Ivabradine is a new class of selective heart rate lowering agent. It acts by selective and specific inhibition of cardiac pacemaker lf channel, in the sinus node. Ivabradine decreases the slope of the diastolic depolarization potential, prolonging the time to action potential firing. This action results in a reduction of heart rate at rest and during exercise, with little or no effects on mean arterial blood pressure or left ventricular pressure.
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Adult: 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 or if symptoms related to bradycardia, the dose must be adjusted downwards to 2.5 mg 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).
Children and adolescents: Not recommended.