Updated advice on initiating ivabradine in angina

Procoralan (ivabradine) should no longer be initiated in patients with a resting heart rate less than 70 bpm, the MHRA has said.

In the symptomatic treatment of patients with chronic stable angina, Procoralan is indicated in adults with normal sinus rhythm, and a contraindication to or intolerance of ß-blockers. SCIENCE PHOTO LIBRARY
In the symptomatic treatment of patients with chronic stable angina, Procoralan is indicated in adults with normal sinus rhythm, and a contraindication to or intolerance of ß-blockers. SCIENCE PHOTO LIBRARY

The MHRA has published updated advice in the December 2014 edition of Drug Safety Update about initiating the sinus If node inhibitor ivabradine (Procoralan) in patients with angina.

Ivabradine should no longer be initiated in angina patients with a resting heart rate below 70 bpm and must not be used in conjunction with other drugs that cause bradycardia, including the calcium-channel blockers diltiazem and verapamil, or drugs that are strong inhibitors of CYP3A4 (eg, clarithromyin, erythromycin, azole antifungals and protease inhibitors).

Patients should be closely monitored for signs of atrial fibrillation and if symptoms occur, a risk-benefit analysis should be performed. In addition, prescribers should consider discontinuing treatment if there is no or little symptom improvement after 3 months.

These new recommendations follow advice from the MHRA published in June 2014 about cardiac monitoring and dose titration in all patients starting ivabradine following results from the SIGNIFY study.

View Procoralan drug record

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