• 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.

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

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.

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.

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.

• 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 contraception;
• if you are pregnant or trying to become pregnant;
• if you are breast-feeding.

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.

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

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 required:

• 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 depression)
• 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).

Avoid grapefruit juice during treatment with Ivabradine.

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 breastfeeding should be discontinued if you take Ivabradine.

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.

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.

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

The starting dose should not exceed one tablet of Ivabradine 5 mg twice daily. If you still have angina symptoms and if you have tolerated the 5 mg twice daily dose well, the dose may be increased.

The maintenance dose should not exceed 7.5 mg 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 2.5 mg in the morning and one tablet of Ivabradine 2.5 mg in the evening.

The usual recommended starting dose is one tablet of Ivabradine 5 mg twice daily, increasing if necessary to one tablet of Ivabradine 7.5 mg 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 2.5 mg in the morning and one tablet of Ivabradine 2.5 mg in the evening.

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.

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 a forgotten dose.

The calendar printed on the blister containing the tablets should help you remember when you last took a tablet of 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.

Common (may affect up to 1 in 10 people):

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

Uncommon (may affect up to 1 in 100 people):

• Palpitations and cardiac extra beats, feeling sick (nausea), constipation, diarrhoea, abdominal pain, spinning sensation (vertigo), difficulty breathing (dyspnoea), muscle spasms, 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.

Rare (may affect up to 1 in 1,000 people):

• Urticaria, itching, skin reddening, feeling unwell.

Very rare (may affect up to 1 in 10,000 people):

• Irregular heartbeats.

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple Store. By reporting side effects you can help provide more information on the safety of this medicine.

• The active substance is ivabradine (as hydrochloride).
  Ivabradine 2.5 mg: each film-coated tablet contains 2.5 mg ivabradine (as hydrochloride).
  Ivabradine 5 mg: each film-coated tablet contains 5 mg ivabradine (as hydrochloride).
  Ivabradine 7.5 mg: each film-coated tablet contains 7.5 mg ivabradine (as hydrochloride).
• The other ingredients in the tablet core are: Lactose anhydrous, maltodextrin, crospovidone Type A, silica colloidal anhydrous, magnesium stearate, and in the tablet coating: hypromellose, polydextrose, titanium dioxide (E171), talc, maltodextrin/dextrin, medium chain triglycerides, iron oxide yellow (E172) and iron oxide red (E172).

Ivabradine 2.5 mg tablets are salmon-coloured, round, biconvex tablets, engraved with “2.5” on one side.

Ivabradine 5 mg tablets are salmon-coloured, oval, biconvex tablets, scored on both sides, engraved with “5” on one side, approximately 8.6 mm in length and 4.5 mm in width. The tablet can be divided into equal doses.

Ivabradine 7.5 mg tablets are salmon-coloured, triangular, biconvex tablets, engraved with “7.5” on one side, with a triangle median of approximately 6.6 mm.

The tablets are available in calendar packs (cardboard box containing OPA/AL/PVC- Aluminium foil blisters) of 28, 56 or 98 tablets.

Not all pack sizes may be marketed.

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