Ivabradine tablet doses and twice daily titration for the GPhC assessment

The manufacturer's UK product information for Procoralan film-coated tablets for symptomatic chronic stable angina states the starting dose of ivabradine should not exceed 5 mg twice daily in patients aged below 75 years.

The same information states that after three to four weeks, if the patient remains symptomatic, the initial dose is well tolerated and resting heart rate remains above 60 beats per minute, the dose may be increased to the next higher dose, and the maintenance dose should not exceed 7.5 mg twice daily.

It also states that if resting heart rate falls below 50 beats per minute, the dose must be titrated downward, including to the lowest dose of 2.5 mg twice daily, which is one half of a 5 mg tablet twice daily. Persistent bradycardia or related symptoms despite dose reduction requires discontinuation. Heart-failure titration follows a different schedule in the same SmPC.

Each question fixes the values needed for its arithmetic. Write the unit beside every step and distinguish a single dose from a daily total or a supply period. All prescriptions and patients here are fictional; these are revision materials, not for patient care.