Manage Ivabradine: How to Use, Monitor & Stay Safe

Ivabradine is a medicine that slows your heart rate. Doctors use it mainly for heart failure and sometimes for chronic stable angina when patients still have a high resting heart rate despite other drugs. If you’re starting ivabradine, this page gives clear, practical steps to take, what to watch for, and how to avoid common problems.

Quick facts and who should take it

Ivabradine works on the sinus node to lower beats per minute without weakening heart contraction. Guidelines recommend it for people with heart failure with reduced ejection fraction who are in normal sinus rhythm and have a resting heart rate of 70 bpm or more despite an adequate beta-blocker dose. It’s not for people in atrial fibrillation or with very slow heart rates.

Common reasons your doctor might pick ivabradine: ongoing high resting heart rate, intolerance to higher doses of beta-blockers, or specific angina cases. Tell your doctor if you have liver problems, low blood pressure, a pacemaker, or eye issues.

How to take, monitor, and handle problems

Typical adult start is 5 mg twice daily with food. After two weeks your doctor will check your resting pulse and adjust: increase to 7.5 mg twice daily if your pulse is still high, or reduce to 2.5 mg twice daily if your pulse falls below 50 bpm or you have symptoms like dizziness. Older adults or those with low body weight or liver problems may start lower — follow your clinician’s plan.

Do a simple daily pulse check at the same time each day. If your pulse is under 50 bpm, you feel faint, or you have new severe dizziness, stop and contact your provider. Regular follow-up appointments and an occasional ECG may be needed to confirm rhythm and rate.

Watch for these side effects: slow heart rate (bradycardia), tiredness, dizziness, and phosphenes — brief flashes or brightness in vision. Visual changes are usually harmless and short-lived, but report them if they bother you.

Ivabradine is broken down by CYP3A4. Avoid strong CYP3A4 inhibitors like ketoconazole, itraconazole, clarithromycin, and certain HIV drugs — these can raise ivabradine levels and cause severe bradycardia. Grapefruit and grapefruit juice can also interfere and are best avoided. Combining ivabradine with other drugs that slow heart rate (high-dose beta-blockers, digoxin, verapamil) increases risk — your doctor will review all meds before starting.

If you miss a dose, take it as soon as you remember unless it’s almost time for the next dose — don’t double up. Don’t stop ivabradine suddenly without medical advice; your doctor will guide any changes. Also avoid driving or heavy machinery until you know how the drug affects you, especially if you feel dizzy.

Questions for your clinician: Is ivabradine adding to my beta-blocker? What resting heart rate should I aim for? Any drug interactions with my current meds? Keep written notes of pulse checks and symptoms — they help your care team fine-tune treatment quickly.