The sinus node If inhibitor is recommended as an option for prescribing on the NHS to patients:
- with NHYA class II–IV stable chronic heart failure with systolic dysfunction and
- who are in sinus rhythm with a heart rate ≥75 bpm and
- who are also receiving standard therapy, including a beta-blocker, an ACE inhibitor and an aldosterone antagonist, or when a beta-blocker is contraindicated or not tolerated, and
- who have a reduced left ventricular ejection fraction (LVEF) ≤35%.
May be managed in primary care following initiation
Patients should only be prescribed ivabradine following 4 weeks of optimised standard therapy and under the supervision of a heart failure specialist with access to a multidisciplinary team. Subsequent dose titration and monitoring can be managed either by the same specialist or by a GP with a special interest in heart failure or a heart failure specialist nurse.
Dose adjusted according to response and heart rate
Patients should be started on 5mg twice daily with morning and evening meals. The dose is then adjusted according to response and heart rate, within range 2.5–7.5mg twice daily.