Focus on ivabradine: a new heart rate-controlling drug

Angina pectoris is a cardiac condition characterized by an insufficient perfusion to meet myocardial metabolic demand. A high heart rate represents an important factor in the induction of myocardial ischemia and subsequent angina. beta-blocker drugs are effective at reducing angina pectoris by decreasing the heart rate and are usually preferred as initial therapy in the absence of contraindication or intolerance. Ivabradine, a new oral drug for the symptomatic treatment of chronic stable angina pectoris, decreases the resting heart rate of patients with normal sinus rhythm. In many clinical trials, ivabradine has been directly compared with placebo, beta-blocker drugs (e.g., atenolol and propranolol) and calcium channel blockers (e.g., amlodipine). These studies have demonstrated ivabradine, given in doses of 5-10 mg twice daily, to be more effective than placebo for increasing time to angina onset and noninferior to atenolol 50-100 mg daily and amlodipine 10 mg daily for increasing total exercise duration in patients with chronic stable angina. Visual symptoms, a transient, enhanced brightness in a limited area of the visual field known as luminous phenomena or phosphenes, were the most common adverse effects in clinical trials. This article aims to provide a research update regarding this new drug, based on a literature search.