伊伐布雷定(Ivabradine)的作用及功效与副作用是什么？

It is a new and only available cyclic nucleotide gated inhibitor that can act on a special target and reduce heart rate. It has been approved in many countries outside Japan for the treatment of stable angina and chronic heart failure. However, this drug can cause side effects such as bradycardia, conduction disorders, and atrial fibrillation during treatment. Patients should follow the doctor's instructions to use the drug correctly, and deal with any abnormalities in time.

The role and efficacy of Ivabradine

1. Reduce sinus heart rate:

Controlling heart rate is a widespread and commonly used method in the treatment of cardiovascular diseases. Ivabradine works through special targets , inhibits the sinoatrial node, reduces sinus heart rate, and achieves the purpose of controlling symptoms and improving prognosis in the treatment of cardiovascular diseases. It has definite curative effect in the treatment of chronic heart failure. It also shows certain therapeutic effects on acute heart failure and arrhythmia. It has also been found to delay the progression of cardiomyopathy and has broad application prospects in the treatment of cardiovascular diseases.

2. Improve clinical outcomes:

As a new drug based on specific targets to control sinus heart rate, ivabradine is a unique drug that is different from beta-blockers and calcium channel blockers because it can reduce heart rate without affecting myocardial contractility or vascular tone.

Ivabradine is a use-dependent inhibitor targeting the sinoatrial node. It is approved in the United States for adjunctive treatment in patients with heart failure with reduced ejection fraction. In this setting, ivabradine has demonstrated improved clinical outcomes due to a reduction in heart failure rehospitalizations.

3. Improve patients’ quality of life:

Ivabradine can improve the quality of life of patients with chronic heart failure, and long-term use can effectively improve left ventricular function and structure.

Side effects of Ivabradine

1. Atrial fibrillation: Ivabradine will increase the risk. In trials of the treatment of systolic heart failure, the incidence of atrial fibrillation was 5.0% per patient-year in patients treated with ivabradine compared with 3.9% in patients treated with placebo.

2. Bradycardia and conduction disorders: Among patients treated with Ivabradine, the incidence of bradycardia was 6.0%, while among patients treated with placebo, the incidence of bradycardia was 1.3%.

Bradycardia may increase the risk of QT prolongation, which may lead to serious ventricular arrhythmias, including torsades de pointes, especially in patients with risk factors.

Measures for dealing with side effects

1. Atrial fibrillation: Patients should monitor their heart rhythm regularly. If atrial fibrillation occurs, Ivabradine should be discontinued.

2. Bradycardia and conduction disorders: Avoid using verapamil or diltiazem and Ivabradine at the same time. Simultaneous use may cause a decrease in heart rate. If patients experience bradycardia, they can go to the hospital in time and receive treatment under the guidance of a doctor.

Efficacy of Ivabradine

Background: Postural orthostatic tachycardia syndrome (POTS) is a complex, multifaceted disorder that impairs functional status and quality of life. Current medical treatments are limited.

Purpose: This study investigated the effect of ivabradine on heart rate, quality of life (QOL) and plasma norepinephrine (ne) levels in patients with hyperadrenergic POTS.

Methods: A total of 22 patients with the predominant subtype of hyperadrenergic POTS completed a randomized, double-blind, placebo-controlled crossover trial of ivabradine. Patients were randomly assigned to start treatment with ivabradine or placebo for 1 month and then crossover to the other treatment for 1 month. Heart rate, QOL, and plasma norepinephrine levels were measured at baseline and at the end of each treatment month.

Results: The average age was 33.9±11.7 years old, 95.5% were female, and 86.4% were white. There was a significant reduction in heart rate between the placebo and ivabradine groups. Patients reported improvements in physical functioning and social functioning on the 36-item Health Survey of QOL 1.0.

After receiving ivabradine (Ivabradine) treatment, norepinephrine levels showed a significant downward trend. Patients did not experience any significant side effects, such as bradycardia or hypotension, while using ivabradine.

Conclusion: Ivabradine can be safe and effective in significantly improving heart rate and QOL in patients with hyperadrenergic POTS.

Summary

Ivabradine can reduce sinus heart rate, improve clinical outcomes, and improve patients' quality of life. However, Ivabradine may cause bradycardia as a side effect. It is recommended that patients use medications correctly under the guidance of a doctor to ensure the safety and effectiveness of the medication.

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