WHAT IS THIS MEDICINE AND WHAT IS IT USED FOR?
Procoralan contains ivabradine, a medicine that slows the heart rate by
blocking a specific electrical channel in the heart's natural pacemaker called
the If (funny) channel. Unlike beta-blockers, which also slow the heart but
affect blood pressure and have other systemic effects, ivabradine exclusively
slows the heart rate with minimal impact on blood pressure or heart muscle
contractility.
A slower heart rate means the heart muscle has more time to receive blood
through the coronary arteries between beats, which reduces the painful symptoms
of angina.
It is used for: chronic stable angina (chest pain brought on by exertion)
— in patients in normal sinus rhythm whose heart rate is above 70 beats per
minute, either when beta-blockers cannot be used or in addition to
beta-blockers; and chronic heart failure (the heart's pumping function is
reduced) — in adults in sinus rhythm with a resting heart rate of 75 beats per
minute or more and a left ventricular ejection fraction below 35%, to reduce
the risk of hospitalisation due to heart failure.
3. HOW TO TAKE THIS MEDICINE
For angina: usually 5mg twice daily to start, increased to 7.5mg twice
daily after 3 to 4 weeks if the heart rate remains above 60 beats per minute
and the medicine is well tolerated. For heart failure: 5mg twice daily,
adjusted up to 7.5mg or down to 2.5mg based on resting heart rate. Take each
dose with a meal — food improves the consistency of absorption. Take at
approximately the same times each day — one dose in the morning and one in the
evening, with meals.
Ivabradine should only be used in patients who are in regular (sinus)
heart rhythm. It is not effective and may be harmful in patients with atrial
fibrillation (AF) or other irregular heart rhythms, as it works by slowing the
sino-atrial node — the natural pacemaker — which is bypassed in AF. Your doctor
will confirm your heart rhythm before prescribing.
⚠ PATIENT TIP: Ivabradine can cause temporary
visual symptoms — particularly luminous phenomena, sometimes described as
flashes of light in the vision or increased brightness, especially when moving
from dark to light environments. These are usually harmless and temporary, but
they can be disorienting. Be careful driving at night or in low-light
conditions, particularly when first starting the medicine.
4. POSSIBLE SIDE EFFECTS
|
How Common? |
Side Effects |
|
Very Common |
Luminous phenomena
(phosphenes) — brief, reversible visual brightness, coloured halos, or light
flashes, especially when transitioning between darkness and bright light.
Affects up to 15% of patients, usually in the first 2 months of treatment and
fades with time. |
|
Common |
Slow heart rate
(bradycardia — heart rate below 60 bpm), dizziness, headache, blurred vision,
raised blood pressure in some patients |
|
Serious — Tell Your
Doctor |
Symptomatic
bradycardia — if the heart rate drops below 50 to 60 beats per minute and you
feel faint, very dizzy, light-headed, or extremely breathless, contact your
doctor — the dose may need to be reduced or stopped. Atrial fibrillation
(irregular heart rhythm) — ivabradine should be discontinued if AF develops.
Very rarely: ventricular extrasystoles (irregular heartbeats). QT
prolongation reported rarely. |
5. WHO SHOULD NOT TAKE THIS MEDICINE
Ivabradine must not be used in: patients with a resting heart rate below
70 beats per minute before starting treatment; patients with atrial
fibrillation, flutter, or a pacemaker-dependent rhythm; severe liver disease;
patients who are pregnant or breastfeeding.
It must not be combined with strong CYP3A4 inhibitors (see interactions)
— this combination is absolutely contraindicated. Use with caution in patients
with low blood pressure, second-degree heart block, or recent stroke.
⚠ HEART RHYTHM CHECK: Ivabradine only works
safely in patients in normal sinus rhythm. If you develop an irregular
heartbeat (such as AF) while on ivabradine, stop it and contact your
cardiologist promptly. Continuing ivabradine in AF is not effective and may be
harmful.
⚠ VISUAL SYMPTOMS: Luminous visual phenomena —
bright spots, halos, or light flashes — are common and usually harmless.
However, if you experience sudden visual disturbance, loss of vision, or
significant blurring, seek prompt medical assessment to rule out other causes.
⚠ BRADYCARDIA (SLOW HEART RATE): If your pulse
drops below 50–60 bpm and you feel faint, unwell, or breathless at rest,
contact your doctor immediately — dose reduction or stopping the medicine may
be needed.
6. MEDICINES THAT INTERACT WITH THIS TREATMENT
Absolutely contraindicated with strong CYP3A4 inhibitors: ketoconazole,
itraconazole, voriconazole (antifungals), clarithromycin, erythromycin
(antibiotics), ritonavir and other HIV protease inhibitors, nefazodone
(antidepressant) — these massively increase ivabradine levels, causing
dangerous bradycardia and QT prolongation.
Moderate CYP3A4 inhibitors (diltiazem, verapamil) also significantly
increase ivabradine levels — avoid or use with great caution and dose
reduction. CYP3A4 inducers (rifampicin, carbamazepine, St. John's Wort) reduce
ivabradine levels and effectiveness. Grapefruit juice modestly increases
ivabradine levels — avoid. QT-prolonging medicines increase cardiac risk.
7. HOW TO STORE THIS MEDICINE
Store below 25°C. Keep in original packaging. Keep out of reach of
children.
8. PRESCRIPTION REQUIREMENT
|
Field |
Details |
|
Status |
Prescription Only
Medicine (POM) — prescribed by cardiologists or GPs under specialist guidance |
9. GUIDANCE FOR PATIENTS & CAREGIVERS
Take one tablet in the morning and one in the evening, with your meals.
Measure your pulse (heart rate) regularly at home — you can check it by placing
two fingers on the inside of your wrist. Contact your doctor if your resting
pulse is consistently below 50 beats per minute or if you feel faint or unwell.
Visual light flashes or brightness changes are common in the first few
months — they are usually harmless but avoid driving at night or in low light
if they affect you. If you develop an irregular heartbeat, contact your
cardiologist promptly. Tell all your healthcare providers about ivabradine
before any new medicine is prescribed — several common medicines dangerously
increase its levels.
10. PHARMACIST & PRESCRIBER NOTES
|
Field |
Details |
|
Clinical Dispensing
Notes |
Ivabradine is an
If-channel inhibitor — sinus-rhythm only. Confirm patient is in sinus rhythm
before dispensing — contraindicated in AF/atrial flutter. CYP3A4 interaction
screening is critical and there are multiple absolute contraindications:
ketoconazole, itraconazole, voriconazole, clarithromycin, erythromycin, HIV
PIs, nefazodone — all contraindicated. Diltiazem and verapamil: significant
increase in ivabradine exposure — avoid or exercise extreme caution.
Grapefruit avoidance. Baseline resting HR must be ≥70 bpm (angina) or ≥75 bpm
(heart failure) — confirm before dispensing. Dose adjustment based on HR
monitoring: target resting HR 50–60 bpm. Bradycardia counselling — pulse
self-monitoring. Phosphene visual phenomena: counsel proactively — commonly leads
to unnecessary discontinuation if patients are not forewarned. Driving at
night/low light caution. Pregnancy and severe hepatic impairment:
contraindicated. |
11. FREQUENTLY ASKED QUESTIONS
Q: What are the visual light flashes?
Some patients on ivabradine experience brief, bright visual phenomena —
described as flashes of light, coloured rings, or a sudden brightening of
vision, especially when going from a dark room to a bright one, or when
headlights shine in their eyes at night. This is a known and generally harmless
side effect called phosphenes — it is caused by the medicine blocking If
channels in the retina as well as the heart. It tends to improve after the
first few weeks. If it is severe or affects your vision significantly, tell
your cardiologist.
Q: Can I still drive?
Possibly — but be cautious, particularly at night or in low-light
conditions while the visual effects are present. Do not drive if the light
flashes significantly, as it can impair your vision. If they affect you only briefly and
mildly, driving may be safe — discuss with your cardiologist.
Q: What if my heart rate goes below 50 bpm?
Contact your doctor. A resting heart rate below 50 beats per minute
(bradycardia) can cause symptoms such as dizziness, fatigue, faintness, or
breathlessness. Your dose may need to be reduced. Learn to check your own pulse
at home — at the wrist or neck — so you can monitor this between appointments.
Q: How do I check my pulse at home?
Place two fingers (not your thumb) on the inside of your wrist, just
below the base of your thumb. Count the number of beats in 30 seconds and
multiply by 2 to get your beats per minute. Do this when you are seated and
relaxed — not immediately after activity. A resting heart rate of 50 to 60 bpm
is the target on ivabradine.