Cardiovascular Medicine Book

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Ivabradine

Aka: Ivabradine, Corlanor
  1. Mechanism
    1. Hyperpolarization-activated cyclic nucleotide-gated channel blocker
    2. Decreases Heart Rate without affecting myocardial contractility
      1. Does not cause Hypotension
  2. 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
  3. 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
  4. 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%)
  5. Efficacy
    1. Prevents CHF hospitalizations (NNT 25)
    2. Does not reduce mortality
  6. 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]
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.

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