Inhibition of the  channels ( I _f ) responsible fot the cardiac pacemaker current  in the sinus node. Selective slowing of sinus rhythm, without the side effects of beta blockers.

These channels are also present in the retina.

Slowing down the heart rate:

• Improved hemodynamics by increasing diastolic filling time and myocardial perfusion time, resulting in higher inotropy, improvement of LVEF and cardiac output.
• Decrease in myocardial overload and progressive LV dysfunction.

Trials: SHIFT.

• Reduction of heart failure-related mortality
• Reduction of hospitalizations for heart failure
• Reduction of symptoms and improvement of quality of life

Refund in Belgium if these 3 conditions are met:

• Persistent symptomatic heart failure, NYHA II-IV.
• LVEF ≤ 35%.
• Sinus rhythm ≥ 75/min.

• Depending on the heart rate. Target heart rate : 60 per minute.
• To be initiated by a cardiologist (reimbursement must be requested by a cardiologist).
• Starting dose: 5 mg 0.5 or 1 tablet 2x per day. If necessary, increase to 7.5 mg 2 x 1 tablet per day.
• No use in atrial fibrillation: to be stopped if progression to persistent/permanent AF.

• Grapefruit juice increases the level of ivabradine
• Rifampicin, St. John's wort, phenytoin and barbiturates reduce the level of ivabradine

• Resting heart rate < 60/min before therapy
• Very low blood pressure < 90/50 mmHg
• Pregnancy and lactation
• Potent CYP3A4 inhibitors: Macrolide antibiotics, azoles and HIV protease inhibitors
• Severe hepatic impairment

• Temporary visual changes (light flashes) during the first days of ingestion. Normally this is a transient phenomenon.
• Sinus bradycardia.