What is Ivabradine used for?

Ivabradine is evaluated for the following indications with varying evidence strength: Heart failure (evidence tier A), Stable angina (evidence tier B), Athletic endurance (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Ivabradine?

Common side effects of Ivabradine (≥ 1 in 100): Luminous phenomena in vision (phosphenes) – 14%, reversible, Bradycardia, Headache, Dizziness, Atrioventricular extrasystoles. See the Safety section for uncommon and serious reactions.

Who should not take Ivabradine?

Ivabradine is contraindicated in: Ivabradine hypersensitivity; Resting HR under 70 bpm at baseline; Cardiogenic shock; Acute myocardial infarction; Severe hypotension (BP under 90/50). Full list in the Safety section.

Second-line in HFrEF per 2023 in symptomatic NYHA II–IV patients with sinus rhythm, HR ≥75 bpm, EF ≤35%. Added to standard therapy (ARNI/ACEi, β-blockers, aldosterone antagonists, SGLT2 inhibitors) when β-blockers are contraindicated or HR remains high on maximum tolerated dose. SHIFT showed 18% reduction in cardiovascular death or HF hospitalization. Starting dose 5 mg twice daily, titrated to 7.5 mg twice daily.

Only in HFrEF patients with sinus rhythm and HR ≥75 bpm on optimal foundation therapy.

Stable angina

Second line

Used in stable angina in patients with sinus rhythm and resting HR ≥70 bpm intolerant to or inadequately controlled on β-blockers. SIGNIFY in non-HF patients raised cardiovascular death and non-fatal MI by 18% – since then, angina-only indications are restricted to patients without alternatives.

Sources

Athletic endurance

Not recommended

Ivabradine is a selective sinus node If-channel inhibitor that reduces heart rate. It is prescribed for stable angina and heart failure with reduced ejection fraction ( 2024). In sports circles, ivabradine is occasionally promoted for pulse control during cardio in people without heart failure. In healthy athletes, no clinical studies of prophylactic use exist; such prescription can mask cardiovascular symptoms and is dangerous. The drug has specific risks: bradycardia, phosphenes (flashes of bright light in the visual field, in 14% of patients), atrial fibrillation, and conduction disturbances. Ivabradine is on the WADA Prohibited List in competition. If ivabradine was prescribed to an athlete for training, consider seeking a second opinion.

Sources

Timing and administration

Take twice daily with food – meals raise bioavailability by 20%. Check HR before each titration: target resting HR 50–60 bpm. With HR under 50 or bradycardia symptoms (dizziness, fatigue), reduce dose or stop. Strong CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) raise ivabradine levels 7–8 fold – combination contraindicated. Grapefruit juice doubles exposure.

Contraindications

Ivabradine hypersensitivity
Resting HR under 70 bpm at baseline
Cardiogenic shock
Acute myocardial infarction
Severe hypotension (BP under 90/50)
Severe hepatic impairment
Sick sinus syndrome, sinoatrial block
Third-degree AV block
Pacemaker-dependent rhythm
Unstable or acute heart failure
Concomitant strong CYP3A4 inhibitors
Pregnancy and lactation

Serious adverse effects

Severe bradycardia and AV block
Atrial fibrillation (30% increased risk)
Heart failure decompensation
Cardiovascular events in non-HF patients (SIGNIFY)

Common adverse effects

Luminous phenomena in vision (phosphenes) – 14%, reversible
Bradycardia
Headache
Dizziness
Atrioventricular extrasystoles

PregnancyFDA D

Contraindicated. Animal studies show embryo-fetal defects. Reliable contraception is required in women of reproductive age.

Breastfeeding

Contraindicated during lactation.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Ivabradine

Mechanism of action

Indications

Heart failure

Stable angina

Marketing claims without evidence base

Athletic endurance

Practical notes

Timing and administration

Check interaction with another drug

Official sources

Safety