Ivabradine is indicated-

• To reduce the risk of hospitalization for worsening heart failure in adult patients with stable, symptomatic chronic heart failure with reduced left ventricular ejection fraction. 
• For the treatment of stable symptomatic heart failure due to dilated cardiomyopathy in pediatric patients ages 6 months and older. 

Heart Failure

Adult and pediatric patients greater than 40 kg: Starting dose is 2.5 (pediatrics and 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.

Pediatric Patients less than 40 kg: Starting dose is 0.05 mg/kg twice daily with food. Adjust dose at two-week intervals by 0.05 mg/kg based on heart rate. Maximum dose is 0.2 mg/kg (patients 6 months to less than 1 year old) or 0.3 mg/kg (patients 1 years old and older), up to a total of 7.5 mg twice daily. 

The most common adverse reactions reported with ivabradine include-

• bradycardia
• hypertension
• atrial fibrillation
• visual brightness
• phosphenes

Less common adverse reactions include dizziness, blurred vision, and headache.

Bradycardia

Hypertension (High Blood Pressure)

Atrial Fibrillation

Dizziness

• Ivabradine is contraindicated in patients with sick sinus syndrome, sinoatrial block, or third-degree atrioventricular block, unless a functioning demand pacemaker is present.
• Patients with severe hypotension, cardiogenic shock, acute myocardial infarction, unstable angina pectoris, or decompensated heart failure should not be treated with ivabradine.
• Ivabradine should be used with caution in patients with concomitant administration of strong CYP3A4 inhibitors, as this may lead to an increase in ivabradine plasma concentration and adverse reactions.
• Patients with liver impairment should be closely monitored during treatment with ivabradine, as hepatic impairment can increase the bioavailability of ivabradine.
• Ivabradine should not be used during pregnancy or breastfeeding, as the safety and efficacy of the drug have not been established in these populations.