[Ivabradine (Procoralan)]

Ivabradine (Procoralan), a new If inhibitor which acts specifically and in a dose-dependent manner on the pacemaker activity of the sinoatrial node, is a pure heart rate lowering agent. It slows the diastolic depolarization slope of sinoatrial node cells and reduces heart rate at rest and during exercise. It has shown anti-ischaemic and anti-anginal activity at recommended doses of 5 and 7.5 mg bid in patients with stable angina. Ivabradine is as effective as atenolol and amlodipine to prevent or attenuate exercise-induced ischaemia in these patients. It is well tolerated, with transient visual symptoms being the main drug-related adverse event. These symptoms may be linked to the presence in the retina of ion channels similar to cardiac If channels and did not adversely affect the tolerability of the drug for most patients. In Belgium, ivabradine is currently reimbursed in patients with stable angina and normal sinus rhythm who do not tolerate beta-blockers and non-dihydropyridine calcium antagonists or in whom these treatments are contra-indicated.