The usual recommended starting dose of Ivabradine is 5 mg twice daily which may be increased after 3-4 weeks of treatment to 7.5 mg twice daily, depending on therapeutic response. Usual dose is 1 tablet in the morning and 1 tablet in the evening during meals.
If the heart rate decreases persistently below 50 bpm at rest o or if symptoms related to bradycardia, the dose must be adjusted downwards to 2.5mg twice daily (one half of the 5 mg tablet twice daily). Treatment must be discontinued if heart rate remains below 50 bpm or symptoms of bradycardia persist. Elderly: Consider a lower starting dose (2.5 mg twice daily i.e. one half 5 mg tablet twice daily).
Renal insufficiency: Use with caution in patients with creatinine clearance less than 15 ml/min.
Hepatic Impairment: Use with caution in patients with moderate hepatic impairment; contraindicated in severe hepatic impairment.