Ivabradine is a heart medication that is used in addition to other medications to treat stable, chronic (long-term) heart failure in adults who have a heart rate of 77 or more beats per minute. It reduces the heart rate by acting on specific cells in the heart that cause the heart muscle to contract, or "beat."  An increased heart rate is associated with increased hospital admissions and an increased risk of dying from heart failure.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended starting dose of ivabradine is 5 mg taken by mouth, 2 times a day. After 2 weeks, the doctor may adjust your dose up or down, depending on how well the medication is working and side effects. The maximum dose of ivabradine should not be more than 7.5 mg taken 2 times a day.

Ivabradine should be taken once in the morning with food and again, 12 hours later in the evening with food.

This medication should be taken with food, to get the best effect from each dose.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

5 mg
Each salmon-coloured, rod-shaped, film-coated tablet, scored on both edges with "5" engraved on one side and two triangles, one inverted underneath the other, on the other side, contains 5 mg of ivabradine. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, maize starch, maltodextrin, and colloidal anhydrous silica; film-coating: glycerol, hypromellose, macrogol 6000, magnesium stearate, red iron oxide (E 172), titanium dioxide (E 171), and yellow iron oxide (E 172).

7.5 mg
Each salmon-coloured, triangular, film-coated tablet, engraved with "7.5" engraved on one side and two triangles, one inverted underneath the other, on the other side, contains 7.5 mg of ivabradine. Nonmedicinal ingredients: lactose monohydrate, magnesium stearate, maize starch, maltodextrin, and colloidal anhydrous silica; film-coating: glycerol, hypromellose, macrogol 6000, magnesium stearate, red iron oxide (E 172), titanium dioxide (E 171), and yellow iron oxide (E 172).

Do not take this medication if you:

• are allergic to ivabradine or any ingredients of the medication
• have a heart rate below 70 beats per minute before starting this medication
• are experiencing unstable or acute heart failure
• are or may become pregnant
• are breast-feeding
• are in cardiogenic shock
• are experiencing or have recently had a heart attack (myocardial infarction)
• depend on a pace maker to keep your heart rate constant
• have an irregular heart rhythm causing a prolonged QT interval (e.g., congenital long QT syndrome)
• have very low blood pressure (<90/50 mmHg)
• have severely decreased liver function
• have sick sinus syndrome
• have heart block, including sino-atrial block or third-degree atrioventricular block
• are taking certain medications:
  • "azole" antifungals (e.g., itraconazole, ketoconazole, voriconazole)
  • diltiazem
  • hepatitis C antivirals (e.g., ombitasvir, paritaprevir)
  • HIV protease inhibitors (e.g., atazanavir, lopinavir, ritonavir)
  • macrolide antibiotics (e.g., clarithromycin, erythromycin)
  • verapamil
• have galactose intolerance, glucose-galactose malabsorption, or the Lapp lactase deficiency

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• abdominal pain
• cold extremities (fingers and toes)
• constipation
• diarrhea
• dizziness
• fatigue
• general feeling of being unwell
• headache
• joint pain
• muscle cramps
• nausea
• red, itchy skin
• vision changes (blurred vision, light spots, flashes)
• weakness

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• abnormally slow heart rate (less than 50 beats per minute) (e.g., dizziness, fainting, weakness, shortness of breath, chest pain)
• cramping in the lower legs
• fainting
• increased blood pressure (e.g., severe headache, tiredness, confusion, vision changes, trouble breathing)
• sudden decrease in blood pressure (e.g., lightheadedness or dizziness)
• worsening symptoms of heart failure (e.g., change in heartbeat, increased fatigue, swelling of feet and legs, shortness of breath)
• symptoms of irregular heart beat (e.g., chest pain, dizziness, rapid, slow, or irregular heartbeat, shortness of breath, pain or pressure in the chest)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
• signs of a heart attack (e.g., chest pain or pressure, pain extending through shoulder and arm, nausea and vomiting, sweating)
• signs of stroke (e.g., sudden or severe headache; sudden loss of coordination; vision changes; sudden slurring of speech; or unexplained weakness, numbness, or pain in arm or leg)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Driving and using machines: Ivabradine may cause blurred vision and dizziness or weakness affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until you have determined how this medication affects you.

Heart rhythm: Ivabradine is intended to slow the heart rate down; however, it can cause other changes to the normal rhythm of the heart. If this medication causes your heart rate to slow down too much, it may leave you feeling unusually tired, or lightheaded.

Ivabradine may cause an increased risk of developing atrial fibrillation, a condition where the two smaller chambers of the heart beat rapidly and irregularly. People with atrial fibrillation may experience shortness of breath, a pounding heartbeat, or dizziness.

Ivabradine may cause an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Your doctor will monitor your heart rhythm regularly while you are taking this medication with a test called an electrocardiogram (ECG). You should not take this medication if your ECG already shows that you have QT prolongation or if you are taking a medication that can cause QT prolongation.

Contact your doctor if you experience symptoms of irregular heartbeat.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Vision changes: This medication may affect your vision, causing blurring or spots of light. Contact your doctor if you notice any changes in your vision.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately. People who are of childbearing age should use effective birth control while taking ivabradine.

Breast-feeding: It is not known if ivabradine passes into breast milk. If you are breast-feeding and taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

Seniors: Adults 75 years of age and over may be more at risk of experiencing side effects from this medication and may require lower doses.

For a full list of interactions, use the Drug Interaction Checker available on the Drugs.com website.

If you are taking other medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.