Indication:Angina chronic stable, Heart Failure
CG 126 Update Stable Management of Angina
MHRA Drug Safety Update: Ivabradine may be associated with the risks of bradycardia, atrial fibrillation, and other cardiovascular risks. Only start ivabradine if the resting heart rate is at least 70 beats per minute. Do not prescribe ivabradine with other medicines that cause bradycardia. Monitor patients regularly for atrial fibrillation and consider stopping ivabradine if there is only limited symptom improvement after 3 months
Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists.
Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse.
NICE Guidance TA267 November 2012
Advice for monitoring
Heart rate and rhythm should be checked around 4 weeks and 6 months following initiation, and annually thereafter. Bradycardia occurs in a small number of patients (3.3%) started on ivabradine. The drug should be discontinued if the patients becomes symptomatic, or the patient has atrial fibrillation, where it will be ineffective.