Ivabradine ? a selective and specific If inhibitor: efficacy and safety in stable angina

Aims To assess the antianginal and anti-ischaemic efficacy and safety of ivabradine in patients with stable angina. Methods and results A total of 360 patients with stable angina were randomly assigned, in a double-blind fashion, to receive placebo or ivabradine 2.5 mg twice daily, 5 mg twice daily or 10 mg twice daily for 2 weeks. Patients voluntarily continued treatment (ivabradine 10 mg twice daily) in a 2- to 3-month, open-label extension period; this was followed by a randomized withdrawal period in which patients received ivabradine 10 mg twice daily or placebo for 1 week. Ivabradine was well tolerated, and no rebound phenomena were observed on treatment withdrawal. Dose-dependent significant reductions in heart rate were achieved at all dose levels (⁠ \(P\ {<}\ 0.05\) ⁠). Ivabradine 5 and 10 mg twice daily significantly increased time to 1-mm ST-segment depression (⁠ \(P\ {<}\ 0.005\) ⁠) and time to limiting angina on exercise tolerance testing. Patients continuing on ivabradine during the withdrawal period maintained the improvements in exercise tolerance test criteria, whereas those who received placebo showed significant deterioration. Conclusion Ivabradine (Procoralan®, Servier, Neuilly-sur-Seine, France) — a selective and specific inhibitor of the If (cardiac pacemaker, or ‘funny’) current — is a well-tolerated heart rate lowering agent with antianginal and anti-ischaemic efficacy in patients with stable angina. Results from the present study suggest that ivabradine could be a valuable alternative to current angina therapies.