Ivabradine
CORLANOR
What it isSelective funny-current inhibitor in the sinus node; heart failure and inappropriate sinus tachycardia.
Why this oneIt slows the heart without lowering blood pressure or contractility, so it works when beta blockade is maximal or not tolerated.
What limits itFetal toxicity, and it only works in sinus rhythm. Luminous phenomena; CYP3A4-dependent.
FDA-approved for
- heart failure (2015)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Stable symptomatic heart failure (reduce hospitalization) | Adult | 5 mg BID (2.5 mg BID if vulnerable or conduction defect) | titrate to resting HR 50-60 bpm | 7.5 mg BID |
Titration Reassess after 2 weeks, then adjust by 2.5 mg BID based on resting heart rate.
Renal No adjustment for CrCl ≥15 mL/min; no data if CrCl <15 mL/min.
Hepatic No adjustment in mild-moderate impairment; contraindicated in severe (Child-Pugh C).
Instructions
- Take twice daily with food
- Oral solution may be used in adults unable to swallow tablets
- Discontinue if atrial fibrillation develops
Contraindications
- Acute decompensated heart failure
- Clinically significant hypotension
- Sick sinus syndrome, sinoatrial block, or 3rd-degree AV block (unless functioning demand pacemaker)
- Clinically significant bradycardia
- Severe hepatic impairment
- Pacemaker dependence (heart rate maintained exclusively by pacemaker)
- Concomitant strong CYP3A4 inhibitors
Cautions
- Fetal toxicity — use effective contraception
- Increases risk of atrial fibrillation — monitor rhythm
- Bradycardia and conduction disturbances
- Not recommended in 2nd-degree AV block
Adverse reactions
- Bradycardia
- Hypertension
- Atrial fibrillation
- Luminous phenomena (phosphenes)
Pregnancy May cause fetal harm (cardiac teratogenicity in animals); advise effective contraception.
Lactation Undefined
NO BOXED WARNINGS
Principal riskFetal toxicity; it works only in sinus rhythm
Cost, est. cash$300–$2,500/month
Generic entry2021
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Ivabradine ballicule
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