STEPS

New Drug Reviews

Ivabradine (Corlanor) for Heart Failure

 


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Am Fam Physician. 2016 Apr 15;93(8):682-684.

Ivabradine (Corlanor) is labeled for the reduction of hospitalizations in patients with chronic systolic heart failure. It inhibits the so-called funny current within the sinoatrial node, reducing heart rate without lowering blood pressure.1 Ivabradine is added to preexisting maximal medical treatment.

View/Print Table

DrugDosageDose formCost*

Ivabradine (Corlanor)

5 mg twice daily

5- and 7.5-mg tablets

$390

2.5 mg twice daily in patients with a history of conduction defects


*—Estimated retail price of one month's treatment based on information obtained at http://www.goodrx.com (accessed February 16, 2016).

DrugDosageDose formCost*

Ivabradine (Corlanor)

5 mg twice daily

5- and 7.5-mg tablets

$390

2.5 mg twice daily in patients with a history of conduction defects


*—Estimated retail price of one month's treatment based on information obtained at http://www.goodrx.com (accessed February 16, 2016).

SAFETY

Atrial fibrillation, bradycardia, and hypertension may occur in patients taking ivabradine. As demonstrated in clinical trials, 5.3% to 9% of patients will develop atrial fibrillation vs. 3.8% to 8% of patients treated with placebo (number needed to treat to harm = 55 to 100). Bradycardia will occur in 10% to 13% of patients, most notably in those with cardiac conduction disorders, a low resting heart rate, and in patients also taking digoxin, diltiazem, verapamil, or amiodarone. Conduction disturbances such as sinus arrest and heart block may also occur.2,3

Ivabradine is contraindicated in patients with severe hepatic impairment, sick sinus syndrome, sinoatrial block, second- or third-degree atrioventricular block (unless a functioning demand pacemaker is present), a resting heart rate less than 60 beats per minute (bpm), or pacemaker dependence.3

Ivabradine is metabolized by the cytochrome P450 (CYP450) system. Verapamil, diltiazem, macrolide antibiotics, protease inhibitors, and other moderate to strong CYP3A4 inhibitors may potentiate its effect and should therefore be avoided. Rifampin, phenytoin (Dilantin), and other inducers of CYP3A4 may reduce its effect.3 Ivabradine is a U.S. Food and Drug Administration pregnancy category D drug.

TOLERABILITY

Approximately one in six patients will discontinue ivabradine due to adverse effects, with 1% of discontinuations attributed to bradycardia.2 On average, ivabradine reduces heart rate by 11 bpm. At the

Address correspondence to Kyle Davis, PharmD, BCPS, at kyle.davis@ochsner.org. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

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1. Joannides R, Moore N, Iacob M, et al. Comparative effects of ivabradine, a selective heart rate-lowering agent, and propranolol on systemic and cardiac haemodynamics at rest and during exercise. Br J Clin Pharmacol. 2006;61(2):127–137....

2. Swedberg K, Komajda M, Böhm M, et al.; SHIFT Investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study [published correction appears in Lancet. 2010;376(9757):1988]. Lancet. 2010;376(9744):875–885.

3. National Institutes of Health. Daily Med. Drug label information: Corlanor–ivabradine hydrochloride tablet, film coated. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=92018a65-38f6-45f7-91d4-a34921b81d0d#section-3. Accessed October 12, 2015.

4. Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999;353(9169):2001–2007.

5. McMurray JJ, Adamopoulos S, Anker SD, et al.; ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC [published correction appears in Eur Heart J. 2013;34(2):158]. Eur Heart J. 2012;33(14):1787–1847.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, Contributing Editor.

A collection of STEPS published in AFP is available at http://www.aafp.org/afp/steps.



 

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