Medication: Ivabradine

What is Ivabradine?

Ivabradine is a medication used off‑licence to help manage the symptoms of PoTS. It’s usually offered when other methods – such as compression clothing, drinking more fluids, and increasing salt intake – haven’t fully controlled your symptoms. It can also be a choice if you cannot take beta‑blocker medication.

What Does “Off‑Licence” Mean?

In the UK, ivabradine is approved for treating angina (chest pain) and heart failure. When used for PoTS, it is considered off‑licence because this is not one of its officially approved uses.

How Does Ivabradine Work?

Ivabradine slows down your heart rate by acting on the sino‑atrial node, the heart’s natural pacemaker. This means it helps prevent your heart from beating too quickly. Unlike beta‑blockers, ivabradine does not typically lower your blood pressure. After some time, many people find that their ability to exercise improves, and they feel less tired. You may find it useful to keep a diary tracking how your symptoms change to help understand if it is helping you.

Lifestyle Changes That Help

Ivabradine works best when used alongside simple lifestyle changes which include:

• Drinking more fluids and adding more salt to your diet (to boost blood volume).
• Eating small, frequent meals.
• Wearing compression garments.

For more advice on these changes and others, see the PoTS UK general advice page.

How Do You Take Ivabradine?

Ivabradine comes in tablet form, often under the brand name “Procoralan”. It is available in doses from 2.5mg to 7.5mg and is usually taken once or twice a day with a meal. Your doctor may also combine it with other medications for PoTS.

Who Should Not Take Ivabradine?

Only take ivabradine if your doctor has prescribed it. It is not suitable if you have:

• A history of a heart attack or certain heart rhythm-related problems.
• Angina or heart failure (in some circumstances).
• Very low blood pressure
• Retinitis pigmentosa (a type of inherited eye condition)
• Severe liver and kidney damage.

There are some medications (including herbal medicines) that interact with ivabradine and should not be taken at the same time. Speak to your doctor if you have any concerns.

Do not drink grapefruit juice or eat grapefruits while taking this medication as they alter the way in which ivabradine is absorbed into the body and this can cause more side effects.

Your doctor should check your heart with an ECG and monitor your blood pressure and heart rate before and during treatment. Ivabradine can be given to children under 18 but only under careful medical supervision. It might not be suitable for people with liver or kidney problems, and it can interact with other medicines. Ivabradine should not be taken during pregnancy or breastfeeding, and effective contraception should be used.

What Are the Side Effects?

Common – more than 1 in 100 people experience this:

• Dizziness
• Headache
• Tiredness
• Vision problems
• Nausea

Less common – fewer than 1 in 100 people experience this:

• Abdominal pain
• Constipation
• Diarrhoea
• Muscle cramps
• Fainting
• Dizziness (vertigo)

Rarely, more serious side effects may occur, such as changes in heart rhythm, high blood pressure, or allergic reactions. If you experience any of these, contact your doctor immediately. There is limited information on the long-term side effects of ivabradine for PoTS.

How to Get and Store Ivabradine

Since ivabradine is not licensed for PoTS, it is usually prescribed by a hospital doctor or nurse who is experienced in its use. Once it has been initiated by a specialist some GPs will continue to prescribe and monitor it.  Occasionally GPs with experience of managing PoTS will initiate prescriptions for ivabradine.

It can be dispensed by the hospital pharmacy or via an NHS prescription (FP10) at your local pharmacy. Private prescriptions are also available, though these may be more expensive.

Store your medication in a cool, dry place away from direct sunlight and out of reach of children, keeping it in its original packaging. Always check the expiry date before use.

Please note this is a brief summary of Ivabradine, and it is not a substitute for advice from your healthcare professional.