Ivabradina: Indications and Contraindications

Introduction to Ivabradina

• The American College of Cardiology recommends ivabradina to reduce hospitalizations due to heart failure in patients with heart failure with reduced ejection fraction (HFrEF) who remain symptomatic despite optimal treatment with beta-blockers 1, 2
• Ivabradina inhibits the If current in the sinoatrial node, reducing heart rate without affecting myocardial contractility or blood pressure, as stated by the American College of Cardiology 2

Indications for Ivabradina

• The American Heart Association and the Heart Failure Society of America recommend ivabradina for patients with HFrEF (NYHA class II-III) who are in sinus rhythm with a heart rate ≥70 beats per minute despite receiving optimal medical therapy, including beta-blockers at maximum tolerated doses 1, 2, 3
• Ivabradina is also recommended for patients with inappropriate sinus tachycardia who are symptomatic and do not respond or tolerate beta-blockers or calcium channel blockers, according to the American College of Cardiology 4

Dosage and Administration

• The initial dose of ivabradina is 5 mg twice daily with food, as recommended by the American College of Cardiology 7
• The dose can be adjusted based on heart rate, with a target heart rate between 50-60 beats per minute, as stated by the American College of Cardiology 2, 7

Contraindications and Precautions

• Ivabradina should be discontinued immediately if the patient develops atrial fibrillation, as it increases the risk of this event and loses efficacy in non-sinusual rhythms, according to the American College of Cardiology 2
• Ivabradina is contraindicated in patients with severe hepatic impairment, as stated by the American College of Cardiology 5
• Ivabradina should be used with caution in patients with hypotension, and the dose should be reduced or discontinued if the patient experiences symptomatic bradycardia or severe hypotension, as recommended by the American College of Cardiology 5