavailability)

Protein binding

~70%

Metabolism

Extensive hepatic via CYP3A4 (major) and oxidation; active metabolite S18982 contributes ~40% of activity

Excretion

~4% unchanged in urine; ~66% fecal (metabolites); remainder renal

Contraindications

Acute decompensated heart failure
Severe hepatic impairment (Child-Pugh C)
Sick sinus syndrome or sinoatrial block
Second or third-degree AV block without pacemaker
Resting heart rate <60 bpm before treatment
Concomitant strong CYP3A4 inhibitors
Pregnancy and breastfeeding
Acute cerebrovascular event

Side effects

Common

Luminous phenomena / phosphenes (transient brightness in visual field—~15%, dose-dependent, reversible)BradycardiaAtrial fibrillation (new onset or conversion—~10% increased risk)HeadacheDizziness

Serious

Severe bradycardia (<40 bpm)
Atrial fibrillation
Sinoatrial block
Ventricular arrhythmias
Severe visual disturbances

Pregnancy & lactation

Pregnancy

Contraindicated in pregnancy—animal studies show embryotoxicity and teratogenicity at high doses. Effective contraception required.

Lactation

Excreted in breast milk; contraindicated during breastfeeding.

Drug interactions

Lopinavir

Contraindicated

Textbook

Increased plasma levels and toxicity of ivabradine, leading to excessive bradycardia and other adverse effects.

Concurrent use of drugs which inhibit CYP3A4 is contraindicated.

Source: KDT 7e · p554

Q T Prolonging Drugs

Contraindicated

Textbook

Increased risk of Q-T prolongation and arrhythmias.

Concurrent use of drugs which prolong Q-T is contraindicated.

Source: KDT 7e · p554

Strong Cyp3a4 Inhibitors

Contraindicated

Database

Markedly increases ivabradine levels (~2-3 fold), causing severe bradycardia and heart block.

Contraindicated. Avoid grapefruit juice during treatment.

Source: Kimi deep-research + Cla

Abarelix

Severe

Database