Ivabradine

Adults: Adults: The usual recommended starting dose of ivabradine is 5 mg twice daily. After 3 to 4 weeks of treatment, this may be increased to 7.5 mg twice daily, depending on the response to therapy. The usual dose is 1 tablet in the morning and 1 tablet in the evening, taken with meals. If the resting heart rate falls persistently below 50 bpm, or if symptoms related to a slow heart rate (bradycardia) occur, the dose must be reduced to 2.5 mg twice daily (one half of the 5 mg tablet twice daily). Treatment must be stopped if the heart rate remains below 50 bpm or if symptoms of bradycardia persist. Elderly: Because ivabradine has been studied in only a limited number of patients aged 75 years or older, a lower starting dose should be considered for these patients (2.5 mg twice daily, that is, one half of a 5 mg tablet twice daily) before increasing the dose if needed. Renal insufficiency: No dose adjustment is needed in patients with renal insufficiency whose creatinine clearance is above 15 ml/min. No data are available for patients with a creatinine clearance below 15 ml/min, so ivabradine should be used with caution in this group. Hepatic impairment: No dose adjustment is needed in patients with mild hepatic impairment. Caution should be used when giving ivabradine to patients with moderate hepatic impairment. Ivabradine is contraindicated in patients with severe hepatic insufficiency. Children and adolescents: Ivabradine is not recommended for children and adolescents because there is a lack of data on its safety and efficacy in this age group.