Cardiology · Selective If channel inhibitor (SA node)
Ivabradine
Dose
5 mg BD, adjust after 2 weeks to 7.5 mg BD (target HR 50–60).
Mechanism
Slows SA node without affecting contractility or BP.
Indications
- • HFrEF (EF ≤35) in sinus rhythm HR ≥75 despite maximal β-blocker
- • Chronic stable angina intolerant to β-blocker
Contraindications
- • AF/flutter
- • Sick sinus syndrome
- • HR <70 pre-dose
- • Severe hepatic impairment
Use
Add-on to β-blocker in HF if HR remains ≥75.
Monitoring
HR, ECG (for AF onset).
Side effects
- • Bradycardia
- • Phosphenes (luminous visual disturbance)
- • AF
- • Headache
Related in WardRound
Always confirm dose against your local formulary / BNF before prescribing.
