ivabradine + metoprolol

Ivabradine + metoprolol is a fixed-dose combination of two cardiovascular agents used primarily for the management of stable angina, heart failure, and inappropriate sinus tachycardia (IST). Ivabradine selectively inhibits the If current in the sinoatrial node, leading to a reduction in heart rate without affecting myocardial contractility or blood pressure. Metoprolol is a beta-1 adrenergic receptor blocker that decreases heart rate and myocardial oxygen demand by inhibiting sympathetic stimulation. The combination provides additive effects on heart rate reduction and symptom control, especially in patients who are refractory to monotherapy with either agent. This therapy has been shown to improve exercise capacity and reduce angina symptoms as well as IST-related symptoms[1][2][3][5][7].