An extended indication for ivadrabine now includes treatment of chronic heart failure as well as chronic stable angina from atherosclerotic coronary artery disease (although only where control by beta blockers is inadequate or contraindicated, as benefits are marginal).

Ivabradine is the first in a class of agent that selectively inhibits sinus node depolarisation to slow heart rate, reduce cardiac workload, and myocardial oxygen demand without the adverse cardiac effects of beta blockers.

It should not be used where the sino-atrial node is not providing a sinus rhythm or where heart failure, hypotension, angina, myocardial infarction, or hepatic failure is severe or unstable.

Transient, reversible luminous phenomena (phosphenes) are very common and usually resolve spontaneously. Bradycardia, extrasystoles, heart block, headache, and dizziness also occur.

Tablets should be taken twice daily with food, and do not require adjustment for renal or mild hepatic insufficiency. Ivadrabine should not be taken with potent cytochrome P450 3A4 inhibitors or verapamil, and cautiously with moderate inhibitors, or inducers.

The place and impact of ivadrabine on the PBS is still under negotiation.

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