II. Mechanism

  1. Hyperpolarization-activated cyclic nucleotide-gated channel blocker
  2. Decreases Heart Rate without affecting myocardial contractility
    1. Does not cause Hypotension

III. 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

IV. 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

V. 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%)

VI. Efficacy

  1. Prevents CHF hospitalizations (NNT 25)
  2. Does not reduce mortality

VII. 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]

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Cost: Medications

corlanor (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
CORLANOR 5 MG TABLET $6.86 each
CORLANOR 7.5 MG TABLET $6.92 each