What is the recommended dosage and usage of Ivabradine (Ivabradine) for treating tachycardia (rapid heart rate) in patients with heart failure or inappropriate sinus tachycardia?

From the Guidelines

Ivabradine is typically initiated at 5 mg twice daily for treating tachycardia in heart failure patients or those with inappropriate sinus tachycardia, with a target heart rate of 50-60 bpm, as recommended by the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1. The dosage can be adjusted based on heart rate response after 2 weeks: increased to 7.5 mg twice daily if resting heart rate remains above 60 beats per minute (bpm), maintained if heart rate is 50-60 bpm, or decreased to 2.5 mg twice daily if heart rate falls below 50 bpm or if symptoms of bradycardia occur. Some key points to consider when using ivabradine include:

• Ivabradine should be taken with meals at approximately 12-hour intervals and requires regular heart rate monitoring, especially during dose adjustments.
• The medication works by selectively inhibiting the If current in the sinoatrial node, reducing heart rate without affecting blood pressure or cardiac contractility.
• Ivabradine should not be used in patients with severe liver disease, resting heart rate below 60 bpm before treatment, or in combination with strong CYP3A4 inhibitors.
• Patients should be advised that visual disturbances (phosphenes) are a common side effect but typically resolve during continued treatment. It's also important to note that ivabradine is indicated for patients with heart failure with reduced ejection fraction (HFrEF) who are in sinus rhythm with a heart rate of 70 bpm or greater at rest, and who are receiving guideline-directed management and therapy, including a beta blocker at maximum tolerated dose, as recommended by the 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure 1. Additionally, ivabradine has been shown to reduce the risk of hospitalization for worsening heart failure in patients with stable, symptomatic, chronic heart failure with reduced ejection fraction, as approved by the FDA in 2015 1. The recommended dosage and usage of ivabradine are also supported by the European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 1. Overall, ivabradine is a valuable treatment option for patients with heart failure and inappropriate sinus tachycardia, and its use should be guided by the latest clinical evidence and guidelines.

From the FDA Drug Label

The recommended starting dose of ivabradine tablets is 5 mg twice daily with food. Assess patient after two weeks and adjust dose to achieve a resting heart rate between 50 and 60 beats per minute (bpm) as shown in Table 1. Thereafter, adjust dose as needed based on resting heart rate and tolerability. The maximum dose is 7.5 mg twice daily.

The recommended dosage and usage of Ivabradine for treating tachycardia (rapid heart rate) in patients with heart failure or inappropriate sinus tachycardia is:

• Starting dose: 5 mg twice daily with food
• Dose adjustment: Assess patient after two weeks and adjust dose to achieve a resting heart rate between 50 and 60 beats per minute (bpm)
• Maximum dose: 7.5 mg twice daily
• Key considerations:
  • Patients with a history of conduction defects or other patients in whom bradycardia could lead to hemodynamic compromise should initiate therapy at 2.5 mg twice daily
  • Regularly monitor cardiac rhythm and discontinue ivabradine if atrial fibrillation develops
  • Risk factors for bradycardia include sinus node dysfunction, conduction defects, ventricular dyssynchrony, and use of other negative chronotropes 2

From the Research

Dosage and Usage of Ivabradine

The recommended dosage and usage of Ivabradine for treating tachycardia (rapid heart rate) in patients with heart failure or inappropriate sinus tachycardia are as follows:

• The initial dose of Ivabradine is 5 mg twice daily, which can be increased to 7.5 mg twice daily if necessary 3, 4, 5, 6.
• Ivabradine has been shown to be effective in reducing heart rate and improving symptoms in patients with inappropriate sinus tachycardia 3, 4, 5, 6.
• In patients with heart failure, Ivabradine is indicated for use in combination with standard therapy, including beta-blocker therapy, or when beta-blocker therapy is contraindicated or not tolerated 7.
• The efficacy and tolerability of Ivabradine have been shown to be similar in subgroups with diabetes mellitus, low systolic blood pressure, renal dysfunction, or chronic obstructive pulmonary disease (COPD) 7.

Efficacy of Ivabradine

The efficacy of Ivabradine in treating tachycardia (rapid heart rate) in patients with heart failure or inappropriate sinus tachycardia has been demonstrated in several studies:

• Ivabradine has been shown to significantly reduce maximum and mean heart rate in patients with inappropriate sinus tachycardia 3, 4, 5, 6.
• Ivabradine has also been shown to improve symptoms and quality of life in patients with inappropriate sinus tachycardia 3, 4, 5, 6.
• In patients with heart failure, Ivabradine has been shown to reduce the risk of cardiovascular mortality or heart failure hospitalization by 18% 7.

Safety and Tolerability of Ivabradine

The safety and tolerability of Ivabradine have been evaluated in several studies:

• Ivabradine has been shown to be generally well-tolerated, with an increase in (a)symptomatic bradycardia and visual side effects being the most common adverse effects 7.
• The safety and tolerability of Ivabradine have been shown to be similar in subgroups with diabetes mellitus, low systolic blood pressure, renal dysfunction, or chronic obstructive pulmonary disease (COPD) 7.