Sivab 5mg tablet is Ivabradine that is a heart rate lowering agent which acts by selective inhibition of the cardiac pacemaker current.
Sivab 5mg tablet is indicated for the following conditions:
- Symptomatic treatment of chronic stable angina pectoris in coronary artery disease adults with normal sinus rhythm.
- Symptomatic treatment of chronic heart failure of NYHA Classes II or III and with documented left ventricular ejection fraction (LVEF) ≤ 35% in adult patients in sinus rhythm and with heart rate at or above 77 bpm, in combination with optimal standard chronic heart failure treatment.
Sivab 5mg tablet may cause luminous phenomena in the visual field (Phosphenes). Other adverse reactions include blurred vision, bradycardia, which may be severe and other cardiac arrhythmias, nausea, constipation, diarrhea, headache, dizziness, dyspnea and muscle cramps. Hyperuricemia, eosinophilia and elevated blood creatinine concentrations have been reported.
WHEN NOT TO USE:
Sivab 5mg tablet is not contraindicated in the following conditions:
- Hypersensitivity to ivabradine or to any of the excipient of the product
- Resting heart rate below 60 bpm prior to treatment
- Cardiogenic shock
- Acute myocardial infarction
- Severe hypotension (< 90/50 mm/Hg)
- Severe hepatic impairment – Sick sinus syndrome
- Sino-atrial block
- Unstable or acute heart failure
- Pacemaker dependent
- Unstable angina
- AV-block 3rd degree
- Combination with strong cytochrome P450 3A4 inhibitors such as azole antifungals
Sivab 5mg tablet is used cautiously in:
- Ivabradine is not recommended in patients with atrial fibrillation or other cardiac arrhythmias that interfere with sinus node function.
- The use of ivabradine is not recommended immediately after a stroke.
CYP3A4 inhibitors increase ivabradine plasma concentrations, while inducers decrease them. Increased plasma concentrations of ivabradine may be associated with a risk of excessive bradycardia
- Moderate CYP3A4 inhibitors (e.g. diltiazem, verapamil) with heart rate reducing properties: Concomitant use of ivabradine with diltiazem and verapamil is not recommended due to the potential for additive heart rate lowering effects.
- Other moderate CYP3A4 inhibitors: Ivabradine can be used with caution if resting heart rate is at or above 60 bpm and heart rate is carefully monitored.
- Grapefruit Juice: Grapefruit juice increase ivabradine exposure. Therefore, the intake of grapefruit juice should be restricted during the treatment with ivabradine
Sivab 5mg tablet must be taken orally twice daily. i.e., once in the morning and once in the evening during meals