Ivabradine: Difference between revisions
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==Adverse effects== |
==Adverse effects== |
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14.5% of all patients taking ivabradine experience luminous phenomena (by patients described as sensations of enhanced brightness in a fully maintained visual field). This is probably due to blockage of I <sub>''h''</sub> ion channels in the [[retina]] which are very similar to cardiac I<sub>''f''</sub>. These symptoms are mild, transient, fully reversible and non-severe. In clinical studies about 1% of all patients had to discontinue the drug because of these sensations, which occurred on average 40 days after commencement of the drug.<ref name=Tardif/> |
14.5% of all patients taking ivabradine experience [[phosphene|luminous phenomena]] (by patients described as sensations of enhanced brightness in a fully maintained visual field). This is probably due to blockage of I <sub>''h''</sub> ion channels in the [[retina]] which are very similar to cardiac I<sub>''f''</sub>. These symptoms are mild, transient, fully reversible and non-severe. In clinical studies about 1% of all patients had to discontinue the drug because of these sensations, which occurred on average 40 days after commencement of the drug.<ref name=Tardif/> |
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[[Bradycardia]] (unusually slow heart rate) occurs at 2% and 5% for doses of 7.5 and 10 mg respectively (compared to 4.3% in atenonol)<ref name=Tardif/>. 2.6-4.8% reported [[headache]]s<ref name=Tardif/>. Other common [[adverse drug reaction]]s (1–10% of patients) include first-degree [[heart block|AV block]], [[Premature ventricular contraction|ventricular extrasystoles]], dizziness and/or blurred vision.<ref>{{cite journal | Author = Anonymous | Title = New medicines: Procoralan | url = http://www.pjonline.com/Editorial/20060204/products/p131products.html | journal = Pharmaceutical Journal | year = 2006 | volume = 276 | issue = 7386 | pages=131 }}}</ref> |
[[Bradycardia]] (unusually slow heart rate) occurs at 2% and 5% for doses of 7.5 and 10 mg respectively (compared to 4.3% in atenonol)<ref name=Tardif/>. 2.6-4.8% reported [[headache]]s<ref name=Tardif/>. Other common [[adverse drug reaction]]s (1–10% of patients) include first-degree [[heart block|AV block]], [[Premature ventricular contraction|ventricular extrasystoles]], dizziness and/or blurred vision.<ref>{{cite journal | Author = Anonymous | Title = New medicines: Procoralan | url = http://www.pjonline.com/Editorial/20060204/products/p131products.html | journal = Pharmaceutical Journal | year = 2006 | volume = 276 | issue = 7386 | pages=131 }}}</ref> |
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Some studies have shown an increase in [[acute coronary syndrome|coronary events]] and severe [[cardiac arrhythmia]]s, leading to doubts about its long-term safety; in addition, it is unclear whether the ocular side-effects point to a long-term toxicity to the retina.<ref name=PrescrireInt/> |
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Data about long-term safety are in progress but are promising.{{Fact|date=October 2007}} |
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==Contraindications== |
==Contraindications== |
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Revision as of 16:07, 10 January 2008
| File:Ivabradine.png | |
| Clinical data | |
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| License data | |
| Pregnancy category |
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| Routes of administration | Oral |
| ATC code | |
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| Legal status |
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| Pharmacokinetic data | |
| Bioavailability | 40% |
| Protein binding | 70% |
| Metabolism | Hepatic (first-pass) >50%, CYP3A4-mediated |
| Elimination half-life | 2 hours |
| Excretion | Renal and fecal |
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| CompTox Dashboard (EPA) | |
| Chemical and physical data | |
| Formula | C27H36N2O5 |
| Molar mass | 468.585 g/mol g·mol−1 |
Ivabradine (INN) (Template:PronEng) is a novel medication used for the symptomatic management of stable angina pectoris. It is marketed under the trade name Procoralan (Servier), and was also known as S-16257 during its development. Ivabradine acts by reducing the heart rate in a mechanism different from beta blockers and calcium channel blockers, two commonly prescribed antianginal drugs. It is classified as a cardiotonic agent.
Mode of action
Ivabradine acts on the If (f is for "funny", so called because it had unusual properties compared with other current systems known at the time of its discovery) ion current, which is highly expressed in the sinoatrial node. If is a mixed Na+–K+ inward current activated by hyperpolarization and modulated by the autonomic nervous system. It is one of the most important ionic currents for regulating pacemaker activity in the sinoatrial (SA) node. Ivabradine selectively inhibits the pacemaker If current in a dose-dependent manner. Blocking this channel reduces cardiac pacemaker activity, slowing the heart rate and allowing more time for blood to flow to the myocardium.[1][2]
Uses
Ivabradine was approved by the European Medicines Agency in 2005. It is indicated for the symptomatic treatment of stable angina pectoris in patients with normal sinus rhythm, who have a contraindication to or intolerance to beta blockers. It has been shown to be non-inferior to the beta-blocker atenolol for this indication[3] and amlodipine.[4]
Apart from angina, it is also being used off-label in the treatment of inappropriate sinus tachycardia.[5]
Dosage
A dose of 5 mg twice daily is recommended initially; after 1 month, it is recommended to increase to 7.5 mg twice daily to get the optimal efficacy linked to heart rate reduction. Given limited experience in the elderly, the manufacturer recommends a starting dose of 2.5 mg[6].
Adverse effects
14.5% of all patients taking ivabradine experience luminous phenomena (by patients described as sensations of enhanced brightness in a fully maintained visual field). This is probably due to blockage of I h ion channels in the retina which are very similar to cardiac If. These symptoms are mild, transient, fully reversible and non-severe. In clinical studies about 1% of all patients had to discontinue the drug because of these sensations, which occurred on average 40 days after commencement of the drug.[3]
Bradycardia (unusually slow heart rate) occurs at 2% and 5% for doses of 7.5 and 10 mg respectively (compared to 4.3% in atenonol)[3]. 2.6-4.8% reported headaches[3]. Other common adverse drug reactions (1–10% of patients) include first-degree AV block, ventricular extrasystoles, dizziness and/or blurred vision.[7]
Some studies have shown an increase in coronary events and severe cardiac arrhythmias, leading to doubts about its long-term safety; in addition, it is unclear whether the ocular side-effects point to a long-term toxicity to the retina.[4]
Contraindications
Ivabradine is contraindicated in sick sinus syndrome, and cannot be used concominantly with inhibitors of CYP3A4 such as azole antifungals (such as ketoconazole), macrolide antibiotics, nefazodone and the anti-HIV drugs nelfinavir and ritonavir[6].
References
- ^ Thollon C, Cambarrat C, Vian J, Prost JF, Peglion JL, Vilaine JP (1994). "Electrophysiological effects of S 16257, a novel sino-atrial node modulator, on rabbit and guinea-pig cardiac preparations: comparison with UL-FS 49". Br. J. Pharmacol. 112 (1): 37–42. PMID 8032660.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Sulfi S, Timmis AD (2006). "Ivabradine -- the first selective sinus node I(f) channel inhibitor in the treatment of stable angina". Int. J. Clin. Pract. 60 (2): 222–8. doi:10.1111/j.1742-1241.2006.00817.x. PMID 16451297.
- ^ a b c d Tardif JC, Ford I, Tendera M, Bourassa MG, Fox K (2005). "Efficacy of ivabradine, a new selective I(f) inhibitor, compared with atenolol in patients with chronic stable angina". Eur. Heart J. 26 (23): 2529–36. doi:10.1093/eurheartj/ehi586. PMID 16214830.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ a b Anonymous (2007). "Ivabradine: new drug. Best avoided in stable angina". Prescrire Int. 16 (88): 53–6. PMID 17458043.
- ^ Yusuf S, Camm AJ (2003). "Sinus tachyarrhythmias and the specific bradycardic agents: a marriage made in heaven?". J. Cardiovasc. Pharmacol. Ther. 8 (2): 89–105. PMID 12808482.
- ^ a b "Servier, procolaran product description for healthcare professionals". Retrieved 2007-10-14.
- ^ Pharmaceutical Journal. 276 (7386): 131. 2006 http://www.pjonline.com/Editorial/20060204/products/p131products.html.
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