Ivabradine

Summary

Ivabradine is a medication used to treat chest pain and heart failure. It works by blocking funny sodium channels in pacemaker cells. This prolongs the slow depolarization of the cell, causing a lengthening of phase 4 of the pacemaker action potential. Side effects of ivabradine include seeing luminous phenomena and bradycardia. Hypertension may also occur as a rare side effect.

Key Points

• Ivabradine
  • Mechanism
    • Selective inhibition of funny sodium channels (IF)
    • Prolongs the slow depolarization phase (phase 4) of the pacemaker action potential
      • This decreases SA and AV nodal activity, leading to negative chronotropy and dromotropy without affecting inotropy
      • This works to reduce myocardial oxygen demands
  • Clinical Use
    • Treats heart failure
      • Used to treat chronic heart failure with reduced ejection fraction
    • Treats angina
      • Reduction in myocardial oxygen demand can treat angina
      • Used as second-line anti-anginal treatment, in patients who cannot take B-blockers
  • Side Effects
    • Luminous phenomena / visual brightness
      • Due to inhibition of ion channels in the retina that are similar to funny channels
    • Hypertension
    • Bradycardia