From the Guidelines
Ivabradine is recommended for the treatment of inappropriate sinus tachycardia (IST) in patients who are symptomatic, as it has been shown to reduce heart rate and improve symptoms 1. The typical starting dose is 2.5 to 7.5 mg twice daily, with a maximum dose of 7.5 mg twice daily.
Key Considerations
- Ivabradine is well tolerated, with an excellent safety profile demonstrated in large RCTs in patients with heart failure 1.
- The drug can cause phosphenes, an enhanced brightness in a portion of the visual field, which is usually transient and reported in 3% of patients taking the drug in the SHIFT trial 1.
- Beta blockers may be considered for ongoing management in patients with symptomatic IST, although their effectiveness is modest and hypotension may limit dose 1.
- The combination of beta blockers and ivabradine may be considered for ongoing management in patients with IST, particularly those with refractory symptoms, and should be monitored closely for the possibility of excess bradycardia 1.
Monitoring and Precautions
- It is essential to monitor heart rate and blood pressure regularly during treatment with ivabradine.
- Patients should be advised to avoid activities that may cause a sudden decrease in blood pressure, such as standing up quickly.
- Ivabradine should be used with caution in patients with a history of heart failure, as it may worsen the condition.
- Treatment should be initiated and monitored by a healthcare professional.
From the FDA Drug Label
Ivabradine is a hyperpolarization-activated cyclic nucleotide-gated channel blocker that reduces the spontaneous pacemaker activity of the cardiac sinus node by selectively inhibiting the I fcurrent, resulting in heart rate reduction with no effect on ventricular repolarization and no effects on myocardial contractility.
Ivabradine can be used for heart rate reduction in certain conditions, such as heart failure. However, it is not explicitly indicated for tachycardia in the provided drug labels. The primary use of ivabradine is to reduce heart rate in patients with heart failure, and its effectiveness for tachycardia is not directly stated. Key points to consider:
- Ivabradine reduces heart rate by inhibiting the I f current in the cardiac sinus node.
- It is used to reduce heart rate in patients with heart failure.
- The drug labels do not explicitly indicate ivabradine for tachycardia. 2
From the Research
Efficacy of Ivabradine for Tachycardia
- Ivabradine has been shown to be effective in reducing heart rate in patients with inappropriate sinus tachycardia (IST) 3, 4, 5, 6.
- Studies have demonstrated a significant reduction in maximum and mean heart rate, as well as an improvement in symptoms such as palpitations, pre-syncope, and exercise intolerance 3, 4, 5, 6.
- Ivabradine has also been shown to improve quality of life in patients with IST, with significant improvements in physical and mental status scores 6.
Safety and Tolerability
- Ivabradine has been found to be well-tolerated in patients with IST, with few reported side effects 4, 5, 6.
- One study reported transient phosphene-like phenomena in three patients, but this did not lead to discontinuation of the medication 4.
- Another study found no severe side effects during therapy, even at maximum daily doses 5.
Clinical Use
- Ivabradine may be considered as a treatment option for patients with IST who are refractory to or intolerant of traditional therapies such as beta-blockers and calcium channel blockers 7.
- The medication has been shown to be effective in reducing heart rate and improving symptoms in patients with IST, and may be used as an adjunct therapy in certain cases 3, 4, 5, 6.