Ivaprex 5 mg is a selective heart rate-lowering agent used primarily for the management of chronic stable angina pectoris in patients with coronary artery disease (CAD) who are in normal sinus rhythm. Unlike traditional beta-blockers, Ivaprex targets the heart's pacemaker directly without affecting myocardial contractility or ventricular repolarization, making it a specific anti-anginal therapy for patients who cannot tolerate beta-blockers or require combination therapy for inadequate heart rate control.

রেজিস্টার্ড চিকিৎসকের পরামর্শ অনুযায়ী ঔষধ সেবন করুন

Therapeutic Class

• Other Anti-anginal & Anti-ischaemic drugs

Indications

Ivaprex 5 mg is indicated for:

• Symptomatic treatment of chronic stable angina pectoris in CAD patients with normal sinus rhythm

• Patients who cannot tolerate beta-blockers

• Patients in combination with beta-blockers when angina is inadequately controlled and resting heart rate is >60 bpm

Pharmacology

Ivaprex 5 mg selectively inhibits the cardiac pacemaker I_f current in the sinus node, which regulates spontaneous diastolic depolarization. By reducing heart rate, Ivaprex decreases cardiac workload and oxygen consumption. Additionally, the prolongation of diastole improves coronary perfusion and oxygen supply to the myocardium.

• Cardiac effects are specific to the sinus node

• Does not affect intra-atrial, atrioventricular, or intraventricular conduction

• Does not reduce myocardial contractility or ventricular repolarization

Dosage & Administration

• Adults: Start with 5 mg twice daily; may increase to 7.5 mg twice daily after 3–4 weeks based on response

• Elderly: Consider starting at 2.5 mg twice daily

• Administer tablets with meals, one in the morning and one in the evening

• If heart rate drops below 50 bpm or bradycardia symptoms develop, reduce dose to 2.5 mg twice daily or discontinue treatment if persistent

Interactions

• Avoid QT-prolonging drugs (cardiovascular or non-cardiovascular) as Ivaprex may exacerbate QT prolongation

• Drugs like quinidine, sotalol, amiodarone, pimozide, halofantrine, cisapride, and erythromycin may interact

• Close cardiac monitoring is required if co-administration is unavoidable

Contraindications

• Hypersensitivity to Ivaprex or excipients

• Resting heart rate <60 bpm

• Cardiogenic shock, acute myocardial infarction

• Severe hypotension (<90/50 mmHg)

• Severe hepatic insufficiency

• Sick sinus syndrome, sino-atrial block

• Heart failure, pacemaker dependence

• Unstable angina, 3rd-degree AV block

• Concomitant use with strong CYP3A4 inhibitors

Side Effects

• Visual disturbances, blurred vision

• Bradycardia, 1st-degree AV block

• Ventricular extrasystoles

• Headache, dizziness

Pregnancy & Lactation

• Contraindicated in pregnancy and breastfeeding

• Animal studies show no fertility issues, but human data are limited

• Excretion into milk occurs; safety for infants not established

  রেজিস্টার্ড চিকিৎসকের পরামর্শ অনুযায়ী ঔষধ সেবন করুন

Precautions & Warnings

• Use with caution in:

  • Mild to moderate hypotension

  • Atrial fibrillation

  • Congenital QT syndrome

  • Moderate hepatic or severe renal insufficiency

Storage Conditions

• Store below 30°C, away from light and moisture

• Keep out of reach of children

Special Populations

• Renal insufficiency: Use cautiously in patients with impaired creatinine clearance

• Hepatic impairment: Use with caution in moderate impairment; contraindicated in severe cases

• Children and adolescents: Not recommended

Mode of Action

Ivaprex 5 mg selectively inhibits the I_f current in the sinus node, lowering heart rate without affecting myocardial contractility or conduction. Reduced heart rate lowers cardiac oxygen demand and prolongs diastole, enhancing coronary perfusion and providing anti-anginal benefits.