Ivabradine is not effective in the treatment or prevention of cardiac arrhythmias and likely loses its efficacy when a tachyarrhythmia occurs (e.g. ventricular or supraventricular tachycardia). Ivabradine is therefore not recommended in patients with atrial fibrillation or other cardiac arrhythmias that interfere with sinus node function. Ivabradine is not recommended in AV-block of 2^nd^ degree. Ivabradine must not be initiated in pre-treatment resting heart rate below 60 bpm. If, during treatment, resting heart rate decreases persistently below 50 bpm or the patient experiences symptoms related to bradycardia such as dizziness, fatigue or hypotension, the dose must be titrated downward or treatment discontinued if heart rate below 50 bpm or symptoms of bradycardia persist. Concomitant use of ivabradine with heart rate-reducing calcium channel blockers such as verapamil or diltiazem is not recommended. Heart failure must be appropriately controlled before considering ivabradine treatment. The use of ivabradine is contraindicated in heart failure patients with NYHA functional classification III-IV, due to a lack of data on clinical efficacy and safety. Caution is needed in patients with asymptomatic left ventricular dysfunction, as well as in heart failure patients with NYHA functional classification II due to a limited number of patients studied. The use of ivabradine is not recommended immediately after a stroke since no data is available in these situations. Ivabradine influences on retinal function. To date, there is no evidence of a toxic effect of ivabradine on the retina, but the effects of long-term ivabradine treatment beyond one year on retinal function are currently not known. Cessation of treatment should be considered if any unexpected deterioration in visual function occurs. Caution should be exercised in retinitis pigmentosa. There is no evidence of risk of (excessive) bradycardia on return to sinus rhythm when pharmacological cardioversion is initiated in patients treated with ivabradine. However, in the absence of extensive data, non urgent DC-cardioversion should be considered 24 hours after the last dose of ivabradine. Limited data are available in patients with mild to moderate hypotension, and ivabradine should therefore be used with caution in these patients. Ivabradine is contraindicated in severe hypotension (blood pressure <90/50 mm Hg). The use of ivabradine in patients with congenital QT syndrome or treated with QT-prolonging medicinal products should be avoided. Caution should be exercised when using ivabradine in moderate hepatic insufficiency. Caution should be exercised when using ivabradine in severe renal insufficiency (CrCl <15 mL/minute). Since tablets contain lactose, patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicinal product.