Ivabradin Medical Valley (Ivabradine)
Heart rate-lowering medication for stable angina pectoris and chronic heart failure
Ivabradin Medical Valley contains ivabradine, a selective heart rate-lowering agent that works by inhibiting the If (funny) current in the sinoatrial node. It is prescribed for adults with stable angina pectoris (resting heart rate ≥70 bpm) who cannot tolerate beta-blockers, or as add-on therapy, and for chronic heart failure (resting heart rate ≥75 bpm) in combination with standard treatment.
Quick Facts
Key Takeaways
- Ivabradine selectively lowers heart rate without affecting blood pressure, contractility, or cardiac conduction – making it distinct from beta-blockers.
- It is approved for stable angina (heart rate ≥70 bpm) when beta-blockers are unsuitable, and for chronic heart failure (heart rate ≥75 bpm) combined with standard therapy.
- The most common side effect is luminous phenomena (phosphenes) – brief episodes of enhanced brightness in the visual field, typically within the first two months of treatment.
- Ivabradine must not be combined with strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) or the calcium channel blockers diltiazem and verapamil.
- It is contraindicated during pregnancy and breastfeeding; reliable contraception is required for women of childbearing potential.
What Is Ivabradin Medical Valley and What Is It Used For?
Quick Answer: Ivabradin Medical Valley (ivabradine) is a prescription heart medication that specifically lowers heart rate by inhibiting the If current in the sinus node. It is used to treat stable angina pectoris and chronic heart failure in adults whose heart rate remains elevated despite other treatments.
Ivabradin Medical Valley belongs to a unique class of cardiovascular medications known as If (funny) channel inhibitors. Unlike beta-blockers or calcium channel blockers, ivabradine acts exclusively on the sinoatrial node – the heart's natural pacemaker – by blocking the hyperpolarization-activated cyclic nucleotide-gated (HCN) channels. This selective mechanism reduces the rate of spontaneous diastolic depolarization, thereby slowing the heart rate without affecting myocardial contractility, blood pressure, or intracardiac conduction pathways.
Stable Angina Pectoris
Stable angina pectoris (commonly known as angina) is a condition that occurs when the heart muscle does not receive sufficient oxygen-rich blood, typically during physical exertion or emotional stress. The most common symptom is a squeezing, pressure-like chest pain or discomfort that usually subsides with rest. In patients with stable angina, an elevated heart rate increases myocardial oxygen demand, thereby worsening the imbalance between oxygen supply and demand.
Ivabradine is indicated for the symptomatic treatment of chronic stable angina pectoris in adults with a resting heart rate of 70 beats per minute (bpm) or higher. It is prescribed for patients who cannot tolerate or have contraindications to beta-blockers, or it may be used in combination with beta-blockers when the condition is not adequately controlled with a beta-blocker alone. By reducing heart rate, ivabradine decreases the heart's oxygen consumption during both rest and exercise, thereby reducing the frequency of angina attacks and improving exercise tolerance.
Chronic Heart Failure
Chronic heart failure is a progressive condition in which the heart cannot pump enough blood to meet the body's needs. Common symptoms include shortness of breath (dyspnoea), fatigue, weakness, and fluid retention leading to swelling of the ankles and legs. An elevated heart rate in heart failure patients is associated with disease progression, increased hospitalization rates, and higher cardiovascular mortality.
Ivabradine is indicated for the treatment of chronic heart failure (New York Heart Association class II to IV) with systolic dysfunction in adult patients in sinus rhythm with a resting heart rate of 75 bpm or higher. It is used in combination with standard therapy, including beta-blockers, or when beta-blockers are contraindicated or not tolerated. The landmark SHIFT trial (Systolic Heart failure treatment with the If inhibitor ivabradine Trial) demonstrated that ivabradine significantly reduced the composite endpoint of cardiovascular death and heart failure hospitalization in these patients.
How Does Ivabradine Work?
The heart rate-lowering effect of ivabradine is achieved through a highly specific mechanism. The If current (where "f" stands for "funny" due to its unusual properties) is responsible for the spontaneous slow depolarization phase of the sinoatrial node action potential. By selectively inhibiting this current, ivabradine slows the pacemaker activity of the sinus node in a dose-dependent manner, reducing heart rate at rest and during exercise.
This targeted approach offers several advantages. Because ivabradine does not affect beta-adrenergic receptors, calcium channels, or potassium channels, it preserves normal cardiac contractility (the force with which the heart pumps), atrioventricular conduction, and ventricular repolarization. Additionally, it does not cause bronchospasm, peripheral vasoconstriction, or the metabolic side effects sometimes associated with beta-blockers. These properties make ivabradine particularly valuable for patients who cannot tolerate conventional heart rate-lowering therapies.
What Should You Know Before Taking Ivabradin Medical Valley?
Quick Answer: Ivabradine is contraindicated in patients with a resting heart rate below 70 bpm (angina) or below 75 bpm (heart failure), cardiogenic shock, severe liver disease, pregnancy, and breastfeeding. It must not be combined with strong CYP3A4 inhibitors or the calcium channel blockers diltiazem and verapamil.
Contraindications
There are several important situations in which ivabradine must not be used. Understanding these contraindications is essential for safe treatment. Do not take Ivabradin Medical Valley if any of the following apply to you:
- You are allergic to ivabradine or any of the other ingredients in this medicine
- Your resting heart rate before treatment is too low (below 70 bpm for angina or below 75 bpm for heart failure)
- You have cardiogenic shock (a serious heart condition treated in hospital)
- You have heart rhythm disorders including sick sinus syndrome, sinoatrial block, or third-degree atrioventricular (AV) block
- You are experiencing a heart attack (acute myocardial infarction)
- You have very low blood pressure (severe hypotension)
- You have unstable angina (a severe condition with frequent or unpredictable chest pain at rest)
- Your heart failure has recently worsened (acute decompensated heart failure)
- Your heart rhythm is entirely maintained by a pacemaker
- You have severe liver disease (hepatic impairment)
- You are taking certain strong CYP3A4 inhibitors including ketoconazole, itraconazole, clarithromycin, telithromycin, erythromycin (oral), josamycin, nelfinavir, ritonavir, nefazodone, diltiazem, or verapamil
- You are a woman of childbearing potential not using reliable contraception
- You are pregnant or trying to become pregnant
- You are breastfeeding
Warnings and Precautions
Talk to your doctor or pharmacist before taking Ivabradin Medical Valley if you have any of the following conditions, as special monitoring or dose adjustments may be necessary:
- Heart rhythm disorders – such as irregular heartbeat, palpitations, increased chest pain, or sustained atrial fibrillation. Ivabradine may increase the risk of atrial fibrillation.
- Symptoms of excessive heart rate reduction – including fatigue, dizziness, or shortness of breath, which may indicate that the heart rate has slowed too much (symptomatic bradycardia).
- Long QT syndrome – an abnormal ECG finding that can predispose to dangerous heart rhythms. Ivabradine should be used with caution in patients with congenital or acquired QT prolongation.
- Recent stroke – ivabradine should be used with caution in patients who have recently had a cerebrovascular event.
- Low blood pressure – mild to moderate hypotension, particularly if your blood pressure medication has recently been changed.
- Severe heart failure or heart failure with an ECG abnormality called bundle branch block, as there is limited experience with ivabradine in these patients.
- Chronic retinal disease – ivabradine can cause visual disturbances (phosphenes), and patients with retinal conditions should be monitored.
- Moderate liver impairment – dose adjustment may be needed as ivabradine is primarily metabolized in the liver.
- Severe kidney disease – caution is required due to limited clinical data.
Ivabradin Medical Valley should not be given to children or adolescents under 18 years of age. There is insufficient data on the safety and efficacy of ivabradine in this age group.
Pregnancy and Breastfeeding
Ivabradine is strictly contraindicated during pregnancy. Animal studies have demonstrated reproductive toxicity, and the drug may cause harm to the developing fetus. Women of childbearing potential must use reliable contraception throughout treatment. If you discover you are pregnant while taking ivabradine, stop the medication immediately and contact your doctor.
Breastfeeding is also contraindicated during ivabradine treatment. Studies in animals have shown that ivabradine is excreted in breast milk. If you are breastfeeding or plan to breastfeed, your doctor will advise you to stop breastfeeding or to discontinue ivabradine, depending on the clinical situation.
Driving and Operating Machinery
Ivabradine can cause luminous phenomena (phosphenes) – temporary visual disturbances consisting of brief episodes of enhanced brightness in the visual field. If you experience these effects, be cautious when driving or operating machinery, especially in situations where sudden changes in light intensity may occur, such as driving at night. Phosphenes may impair your ability to react to changing visual conditions.
Important Information About Excipients
Ivabradin Medical Valley tablets contain lactose monohydrate. If you have been told by your doctor that you have an intolerance to certain sugars, contact your doctor before taking this medicine.
Grapefruit Juice
Avoid consuming grapefruit juice while taking Ivabradin Medical Valley. Grapefruit juice can inhibit the CYP3A4 enzyme responsible for metabolizing ivabradine, potentially increasing blood levels of the drug and the risk of side effects. This interaction can approximately double plasma concentrations of ivabradine.
How Does Ivabradin Medical Valley Interact with Other Drugs?
Quick Answer: Ivabradine is metabolized by the CYP3A4 enzyme and must not be combined with strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) or the heart rate-lowering calcium channel blockers diltiazem and verapamil. Several other medications require dose adjustment or monitoring when used together with ivabradine.
Ivabradine is primarily metabolized in the liver by the cytochrome P450 3A4 (CYP3A4) enzyme system. Drugs that strongly inhibit or induce this enzyme can significantly alter ivabradine blood levels, leading to increased side effects or reduced efficacy. Additionally, drugs that prolong the QT interval or further reduce heart rate can have additive effects when combined with ivabradine.
Major Interactions (Contraindicated)
The following combinations are contraindicated and must be avoided. Taking ivabradine with any of these medications can result in dangerous increases in ivabradine exposure or excessive heart rate reduction:
| Drug / Class | Type | Reason |
|---|---|---|
| Ketoconazole, Itraconazole | Azole antifungals | Strong CYP3A4 inhibitors; dramatically increase ivabradine levels |
| Clarithromycin, Josamycin, Telithromycin, Erythromycin (oral) | Macrolide antibiotics | Strong CYP3A4 inhibitors; significantly increase ivabradine exposure |
| Ritonavir, Nelfinavir | HIV protease inhibitors | Strong CYP3A4 inhibitors; markedly increase ivabradine levels |
| Nefazodone | Antidepressant | Strong CYP3A4 inhibitor |
| Diltiazem, Verapamil | Calcium channel blockers | Moderate CYP3A4 inhibitors + additive heart rate-lowering effect |
Interactions Requiring Caution
The following medications may interact with ivabradine and require dose adjustment, monitoring, or careful clinical consideration. Always inform your doctor if you are taking any of these:
| Drug / Class | Effect | Recommendation |
|---|---|---|
| Fluconazole | Moderate CYP3A4 inhibitor; increases ivabradine levels | Start with 2.5 mg twice daily; monitor heart rate |
| Rifampicin | Strong CYP3A4 inducer; decreases ivabradine levels | Dose increase may be necessary |
| Phenytoin, Barbiturates | CYP3A4 inducers; may reduce ivabradine efficacy | Monitor treatment effect; dose adjustment may be needed |
| St John's Wort (Hypericum perforatum) | CYP3A4 inducer; may reduce ivabradine levels | Avoid or monitor closely; dose adjustment may be needed |
| QT-prolonging drugs (quinidine, disopyramide, amiodarone, sotalol, pimozid, mefloquine, cisapride) | Additive QT prolongation risk with ivabradine-induced bradycardia | Use with caution; regular ECG monitoring recommended |
| Potassium-depleting diuretics (furosemide, hydrochlorothiazide, indapamide) | Low potassium increases risk of arrhythmias | Monitor potassium levels and cardiac rhythm |
What Is the Correct Dosage of Ivabradin Medical Valley?
Quick Answer: The usual starting dose is 5 mg twice daily taken with meals. The dose may be increased to 7.5 mg twice daily after 3–4 weeks if needed. In elderly patients (≥75 years), a lower starting dose of 2.5 mg twice daily may be used. Always take the dose your doctor has prescribed.
Always take Ivabradin Medical Valley exactly as your doctor or pharmacist has instructed. The tablets should be taken with meals, as food increases the absorption of ivabradine by approximately 20–30%. The usual regimen involves one tablet in the morning and one in the evening. The 5 mg tablet is scored and can be divided into two equal halves of 2.5 mg each.
Adults – Stable Angina Pectoris
Angina Dosing Schedule
- Starting dose: 5 mg twice daily (one tablet morning and evening)
- Dose titration: After 3–4 weeks, if symptoms persist and the 5 mg dose is well tolerated, the dose may be increased to 7.5 mg twice daily
- Maximum dose: 7.5 mg twice daily
- Dose reduction: If heart rate falls below 50 bpm at rest, or if bradycardia symptoms (dizziness, fatigue, hypotension) occur, the dose should be reduced. Treatment should be discontinued if heart rate remains below 50 bpm or symptoms persist
Adults – Chronic Heart Failure
Heart Failure Dosing Schedule
- Starting dose: 5 mg twice daily (one tablet morning and evening)
- Dose titration: After 2 weeks, dose may be increased to 7.5 mg twice daily if the resting heart rate remains consistently above 60 bpm
- Maximum dose: 7.5 mg twice daily
- Dose reduction: If heart rate falls below 50 bpm or if symptoms of bradycardia develop, the dose should be reduced to 2.5 mg twice daily. If the heart rate remains between 50 and 60 bpm, the dose of 5 mg twice daily may be maintained
Elderly Patients (≥75 Years)
For patients aged 75 years or older, a lower starting dose should be considered. The recommended initial dose is 2.5 mg twice daily (half a 5 mg tablet in the morning and half a 5 mg tablet in the evening). The dose can then be titrated upward based on response and tolerability. Elderly patients may be more susceptible to bradycardia and its associated symptoms, so careful monitoring of heart rate is essential.
Children and Adolescents
Ivabradine is not recommended for children and adolescents under 18 years of age due to insufficient data on safety and efficacy in this population.
Missed Dose
If you forget to take a dose of Ivabradin Medical Valley, take the next dose at the usual time. Do not take a double dose to make up for a forgotten dose. Skipping a single dose is unlikely to significantly affect your heart rate control, but try to maintain a consistent dosing schedule for optimal therapeutic benefit.
Overdose
A high dose of ivabradine may cause pronounced shortness of breath or fatigue due to excessive reduction in heart rate (severe bradycardia). If you or someone else has taken too much Ivabradin Medical Valley, seek medical attention immediately. Contact your local poison control centre or emergency services for assessment and advice.
Stopping Treatment
Do not stop taking Ivabradin Medical Valley without consulting your doctor. Treatment for stable angina and chronic heart failure is typically long-term or lifelong. Abrupt discontinuation could lead to a return of symptoms, including increased frequency of angina attacks or worsening heart failure symptoms. Your doctor will advise you on whether and how to discontinue treatment safely.
What Are the Side Effects of Ivabradin Medical Valley?
Quick Answer: The most common side effect is luminous phenomena (phosphenes) – brief flashes of enhanced brightness in the visual field, occurring in more than 1 in 10 patients. Bradycardia (slow heart rate), headache, and dizziness are also common. Most side effects are dose-dependent and related to the drug's mechanism of action.
Like all medicines, Ivabradin Medical Valley can cause side effects, although not everyone experiences them. The side effects listed below are based on clinical trials and post-marketing surveillance data. The frequency categories follow standard international convention. If you experience any side effects that concern you, or any effects not listed below, contact your doctor or pharmacist.
Very Common
May affect more than 1 in 10 people
- Luminous phenomena (phosphenes) – brief episodes of enhanced brightness in the visual field, often described as a luminous halo, coloured flashes, image decomposition, or multiple images. They are typically triggered by sudden changes in light intensity and usually appear within the first two months of treatment. Phosphenes are generally mild to moderate in severity and resolve spontaneously during or after treatment.
Common
May affect up to 1 in 10 people
- Bradycardia – slow heart rate, typically appearing within the first 2–3 months of treatment
- Atrial fibrillation – irregular, often rapid heart rhythm originating in the atria
- Abnormal perception of heartbeat – including ventricular extrasystoles and first-degree AV block (prolonged PR interval on ECG)
- Uncontrolled blood pressure
- Headache
- Dizziness
- Blurred vision
Uncommon
May affect up to 1 in 100 people
- Palpitations and extra heartbeats (supraventricular extrasystoles)
- Nausea, constipation, diarrhoea, abdominal pain
- Vertigo (spinning sensation)
- Dyspnoea (shortness of breath)
- Muscle spasms (cramps)
- Elevated uric acid levels in the blood (hyperuricaemia)
- Increased eosinophil count (a type of white blood cell)
- Elevated creatinine levels (a kidney function marker)
- Skin rash, angioedema (swelling of face, tongue, or throat)
- Low blood pressure (hypotension), fainting (syncope)
- Fatigue, feeling of weakness (asthenia)
- Abnormal ECG patterns, double vision (diplopia)
Rare
May affect up to 1 in 1,000 people
- Urticaria (hives), pruritus (itching)
- Erythema (skin redness)
- Malaise (general feeling of being unwell)
Very Rare
May affect up to 1 in 10,000 people
- Second-degree AV block
- Third-degree AV block (complete heart block)
- Sick sinus syndrome
It is important to report suspected side effects after the medicine has been authorised. This helps to continuously monitor the benefit-risk balance of the medicine. Healthcare professionals and patients are encouraged to report any suspected adverse reactions to their national pharmacovigilance authority.
How Should You Store Ivabradin Medical Valley?
Quick Answer: Store Ivabradin Medical Valley at or below 30°C (86°F). Keep the medicine out of the sight and reach of children. Do not use after the expiry date printed on the packaging.
Proper storage of medications is essential to maintain their safety and efficacy. Follow these guidelines for storing Ivabradin Medical Valley:
- Temperature: Store at or below 30°C (86°F). Do not freeze.
- Children: Keep this medicine out of the sight and reach of children at all times.
- Expiry date: Do not use this medicine after the expiry date stated on the carton and blister after "EXP". The expiry date refers to the last day of that month.
- Disposal: Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to dispose of medicines you no longer need. These measures help protect the environment.
Keep the tablets in their original blister packaging to protect them from moisture. If you notice any visible changes in the appearance of the tablets – such as discolouration, crumbling, or unusual odour – do not use them and consult your pharmacist.
What Does Ivabradin Medical Valley Contain?
Quick Answer: Each film-coated tablet contains ivabradine hydrochloride equivalent to 5 mg or 7.5 mg of ivabradine as the active substance. The tablets also contain lactose monohydrate, magnesium stearate, maize starch, and other excipients.
Active Substance
The active substance in Ivabradin Medical Valley is ivabradine (as ivabradine hydrochloride). Each film-coated tablet is available in two strengths:
- 5 mg tablet: Contains ivabradine hydrochloride equivalent to 5 mg ivabradine
- 7.5 mg tablet: Contains ivabradine hydrochloride equivalent to 7.5 mg ivabradine
Other Ingredients
Tablet core: Lactose monohydrate, magnesium stearate (E 470 B), maize starch, maltodextrin, colloidal anhydrous silica (E 551).
Film coating: Lactose monohydrate, hypromellose (E 464), titanium dioxide (E 171), macrogol (E 1521), yellow iron oxide (E 172), red iron oxide (E 172).
Appearance and Pack Sizes
The 5 mg tablets are light orange, capsule-shaped (8.4 x 3.4 mm), biconvex, film-coated tablets with a score line on one side. The tablet can be divided into two equal halves.
The 7.5 mg tablets are light orange, round (7.1 mm x 3.8 mm), biconvex, film-coated tablets.
The tablets are available in blister packs of 14, 28, 56, 84, 98, 100, and 112 tablets. Not all pack sizes may be marketed in all countries.
Frequently Asked Questions About Ivabradin Medical Valley
Ivabradin Medical Valley is used to treat two main conditions: stable angina pectoris (chest pain from insufficient blood flow to the heart) in adults with a resting heart rate of 70 bpm or higher, and chronic heart failure in adults with a resting heart rate of 75 bpm or higher. For angina, it may be used alone when beta-blockers are not tolerated, or in combination with beta-blockers. For heart failure, it is always combined with standard treatment.
The most common side effect is luminous phenomena (phosphenes) – brief flashes or halos of light in the visual field, affecting more than 1 in 10 patients. These are typically mild, triggered by sudden changes in light intensity, and usually appear within the first two months of treatment. Other common side effects include bradycardia (slow heart rate), atrial fibrillation, headache, dizziness, and blurred vision.
Yes, ivabradine can be combined with beta-blockers for both stable angina and chronic heart failure. In fact, for heart failure, combination with a beta-blocker is the preferred approach. However, your doctor will need to carefully monitor your heart rate, as both drugs lower heart rate. The combination with the calcium channel blockers diltiazem and verapamil is contraindicated.
Ivabradine lowers heart rate through a unique mechanism – it selectively inhibits the If current in the sinoatrial node. Unlike beta-blockers, it does not affect blood pressure, myocardial contractility, cardiac conduction, or bronchial tone. This means ivabradine does not cause the fatigue, cold extremities, bronchospasm, or metabolic effects sometimes seen with beta-blockers. It is therefore particularly useful for patients who cannot tolerate beta-blockers due to asthma, very low blood pressure, or other contraindications.
No. Ivabradine is contraindicated during pregnancy and breastfeeding. Animal studies have shown reproductive toxicity. Women of childbearing potential must use effective contraception while taking ivabradine. If you discover you are pregnant, stop the medication immediately and contact your doctor for alternative treatment options.
Luminous phenomena (phosphenes) are the most frequently reported side effect and are usually harmless and temporary. They typically resolve on their own and do not require stopping the medication. However, if the visual disturbances are severe, persistent, or significantly affect your daily activities (particularly driving at night), contact your doctor. In rare cases, retinal dysfunction may occur, and your doctor may recommend an ophthalmological examination.
References & Medical Sources
- European Medicines Agency (EMA). Procoralan (ivabradine) – Summary of Product Characteristics. EMA/EPAR/Procoralan. Last updated 2024.
- Swedberg K, Komajda M, Böhm M, et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. The Lancet. 2010;376(9744):875-885. doi:10.1016/S0140-6736(10)61198-1
- Fox K, Ford I, Steg PG, et al. Ivabradine for patients with stable coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a randomised, double-blind, placebo-controlled trial. The Lancet. 2008;372(9641):807-816. doi:10.1016/S0140-6736(08)61170-8
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2021;42(36):3599-3726. doi:10.1093/eurheartj/ehab368
- Knuuti J, Wijns W, Saraste A, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2020;41(3):407-477. doi:10.1093/eurheartj/ehz425
- National Institute for Health and Care Excellence (NICE). Ivabradine for treating chronic heart failure. Technology appraisal guidance [TA267]. 2012, updated 2024. NICE TA267
- Böhm M, Swedberg K, Komajda M, et al. Heart rate as a risk factor in chronic heart failure (SHIFT): the association between heart rate and outcomes in a randomised placebo-controlled trial. The Lancet. 2010;376(9744):886-894. doi:10.1016/S0140-6736(10)61259-7
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd List. 2023. WHO Essential Medicines 2023
- British National Formulary (BNF). Ivabradine. National Institute for Health and Care Excellence. BNF/ivabradine. Accessed January 2026.
Medical Editorial Team
This article has been written and reviewed by qualified medical professionals with expertise in cardiology, clinical pharmacology, and evidence-based medicine.
All drug information is based on approved product labelling (EMA SmPC), peer-reviewed clinical trials, and international clinical guidelines (ESC, NICE, WHO). We follow the GRADE evidence framework and maintain strict editorial independence with no pharmaceutical industry funding. Read our full editorial policy.