Download IVABRADINE Template example (Word 23KB)

IVABRADINE
Manner of administration and form
Max.
№.of
Oral, 5mg tablet: film-coated
Qty
Rpts
DRUG NAME (IN CAPITALS)
IVABRADINE
1
Dispensed Price for
Max. Qty
5
$56.44
Proprietary Name and Manufacturer
Coralan
Servier
Laboratories
(Aust.) Pty Ltd
{Forms(s)} {strength(s)}
5mg tablet: film-coated, 56 tablets
Category /
Program
Prescriber type:
General Schedule
Dental
Medical Practitioners
Nurse practitioners
Optometrists
Midwives
Episodicity:
Chronic
Severity:
N/A
Condition:
heart failure
PBS Indication:
Chronic heart failure
Treatment phase:
N/A
Restriction Level /
Method:
Restricted benefit
Authority Required - In Writing
Authority Required - Telephone
Authority Required – Emergency
Authority Required - Electronic
Streamlined
Treatment criteria:
N/A
Clinical criteria:

Patient must be symptomatic with NYHA classes II or III,
AND
 Patient must be in sinus rhythm,
AND
 Patient must have a documented left ventricular ejection fraction (LVEF) of less than or
equal to 35%,
AND
 Patient must have a resting heart rate at or above 77 bpm at the time ivabradine
treatment is initiated,
AND

Patient must receive concomitant optimal standard chronic heart failure treatment,
which must include the maximum tolerated dose of a beta-blocker, unless
contraindicated or not tolerated
Population criteria:
N/A
Foreword
N/A
Definitions
N/A
Prescriber
Instructions
Resting heart rate should be measured by ECG after 5 minutes rest
Administrative
Advice
Cautions
The ECG result must be documented in the patient's medical records when treatment is initiated.
Continuing Therapy Only:
For prescribing by nurse practitioners as continuing therapy only, where the treatment of, and
prescribing of medicine for, a patient has been initiated by a medical practitioner. Further
information can be found in the Explanatory Notes for Nurse Practitioners.
N/A