Ivaprex 5 - Tablet Ivabradine - 5mg 10 Tablet(s) / Strip Incepta Pharmaceuticals Ltd. Introduction: Ivaprex 5 is a medicine used for treatment of angina (heart-related chest pain) and chronic (long-term) heart failure. It makes the heart work more efficiently by lowering the heart rate. This relieves chest pain and decreases the risk of hospitalization in heart failure patients. The dose will depend on what you are being treated for. Since the treatment for angina or heart failure is usually life-long, you should not stop using it without talking to your doctor. It should be taken with food at the same time each day. If you take too much in one go, your heart could... Uses of Ivaprex 5: Angina (heart-related chest pain)Heart failure Side effects of Ivaprex 5: Slow heart rateHeadacheLuminous phenomena (Enhanced brightness)High blood pressure How to use Ivaprex 5: Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it. Ivaprex 5 is to be taken with food. How Ivaprex 5 works: Ivaprex 5 is a heart rate lowering medication. It works by reducing the heart rate which lowers the oxygen requirement of the heart. As a result, the heart works more efficiently. What if you forget to take Ivaprex 5?: If you miss a dose of Ivaprex 5, skip it and continue with your normal schedule. Do not double the dose. Indication: Chronic stable angina, Heart Failure Administration: Should be taken with food. Avoid excessive consumption of grapefruit juice. Adult Dose: Oral Heart Failure Initial: 5 mg PO BID with meals (all see Dosage Modifications) After 2 weeks, assess patient and adjust dose to achieve a resting heart rate of 50-60 bpm (see dose adjustment section below) Thereafter, adjust dose prn based on resting heart rate and tolerability; not to exceed 7.5 mg BID Dose adjustment HR >60 bpm: Increase dose by 2.5 mg (given twice daily) up to a maximum dose of 7.5 mg BID HR 50-60 bpm: Maintain dose HR 75 yr Initiate treatment at 2.5 mg bid. Titrate up if necessary. Hepatic impairment Mild or moderate (Child-Pugh A... Child Dose: Safety and efficacy not established Renal Dose: Renal impairment: CrCl (ml/min) Dosage Recommendation <15 Use w/ caution. Contraindication: Pregnancy, lactation, resting heart rate <60 beats/min prior to treatment, cardiogenic shock, acute myocardial infarction, severe hypotension (<90/50 mmHg), severe hepatic insufficiency, sick sinus syndrome, sino-atrial block, heart failure patients with NYHA class III-IV, pacemaker dependent, unstable angina, 3rd degree AV-block, concurrent use with potent CYP3A4 inhibitors. Mode of Action: Ivabradine is a heart rate lowering agent that works through selective and specific inhibition of the cardiac pacemaker If current. If current controls the spontaneous diastolic depolarisation in the sinus node and regulate heart rate. Precaution: Reduce dose if resting heart rate is persistently <50 beats/min or patient develops bradycardia symptoms during treatment; discontinue if heart rate <50 beats/min and symptoms persist. Not recommended in patient with AF or other cardiac arrhythmias that interfere with sinus node rhythm; monitor regularly for AF occurrence. Not recommended for concomitant use with heart rate reducing calcium channel blockers (e.g. diltiazem or verapamil), immediate use after a stroke or in patients with 2nd degree AV-block. Severe renal insufficiency, Moderate hepatic insufficiency. Stop treatment if visual field deteriorates unexpectedly. Patients with retinitis pigmentosa. Side Effect: 1-10% Bradycardia (10%) Hypertension or increased blood pressure (8.9%) Atrial fibrillation (8.3%) Luminous phenomena (phosphenes) or visual brightness (2.8%) Interaction: Concomitant use with QT-prolonging drugs (e.g. quinidine, disopyramide, bepridil, sotalol, ibutilide, amiodarone, pimozide, ziprasidone, sertinole, mefloquine, halofantrine, pentamide, cisapride, erythromycin IV) is not recommended as QT prolongation may be enhanced by heart rate reduction. Concentrations may increase when used with CYP3A4 inhibitors. Use with verapamil or diltiazem (moderate CYP3A4 inhibitors) is not recommended. If used with other moderate CYP3A4 inhibitors (e.g. fluconazole), may consider starting at lower dose and with heart rate monitoring if resting heart rate >60 beats/min. Concentration may be reduced with CYP3A4 inducers (e.g. rifampicin, barbiturates, phenytoin, St John's Wort) and may require Ivabradine dose adjustment. Potentially...