USMLE

Ivabradine

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Cardiovascular Pharm
  1. Adenosine
  2. Magnesium
  3. Nitroprusside
  4. Nitrates
  5. Ivabradine
  6. Digoxin/Digitalis
  7. Class IA Antiarrhythmics
  8. Class IB Antiarrhythmics
  9. Class IC Antiarrhythmics
  10. Class II Antiarrhythmics
  11. Class III Antiarrhythmics - Amiodarone
  12. Class III Antiarrythmics - Sotalol
  13. Class III Antiarrhythmics - Ibutilide, Dofetilide
  14. Class IV Antiarrhythmics - Verapamil, Diltiazem
  15. HMG-CoA Reductase Inhibitors (Statins)
  16. Ezetimibe
  17. Fibrates
  18. PCSK9 Inhibitors (Alirocumab, Evolocumab)
  19. Fish Oil and Omega-3s
  20. Milrinone
  21. Aliskiren
  22. Hydralazine
  23. Ranolazine
  24. Sacubitril

Summary

Ivabradine decreases heart rate without affecting the heart's contractility.  It works by decreasing sodium flow across funny channels, which decreases SA node firing and subsequently slows the heart rate. Since it does not affect inotropy, it can be used to treat angina and systolic heart failure in patients who can’t be on a beta-blocker.  Adverse effects include a luminous phenomenon, which is caused by inhibition of ion channels in the retina that resemble funny channels.

Key Points

  • Ivabradine
    • Mechanism
      • Selective inhibition of funny channels
        • Prolongs the slow depolarization phase (phase 4) of the pacemaker potential
      • Decreases SA node firing
        • Negative chronotropic effect without inotropy
        • Reduces cardiac O2 requirement
    • Clinical Use
      • Chronic stable angina in patients who cannot take B-blockers
      • Chronic heart failure with reduced ejection fraction
    • Adverse Effects
      • Luminous phenomenon / visual brightness
        • Caused by inhibition of ion channels in the retina that are similar to funny channels
      • Bradycardia