Gavrila Dosage/Direction for Use

Symptomatic treatment of chronic stable angina pectoris: Starting of dose: 5 mg twice daily in patients <75 years.
After 3-4 weeks of treatment, if the patient is still symptomatic, remains >60 bpm, the dose may be increased to the next higher dose in patients receiving 2.5 mg twice daily or 5 mg twice daily.
Maintenance dose: 7.5 mg twice daily.
It is recommended that the decision to initiate or titrate treatment takes place with the availability of serial heart rate measurements, electrocardiogram (ECG) or ambulatory 24-hr monitoring. If there is no improvement in symptoms of angina within 3 months after start of treatment, treatment of ivabradine should be discontinued.
In addition, discontinuation of treatment should be considered if there is only limited symptomatic response and when there is no clinically relevant reduction in testing heart rate within 3 months. If, during treatment, heart rate decreases <50 bpm at rest or the patient experiences symptoms related to bradycardia eg, dizziness, fatigue or hypotension, the dose must be titrated downward including the lowest dose of 2.5 mg twice daily (one-half 5 mg tablet twice daily). After dose reduction, heart rate should be monitored. Treatment must be discontinued if heart rate remains <50 bpm or symptoms of bradycardia persist despite dose reduction.
Treatment of Chronic Heart Failure: Usual Recommended Starting Dose: 5 mg twice daily. After 2 weeks of treatment, the dose can be increased to 7.5 mg twice daily if resting heart rate is persistently >60 bpm or decreased to 2.5 mg twice daily (one-half 5 mg tablet twice daily) if resting heart rate is persistently <50 bpm or in case of symptoms related to bradycardia eg, dizziness, fatigue or hypotension. If heart rate is between 50 and 60 bpm, the dose of 5 mg twice daily should be maintained. If during treatment heart rate decreases persistently <50 bpm at rest or the patient experiences symptoms related to bradycardia, the dose must be titrated downward to the next lower dose in patients receiving 7.5 mg twice daily or 5 mg twice daily. If heart rate increases persistently >60 bpm at rest, the dose can be uptitrated to the next upper dose in patients receiving 2.5 mg twice daily or 5 mg twice daily.
Treatment must be discontinued if heart rate remains <50 bpm or symptoms of bradycardia persist. The treatment has to be initiated only in patient with stable heart failure. It is recommended that the treating physician should be experienced in the management of chronic heart failure.