Pharm

Ivabradine

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Ivabradine, Corlanor

  • Mechanism
  1. Hyperpolarization-activated cyclic nucleotide-gated channel blocker
  2. Decreases Heart Rate without affecting myocardial contractility
    1. Does not cause Hypotension
  • 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
  • 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
  • Adverse effects
  1. Bradycardia (8% risk, especially if combined with Beta Blockers, Amiodarone, Digoxin)
    1. Monitor carefully while titrating dose
    2. Avoid in patients with resting Heart Rate <70/min
  2. Atrial Fibrillation (1%)
  3. Visual Field increased brightness (2%)
  • Efficacy
  1. Prevents CHF hospitalizations (NNT 25)
  2. Does not reduce mortality
  • References
  1. (2015) Presc Lett 22(6): 31
  2. (2017) Presc Lett 24(7)
  3. Swedberg (2010) Lancet 376(9744):875-85 +PMID:20801500 [PubMed]