Pharm
Ivabradine
search
Ivabradine
, Corlanor
Mechanism
Hyperpolarization-activated cyclic nucleotide-gated channel blocker
Decreases
Heart Rate
without affecting myocardial contractility
Does not cause
Hypotension
Indications
Persistent CHF symptoms in stable patients in sinus rhythm with
Heart Rate
>70, EF <35
Very expensive adjunct ($430/month) in CHF following
ACE Inhibitor
,
Beta Blocker
,
Aldosterone Antagonist
Dose
Start at 5 mg twice daily
Increase to 7.5 mg twice daily after 2 weeks if
Heart Rate
>60/min
Decrease to 2.5 mg twice daily after 2 weeks if
Heart Rate
<50/min
Adverse effects
Bradycardia
(8% risk, especially if combined with
Beta Blocker
s,
Amiodarone
,
Digoxin
)
Monitor carefully while titrating dose
Avoid in patients with resting
Heart Rate
<70/min
Atrial Fibrillation
(1%)
Visual Field
increased brightness (2%)
Efficacy
Prevents CHF hospitalizations (NNT 25)
Does not reduce mortality
References
(2015) Presc Lett 22(6): 31
(2017) Presc Lett 24(7)
Swedberg (2010) Lancet 376(9744):875-85 +PMID:20801500 [PubMed]
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