From the Guidelines
Ivabradine is a recommended treatment option for Postural Orthostatic Tachycardia Syndrome (POTS) patients, particularly those with severe fatigue exacerbated by beta-blockers and calcium-channel blockers, as it has been shown to improve heart rate and quality of life in a trial of 22 patients with POTS 1. When considering ivabradine for POTS, it is essential to weigh the potential benefits against the potential risks and side effects. The medication works by selectively blocking the funny sodium channel (If) in the sinoatrial node, which slows heart rate without affecting blood pressure or cardiac contractility. Key points to consider when prescribing ivabradine for POTS include:
- Starting dose: typically 2.5-5mg twice daily, with potential increases to 7.5mg twice daily as needed
- Mechanism of action: selective blockade of the funny sodium channel (If) in the sinoatrial node
- Benefits: slows heart rate without affecting blood pressure or cardiac contractility, making it valuable for POTS patients with inappropriate heart rate increases upon standing
- Side effects: visual disturbances like phosphenes (seeing flashes of light), which are typically temporary
- Monitoring: patients should monitor their heart rate response and report if it drops below 50 beats per minute at rest
- Administration: ivabradine should be taken with food at the same times each day for consistent absorption. It is crucial to note that while ivabradine has shown effectiveness in clinical practice and studies for managing the tachycardia component of POTS, it is not FDA-approved specifically for this condition 1.
From the Research
Ivabradine for Postural Orthostatic Tachycardia Syndrome (POTS)
- Ivabradine is a novel heart rate lowering agent that has been studied as a potential treatment for POTS 2, 3, 4, 5.
- The medication works by selectively inhibiting the If-current in the sinoatrial node cells, resulting in a reduction in heart rate without affecting blood pressure 2, 4.
- Studies have shown that ivabradine can provide symptomatic relief for patients with POTS, including improvements in palpitations, lightheadedness, and overall quality of life 2, 3, 4, 5.
- Common side effects of ivabradine include dizziness, nausea, headache, fatigue, and luminous phenomena/visual brightness, but these are often mild and do not lead to discontinuation of treatment 2, 3, 4.
- Ivabradine has been shown to be effective in both adult and pediatric patients with POTS, with response rates ranging from 68% to 88% 3, 4.
- While the current evidence suggests that ivabradine may be a useful treatment option for POTS, further research is needed to fully establish its efficacy and safety in this population 2, 3, 4, 5.
Key Findings
- A systematic review of 13 articles found that ivabradine lowered heart rate and provided symptomatic relief for patients with POTS without affecting blood pressure 2.
- A retrospective study of 49 patients with POTS found that ivabradine resulted in significant improvements in symptoms, including palpitations and lightheadedness, with a response rate of 78% 4.
- A review of the literature found that ivabradine is a promising treatment option for POTS, with a favorable safety profile and potential for improving symptoms and quality of life 5.
- A case report found that ivabradine was effective in treating a patient with POTS and a dual chamber pacemaker who had resistant inappropriate sinus tachycardia 6.