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Ivabradine Zentiva is a brand name for Ivabradine. The medicine, its uses, side effects and dosage are the same regardless of brand.
Used for: Symptomatic treatment of chronic stable angina pectoris Ivabradine is indicated for the symptomatic treatment of chronic stable angina pectoris in coronary artery disease adults with normal sinus rhythm and heart rate ≥ 70 beats per minute (bpm). Ivabradine is indicated: ‒ in adults unable to tolerate or with a…
Verbatim from this product's EMA label. Tap a section to expand.
Posology Symptomatic treatment of chronic stable angina pectoris It is recommended that the decision to initiate or titrate treatment takes place with the availability of serial heart rate measurements, ECG or ambulatory 24-hour monitoring.
The starting dose of ivabradine should not exceed 5 mg twice daily in patients aged below 75 years. 5 mg twice daily or 5 mg twice daily. 5 mg twice daily. If there is no improvement in symptoms of angina within 3 months after start of treatment, treatment of ivabradine should be discontinued.
In addition, discontinuation of treatment should be considered if there is only limited symptomatic response and when there is no clinically relevant reduction in resting heart rate within three months. 5 mg twice daily (one half 5 mg tablet twice daily).
4). Treatment must be discontinued if heart rate remains below 50 bpm or symptoms of bradycardia persist despite dose reduction. Treatment of chronic heart failure The treatment has to be initiated only in patient with stable heart failure.
It is recommended that the treating physician should be experienced in the management of chronic heart failure. The usual recommended starting dose of ivabradine is 5 mg twice daily. 5 mg twice daily (one half 5 mg tablet twice daily) if resting heart rate is persistently below 50 bpm or in case of symptoms related to bradycardia such as dizziness, fatigue or hypotension.
If heart rate is between 50 and 60 bpm, the dose of 5 mg twice daily should be maintained. 5 mg twice daily or 5 mg twice daily. 5 mg twice daily or 5 mg twice daily. 4). e. one half 5 mg tablet twice daily) before up-titration if necessary.
2). No data are available in patients with creatinine clearance below 15 mL/min. Ivabradine should therefore be used with precaution in this population. Hepatic impairment No dose adjustment is required in patients with mild hepatic impairment.
Caution should be exercised when using ivabradine in patients with moderate hepatic impairment. 2). Paediatric population The safety and efficacy of ivabradine in children aged below 18 years have not been established. 2 but no recommendation on a posology can be made.
No data for symptomatic treatment of chronic stable angina pectoris are available. e. 2). Ivabradine Zentiva 5 mg film-coated tablet can be divided into equal doses. Use a tablet cutter to divide the tablet.
3 %). They are dose dependent and related to the pharmacological effect of the medicinal product. Tabulated list of adverse reactions The following adverse reactions have been reported during clinical trials and are ranked using the following frequency: very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1 000 to < 1/100); rare (≥ 1/10 000 to < 1/1 000); very rare (< 1/10 000); not known (cannot be estimated from the available data).
System organ class Frequency Preferred term Blood and lymphatic system disorders Uncommon Eosinophilia Metabolism and nutrition disorders Uncommon Hyperuricaemia Nervous system disorders Common Headache, generally during the first month of treatment Dizziness, possibly related to bradycardia Uncommon* Syncope, possibly related to bradycardia 10 System organ class Frequency Preferred term Eye disorders Very common Luminous phenomena (phosphenes) Common Blurred vision Uncommon* Diplopia Visual impairment Ear and labyrinth disorders Uncommon Vertigo Cardiac disorders Common Bradycardia AV 1st degree block (ECG prolonged PQ interval) Ventricular extrasystoles Atrial fibrillation Uncommon Palpitations Supraventricular extrasystoles ECG prolonged QT interval Very rare AV 2nd and 3rd degree block Sick sinus syndrome Vascular disorders Common Uncontrolled blood pressure Uncommon* Hypotension, possibly related to bradycardia Respiratory, thoracic and mediastinal disorders Uncommon Dyspnoea Gastrointestinal disorders Uncommon Nausea Constipation Diarrhoea Abdominal pain* Skin and subcutaneous tissue disorders Uncommon* Angioedema Rash Rare* Erythema Pruritus Urticaria Musculoskeletal and connective tissue disorders Uncommon Muscle spasms Renal and urinary disorders Uncommon Elevated creatinine in blood General disorders and administration site conditions Uncommon* Asthenia, possibly related to bradycardia Fatigue, possibly related to bradycardia Rare* Malaise, possibly related to bradycardia * Frequency calculated from clinical trials for adverse events detected from spontaneous report.
g. 1). Measurement of heart rate Given that the heart rate may fluctuate considerably over time, serial heart rate measurements, ECG or ambulatory 24-hour monitoring should be considered when determining resting heart rate before initiation of ivabradine treatment and in patients on treatment with ivabradine when titration is considered.
2). g. ventricular or supraventricular tachycardia). Ivabradine is therefore not recommended in patients with atrial fibrillation or other cardiac arrhythmias that interfere with sinus node function. 8). Atrial fibrillation has been more common in patients using concomitantly amiodarone or potent class I anti-arrhythmics.
g. in case of exacerbated angina, palpitations, irregular pulse). Patients should be informed of signs and symptoms of atrial fibrillation and be advised to contact their physician if these occur. If atrial fibrillation develops during treatment, the balance of benefits and risks of continued ivabradine treatment should be carefully reconsidered.
Chronic heart failure patients with intraventricular conduction defects (bundle branch block left, bundle branch block right) and ventricular dyssynchrony should be monitored closely. Use in patients with AV-block of 2nd degree Ivabradine is not recommended in patients with AV-block of 2nd degree.
3). 2). 5). No safety issue has been raised on the combination of ivabradine with nitrates and dihydropyridine calcium channel blockers such as amlodipine. 1). Chronic heart failure Heart failure must be stable before considering ivabradine treatment.
Ivabradine should be used with caution in heart failure patients with NYHA functional classification IV due to limited amount of data in this population. Stroke The use of ivabradine is not recommended immediately after a stroke since no data is available in these situations.
Visual function Ivabradine influences retinal function. 1). Cessation of treatment should be considered if any unexpected deterioration in visual function occurs. Caution should be exercised in patients with retinitis pigmentosa. Patients with hypotension Limited data are available in patients with mild to moderate hypotension, and ivabradine should therefore be used with caution in these patients.
1. ‒ Resting heart rate below 70 beats per minute prior to treatment. ‒ Cardiogenic shock. ‒ Acute myocardial infarction. ‒ Severe hypotension (< 90/50 mmHg). ‒ Severe hepatic insufficiency. ‒ Sick sinus syndrome. ‒ Sino-atrial block. ‒ Unstable or acute heart failure.
‒ Pacemaker dependent (heart rate imposed exclusively by the pacemaker). ‒ Unstable angina. ‒ AV-block of 3rd degree. 2). 5). 6).
Not medical advice. Always read the patient information leaflet and follow your prescriber or pharmacist.
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5% of patients, described as a transient enhanced brightness in a limited area of the visual field. They are usually triggered by sudden variations in light intensity. Phosphenes may also be described as a halo, image decomposition (stroboscopic or kaleidoscopic effects), coloured bright lights, or multiple image (retinal persistency).
The onset of phosphenes is generally within the first two months of treatment after which they may occur repeatedly. Phosphenes were generally reported to be of mild to moderate intensity. 5%) resolved during treatment. Fewer than 1% of patients changed their daily routine or discontinued the treatment in relation with phosphenes.
3% of patients particularly within the first 2 to 3 months of treatment initiation. 5% of patients experienced a severe bradycardia below or equal to 40 bpm. 8% in the placebo group. 39]. 1%). These episodes occurred most frequently shortly after blood pressure treatment was modified, were transient, and did not affect the treatment effect of ivabradine.
Reporting of suspected adverse reactions Reporting suspected adverse reactions after authorisation of the medicinal product is important. It allows continued monitoring of the benefit/risk balance of the medicinal product. Healthcare professionals are asked to report any suspected adverse reactions via the national reporting system listed in Appendix V.
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3). Atrial fibrillation – cardiac arrhythmias There is no evidence of risk of (excessive) bradycardia on return to sinus rhythm when pharmacological cardioversion is initiated in patients treated with ivabradine. However, in the absence of extensive data, non-urgent DC-cardioversion should be considered 24 hours after the last dose of ivabradine.
5). If the combination appears necessary, close cardiac monitoring is needed. Heart rate reduction, as caused by ivabradine, may exacerbate QT prolongation, which may give rise to severe arrhythmias, in particular Torsade de pointes.
8).