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Package leaflet: Information for the patient

Ivabradine 2.5mg film-coated tablets
Ivabradine 5mg film-coated tablets
Ivabradine 7.5mg film-coated tablets
This medicine is subject to additional monitoring. This will allow

quick identification of new safety information. You can help by
reporting any side effects you may get. See the end of section 4 for
how to report side effects.
Read all of this leaflet carefully before you start taking this
medicine because it contains important information for you.
• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to
others. It may harm them, even if their signs of illness are the same
as yours.
• If you get any side effects, talk to your doctor or pharmacist.
This includes any possible side effects not listed in this leaflet.
See section 4.

What is in this leaflet:
1. What Ivabradine is and what it is used for
2. What you need to know before you take Ivabradine
3. How to take Ivabradine
4.Possible side effects
5. How to store Ivabradine
6. Contents of the pack and other information

1 What Ivabradine is and what it is used for
Ivabradine is a heart medicine used to treat:
• Symptomatic stable angina pectoris (which causes chest pain) in adult
patients whose heart rate is over or equal to 70 beats per minute. It is
used in adult patients who do not tolerate or cannot take heart
medicines called beta-blockers. It is also used in combination with
beta-blockers in adult patients whose condition is not fully controlled
with a beta-blocker.
• Chronic heart failure in adult patients whose heart rate is over or equal
to 75 beats per minute. It is used in combination with standard
therapy, including beta-blocker therapy or when beta-blockers are
contraindicated or not tolerated.

About stable angina pectoris (usually referred to as ‘angina’):
Stable angina is a heart disease which happens when the heart does not
receive enough oxygen. It usually appears between 40 and 50 years of
age. The most common symptom of angina is chest pain or discomfort.
Angina is more likely to happen when the heart beats faster in
situations such as exercise, emotion, exposure to the cold or after
eating. This increase in heart rate can cause the chest pain in people
who suffer from angina.

About chronic heart failure:
Chronic heart failure is a heart disease which happens when your heart
cannot pump enough blood to the rest of your body. The most common
symptoms of heart failure are breathlessness, fatigue, tiredness and
ankle swelling.

How does Ivabradine work?
Ivabradine mainly works by reducing the heart rate by a few beats per
minute. This lowers the heart’s need for oxygen especially in the
situations when an angina attack is more likely to happen. In this way
Ivabradine helps to control and reduce the number of angina attacks.
Furthermore as elevated heart rate adversely affects the heart
functioning and vital prognosis in patients with chronic heart failure, the
specific heart rate lowering action of ivabradine helps to improve the
heart functioning and vital prognosis in these patients.

2 What you need to know before you take Ivabradine
Do not take Ivabradine
• if you are allergic to ivabradine or any of the other ingredients of this
medicine (listed in section 6);
• if your resting heart rate before treatment is too slow
(below 70 beats per minute);
• if you are suffering from cardiogenic shock (a heart condition
treated in hospital);
• if you suffer from a heart rhythm disorder;
• if you are having a heart attack;
• if you suffer from very low blood pressure;
• if you suffer from unstable angina (a severe form in which chest pain
occurs very frequently and with or without exertion);
• if you have heart failure which has recently become worse;
• if your heart beat is exclusively imposed by your pacemaker;
• if you suffer from severe liver problems;
• if you are already taking medicines for the treatment of fungal
infections (such as ketoconazole, itraconazole), macrolide antibiotics
(such as josamycin, clarithromycin, telithromycin or erythromycin
given orally), medicines to treat HIV infections (such as nelfinavir,
ritonavir) or nefazodone (medicine to treat depression) or diltiazem,
verapamil (used for high blood pressure or angina pectoris);
• if you are a woman able to have children and not using reliable
• if you are pregnant or trying to become pregnant;
• if you are breast-feeding.

Warnings and precautions
Talk to your doctor or pharmacist before taking Ivabradine
• if you suffer from heart rhythm disorders (such as irregular heartbeat,
palpitation, increase in chest pain) or sustained atrial fibrillation
(a type of irregular heartbeat), or an abnormality of electrocardiogram
(ECG) called ‘long QT syndrome’,

• if you have symptoms such as tiredness, dizziness or shortness of
breath (this could mean that your heart is slowing down too much),
• if you suffer from symptoms of atrial fibrillation (pulse rate at rest
unusually high (over 110 beats per minute) or irregular, without any
apparent reason, making it difficult to measure),
• if you have had a recent stroke (cerebral attack),
• if you suffer from mild to moderate low blood pressure,
• if you suffer from uncontrolled blood pressure, especially after a
change in your antihypertensive treatment,
• if you suffer from severe heart failure or heart failure with abnormality
of ECG called ‘bundle branch block’,
• if you suffer from chronic eye retinal disease,
• if you suffer from moderate liver problems,
• if you suffer from severe renal problems.
If any of the above applies to you, talk straight away to your doctor
before or while taking Ivabradine.

Children and adolescents
Ivabradine is not intended for use in children and adolescents younger
than 18 years.

Other medicines and Ivabradine
Tell your doctor or pharmacist if you are taking, have recently taken or
might take any other medicines.
Make sure to tell your doctor if you are taking any of the following
medicines, as a dose adjustment of Ivabradine or monitoring should be
• fluconazole (an antifungal medicine)
• rifampicin (an antibiotic)
• barbiturates (for difficult sleeping or epilepsy)
• phenytoin (for epilepsy)
• Hypericum perforatum or St John’s Wort (herbal treatment for

• QT prolonging medicines to treat either heart rhythm disorders or
other conditions:
• quinidine, disopyramide, ibutilide, sotalol, amiodarone (to treat heart
rhythm disorders)
• bepridil (to treat angina pectoris)
• certain types of medicines to treat anxiety, schizophrenia or other
psychoses (such as pimozide, ziprasidone, sertindole)
• anti-malarial medicines (such as mefloquine or halofantrine)
• intravenous erythromycin (an antibiotic)
• pentamidine (an antiparasitic medicine)
• cisapride (against the gastro-oesophageal reflux)
• Some types of diuretics which may cause decrease in blood potassium
level, such as furosemide, hydrochlorothiazide, indapamide (used to
treat oedema, high blood pressure).

Ivabradine with food and drink
Avoid grapefruit juice during treatment with Ivabradine.

Pregnancy and breast-feeding
Do not take Ivabradine if you are pregnant or are planning to have a
baby (see ‘Do not take Ivabradine’).
If you are pregnant and have taken Ivabradine, talk to your doctor.
Do not take Ivabradine if you are able to become pregnant unless you
use reliable contraceptive measures (see ‘Do not take Ivabradine’).
Do not take Ivabradine if you are breast-feeding (see ‘Do not take
Ivabradine’). Talk to your doctor if you are breast-feeding or intending to
breast-feed as breast-feeding should be discontinued if you take
If you are pregnant or breast-feeding, think you may be pregnant or are
planning to have a baby, ask your doctor or pharmacist for advice before
taking this medicine.

Driving and using machines
Ivabradine may cause temporary luminous visual phenomena
(a temporary brightness in the field of vision, see ‘Possible side effects’).
If this happens to you, be careful when driving or using machines at
times when there could be sudden changes in light intensity, especially
when driving at night.

Ivabradine contains lactose
If you have been told by your doctor that you have an intolerance to
some sugars, contact your doctor before taking this medicine.

3 How to take Ivabradine
Always take this medicine exactly as your doctor or pharmacist has told
you. Check with your doctor or pharmacist if you are not sure.
Ivabradine should be taken during meals.
If you are being treated for stable angina pectoris
The starting dose should not exceed one tablet of Ivabradine 5mg twice
daily. If you still have angina symptoms and if you have tolerated the
5mg twice daily dose well, the dose may be increased. The maintenance
dose should not exceed 7.5mg twice daily. Your doctor will prescribe the
right dose for you. The usual dose is one tablet in the morning and one
tablet in the evening. In some cases (e.g. if you are elderly), your doctor
may prescribe half the dose i.e., one tablet of Ivabradine 2.5mg in the
morning and one tablet of Ivabradine 2.5mg in the evening.
If you are being treated for chronic heart failure
The usual recommended starting dose is one tablet of Ivabradine 5mg
twice daily increasing if necessary to one tablet of Ivabradine 7.5mg
twice daily. Your doctor will decide the right dose for you. The usual dose
is one tablet in the morning and one tablet in the evening. In some cases
(e.g. if you are elderly), your doctor may prescribe half the dose i.e., one
tablet of Ivabradine 2.5mg in the morning and one tablet of Ivabradine
2.5mg in the evening.

If you take more Ivabradine than you should:

Very common:

A large dose of Ivabradine could make you feel breathless or tired
because your heart slows down too much. If this happens, contact your
doctor immediately.

Luminous visual phenomena (brief moments of increased brightness,
most often caused by sudden changes in light intensity). They can also
be described as a halo, coloured flashes, image decomposition or
multiple images. They generally occur within the first two months of
treatment after which they may occur repeatedly and resolve during or
after treatment

If you forget to take Ivabradine:
If you forget to take a dose of Ivabradine, take the next dose at the usual
time. Do not take a double dose to make up for the forgotten dose.

If you stop taking Ivabradine:
As the treatment for angina or chronic heart failure is usually
life-long, you should discuss with your doctor before stopping this
medicinal product.
If you think that the effect of Ivabradine is too strong or too weak, talk
to your doctor or pharmacist.
If you have any further questions on the use of this medicine, ask your
doctor or pharmacist.

4 Possible side effects
Like all medicines, this medicine can cause side effects, although not
everybody gets them.
The frequency of possible side effects listed below is defined using the
following convention:
very common: may affect more than 1 in 10 people
common: may affect up to 1 in 10 people
uncommon: may affect up to 1 in 100 people
rare: may affect up to 1 in 1,000 people
very rare: may affect up to 1 in 10,000 people
not known: frequency cannot be estimated from the available data
The most common adverse reactions with this medicine are dose
dependent and related to its mode of action:

Modification in the heart functioning (the symptoms are a slowing down
of the heart rate). They particularly occur within the first 2 to 3 months
of treatment initiation.
Other side effects have also been reported:

Irregular rapid contraction of the heart, abnormal perception of
heartbeat, uncontrolled blood pressure, headache, dizziness and blurred
vision (cloudy vision).

Palpitations and cardiac extra beats, feeling sick (nausea), constipation,
diarrhoea, abdominal pain, spinning sensation (vertigo), difficulty
breathing (dyspnoea), muscle cramps, changes in laboratory parameters:
high blood levels of uric acid, an excess of eosinophils (a type of white
blood cell) and elevated creatinine in blood (a breakdown product of
muscle), skin rash, angioedema (such as swollen face, tongue or throat,
difficulty in breathing or swallowing), low blood pressure, fainting,
feeling of tiredness, feeling of weakness, abnormal ECG heart tracing,
double vision, impaired vision.

Urticaria, itching, skin reddening, feeling unwell.

Very rare:
Irregular heart beats.
If you get any side effects, talk to your doctor or pharmacist.
This includes any possible side effects not listed in this leaflet.
You can also report side effects directly via the Yellow Card Scheme

(website: By reporting side effects you
can help provide more information on the safety of this medicine.

5 How to store Ivabradine
Keep this medicine out of the sight and reach of children.
Do not use this medicine after the expiry date which is stated on the
carton and blister after ‘EXP’. The expiry date refers to the last day of
that month.
This medicine does not require any special storage conditions.
Do not throw away any medicine via wastewater or household waste.
Ask your pharmacist how to throw away medicines you no longer use.
These measures will help to protect the environment.

6 Content of the pack and other information
What Ivabradine contains
• The active substance is ivabradine (as hydrochloride).
Ivabradine 2.5mg: one film-coated tablet contains 2.5mg ivabradine
(equivalent to 2.695mg ivabradine as hydrochloride).
Ivabradine 5mg: one film-coated tablet contains 5mg ivabradine
(equivalent to 5.39mg ivabradine as hydrochloride).
Ivabradine 7.5mg: one film-coated tablet contains 7.5mg ivabradine
(equivalent to 8.085mg ivabradine as hydrochloride).
• The other ingredients in the tablet core are: lactose monohydrate,
magnesium stearate, maize starch, maltodextrin, colloidal anhydrous
silica, and in the tablet coating: lactose monohidrate, hypromellose,
titanium dioxide (E171), macrogol 4000, yellow iron oxide (E172).
In addition, the 5mg and 7.5mg tablets also contain red iron
oxide (E172).

Ivabradine 5mg tablets are light salmon, capsule shape (8.25 x 4mm),
biconvex film-coated tablet scored on one side and 3.0 ± 0.2mm in
Ivabradine 7.5mg tablets are light salmon, round, biconvex film-coated
tablet 7mm in diameter and 3.9 ± 0.2mm in thickness.
The tablets of Ivabradine 2.5mg are available in blisters containing packs
of 14, 28, 56, 84, 98, 100 or 112 film-coated tablets
The tablets of Ivabradine 5mg and Ivabradine 7.5mg are available in
blisters containing packs of 14, 28, 56, 84, 98, 100, 112 and 500
film-coated tablets
Not all pack sizes may be marketed.

Marketing Authorisation Holder and Manufacturer:
Marketing Authorisation Holder:
Aspire Pharma Ltd
Unit 4, Rotherbrook Court
Bedford Road
GU32 3QG
United Kingdom
J. Uriach y Compania, S.A.
Av. Cami Reial 51-57
08184 Palau-solita i Plegamans (Spain)

This leaflet was last revised in 09/2016.

What Ivabradine looks like and contents of the pack
Ivabradine 2.5mg tablets are yellow, round, biconvex film-coated tablet
5mm in diameter and 2.2 ± 0.2mm in thickness.


Artwork for:
Product name:

Aspire Pharma Limited
Ivabradine film-coated tablets

PL/PA no:
Artwork dimensions:
Profile supplied:
Date of first artwork:
Reason for request:
Version no:
Date of revision:
Artwork software:
BAC ref:

PL 35533/0080, 0081, 0082
150mm x 500mm
22 October 2015
Text and address edits
27 September 2016
As swatch(es)
9pt Milo
InDesign CC
T049 (formerly T951)


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Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.