Cardiovascular Medicine Book

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Ivabradine

Aka: Ivabradine, Corlanor
  1. Indications
    1. Persistent CHF symptoms in stable patients in sinus rhythm with Heart Rate >70, EF <35
    2. Very expensive adjunct ($430/month) in CHF following ACE Inhibitor, Beta Blocker, Aldosterone Antagonist
  2. Contraindications
    1. Severe Hepatic Impairment
    2. Sick Sinus Syndrome
    3. Sinoatrial Block
    4. Second or Third Degree Atrioventricular Block (without Pacemaker)
    5. Resting Heart Rate <60 beats per minute
    6. Pacemaker dependence
  3. Mechanism
    1. Hyperpolarization-activated cyclic Nucleotide-gated channel blocker
    2. Decreases Heart Rate without affecting myocardial contractility
      1. Does not cause Hypotension
  4. Pharmacokinetics
    1. CYP3A4 metabolized
  5. Dose
    1. Start at 5 mg twice daily
    2. Increase to 7.5 mg twice daily after 2 weeks if Heart Rate >60/min
    3. Decrease to 2.5 mg twice daily after 2 weeks if Heart Rate <50/min
  6. Adverse effects
    1. Bradycardia (8-13%)
      1. Risk factors
        1. Combined with Beta Blockers, Amiodarone, Digoxin, Diltiazem
        2. Cardiac conduction disorders
        3. Low resting Heart Rate
      2. Monitor carefully while titrating dose
      3. Avoid in patients with resting Heart Rate <70/min
    2. Atrial Fibrillation (1%)
    3. Visual Field increased brightness (2%)
    4. Hypertension
  7. Efficacy
    1. Prevents CHF hospitalizations (NNT 25)
    2. Does not reduce mortality
    3. Swedberg (2010) Lancet 376(9744): 875-85 [PubMed]
  8. Drug Interactions
    1. Strong CYP3A4 inhibitors potentiate Ivabradine
      1. Verapamil (also increases Bradycardia risk)
      2. Diltiazem (also increases Bradycardia risk)
      3. Macrolide Antibiotics
      4. Protease Inhibitors
    2. CYP3A4 Inducers reduce Ivabradine effect
      1. Rifampin
      2. Phenytoin (Dilantin)
  9. Safety
    1. Pregnancy Category D
  10. References
    1. (2015) Presc Lett 22(6): 31
    2. (2017) Presc Lett 24(7)
    3. Davis (2016) Am Fam Physician 93(8): 683-4 [PubMed]
    4. Swedberg (2010) Lancet 376(9744):875-85 +PMID:20801500 [PubMed]
Medication Costs
corlanor (on 5/17/2017 at Medicaid.Gov Pharmacy Drug pricing)
CORLANOR 5 MG TABLET $6.86 each
CORLANOR 7.5 MG TABLET $6.92 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

ivabradine (C0257190)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C088408
SnomedCT 421228002, 421692002
English 7,8-dimethoxy-3-(3-(((4,5-dimethoxybenzocyclobutan-1-yl)methyl)methylamino)propyl)-1,3,4,5-tetrahydro-2H-benzazepin-2-one, Ivabradine, Ivabradine (product), Ivabradine (substance), ivabradine, IVABRADINE
Spanish ivabradina, ivabradina (producto), ivabradina (sustancia)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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