Ivabradine: first of a new class of treatments for angina

    loading  Checking for direct PDF access through Ovid

Abstract

Ivabradine is the first selective sinus node inhibitor for use in the treatment of angina. In this article Dr Doig describes its novel mode of action and the results of clinical trials of its efficacy and safety.

PRODUCT PROFILE

Proprietary name: Procoralan

PRODUCT PROFILE

Constituents: ivabradine

PRODUCT PROFILE

Indications: symptomatic treatment of chronic stable angina pectoris in patients with normal sinus rhythm who have a contraindication to or an intolerance of beta-blockers

PRODUCT PROFILE

Dosage and method of administration: usual recommended starting dose is 5mg twice daily, orally with meals. After three to four weeks, this may be increased to 7.5mg twice daily depending on therapeutic response. A lower starting dose should be considered in patients aged 75 years or more. Not recommended in children and adolescents

PRODUCT PROFILE

Contraindications: hypersensitivity to the active substance or to any of the excipients; resting heart rate below 60bpm prior to treatment; acute MI; severe hypotension; severe hepatic insufficiency (see SPC for a full list of contraindications)

PRODUCT PROFILE

Precautions: not recommended in patients: with atrial fibrillation or other cardiac arrhythmias that interfere with sinus node function, with 2nd-degree AV block, immediately after a stroke (no data available); if resting heart rate decreases persistently below 50bpm or the patient experiences bradycardia dose must be titrated downward or treatment discontinued; concomitant use with heart rate-reducing calcium-channel blockers not recommended (no safety issue has been raised on the combination with dihydropyridine calcium-channel blockers); heart failure must be appropriately controlled before considering treatment; effects of treatment beyond one year on retinal function currently not known; use with caution in patients with mild to moderate hypotension (limited data available), moderate hepatic insufficiency and those with severe renal insufficiency; should be avoided in patients with congenital QT syndrome or treated with QT-prolonging drugs

PRODUCT PROFILE

Pregnancy and lactation: contraindicated in pregnant or nursing women

PRODUCT PROFILE

Interactions: QT-prolonging drugs; potent CYP3A4 inhibitors such as azole antifungals, macrolide antibiotics and HIV protease inhibitors; diltiazem or verapamil; fluconazole; CYP3A4-inducing drugs

PRODUCT PROFILE

Side-effects:very common: luminous phenomena usually triggered by sudden variations in light intensity; common: blurred vision, bradycardia, 1st-degree AV block, ventricular extrasystoles, headache, dizziness

PRODUCT PROFILE

Presentation/cost: 5mg, 7.5mg film-coated tablet; 5mg - 56, £39.00; 7.5mg - 56, £39.00

Related Topics

    loading  Loading Related Articles