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Corlanor
Corlanor (ivabradine) is a selective heart rate-lowering medication used to treat chronic heart failure in patients with a resting heart rate of at least 70 beats per minute. It is typically prescribed for patients with left ventricular ejection fraction (LVEF) ≤ 35% who are either intolerant to or not fully managed by beta-blockers. Corlanor works by reducing the heart rate without affecting the strength of the heart's contractions, allowing the heart to work more efficiently and reducing the risk of hospitalization for worsening heart failure.
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Frequently Asked Questions
Can I take Corlanor with other heart medications?
Yes, Corlanor is often used in combination with other heart failure medications, such as beta-blockers, ACE inhibitors, or diuretics. Always follow your healthcare provider’s instructions for combining medications.
How long does it take for Corlanor to start working?
Corlanor begins to lower heart rate within a few hours of the first dose, but full benefits for heart failure management may take a few weeks to become noticeable.
What should I do if I experience flashes of light (phosphenes) while on Corlanor?
Phosphenes are a known side effect of Corlanor and are generally harmless. If they become bothersome or affect your daily life, consult your healthcare provider.
Can Corlanor cure heart failure?
No, Corlanor does not cure heart failure, but it helps manage symptoms and reduces the risk of hospitalization due to worsening heart failure.
Is Corlanor safe during pregnancy?
Corlanor is not recommended during pregnancy, as it may cause harm to the fetus. Women of childbearing potential should use effective contraception while taking this medication.
Comprehensive Drug Guide
How Does Corlanor Work?
Corlanor works by selectively inhibiting the If ("funny") current in the sinoatrial node, the natural pacemaker of the heart. This action slows down the heart rate, allowing more time for the ventricles to fill with blood before pumping, which increases the efficiency of the heart. Importantly, Corlanor reduces the heart rate without negatively impacting contractility or blood pressure.
What is Corlanor Used For?
Chronic heart failure in patients with stable, symptomatic heart failure with a reduced ejection fraction (LVEF ≤ 35%) and a resting heart rate of ≥ 70 beats per minute, despite optimal beta-blocker therapy or in cases where beta-blockers are contraindicated or poorly tolerated.
Common Dosages
Corlanor is available by prescription only and is not classified as a controlled substance. It comes in tablet and oral solution forms.
- Tablets: 5 mg, 7.5 mg
- Oral solution: 5 mg/5 mL for pediatric use
Typical Dosing
FDA Approved Indications
For adults: The recommended starting dose is 5 mg twice daily, adjusted based on heart rate after 2 weeks. The maximum dose is 7.5 mg twice daily.
Pediatric Dosing
For pediatric patients: The dose is based on body weight and age. The oral solution is commonly used for pediatric dosing. Always consult a pediatric cardiologist for specific dosing.
Who Shouldn't Take Corlanor?
Corlanor should not be used in individuals with the following conditions:
- Acute decompensated heart failure
- Sick sinus syndrome or sinoatrial block unless a pacemaker is in place
- Severe liver impairment
- Resting heart rate below 60 beats per minute before treatment
- Pacemaker dependence
- Pregnancy (due to potential harm to the fetus)
Advice From The Pharmacist
- Take Corlanor twice daily with meals for optimal absorption. Consistency in timing helps maintain stable drug levels in the body.
- Monitor your heart rate regularly while on Corlanor. Notify your healthcare provider if your heart rate drops too low (below 50 beats per minute).
- Avoid grapefruit or grapefruit juice while taking Corlanor, as it may increase drug levels and the risk of side effects.
- If you miss a dose, skip the missed dose and continue with your next scheduled dose. Do not double the dose to make up for the missed one.
Side Effects of Corlanor
Common Side Effects
- Bradycardia (slow heart rate)
- Visual disturbances, such as seeing flashes of light (phosphenes)
- High blood pressure
- Dizziness or fatigue
Uncommon/Severe Side Effects
- Severe bradycardia (heart rate too low)
- Atrial fibrillation
- Fainting or lightheadedness
Risks and Warnings of Corlanor
Bradycardia: Corlanor can cause an excessive slowing of the heart rate. Patients with a resting heart rate below 50 beats per minute may need a dose adjustment or discontinuation of the drug.
Atrial Fibrillation: Corlanor may increase the risk of developing atrial fibrillation. Regular monitoring of heart rhythm is recommended.
Visual Disturbances: Some patients experience temporary visual symptoms, such as enhanced brightness or flashes of light, particularly in dim lighting. This effect, known as phosphenes, usually resolves on its own.
Interactions with Corlanor
Common Drug Interactions
- Beta-blockers: Concurrent use with beta-blockers may increase the risk of bradycardia. Dose adjustments may be required if both medications are used together.
- CYP3A4 inhibitors: Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin) can increase ivabradine levels, leading to increased side effects. These drugs should be avoided or used with caution.
- Calcium channel blockers: Non-dihydropyridine calcium channel blockers (e.g., verapamil, diltiazem) may exacerbate the bradycardia effects of Corlanor.
Alternatives to Corlanor
- Beta-blockers (Metoprolol, Carvedilol): These are commonly used in heart failure management to reduce heart rate and improve cardiac function.
- ACE inhibitors (Lisinopril, Enalapril): Medications that help reduce blood pressure and improve heart failure outcomes.
- ARNI (Entresto): A combination of sacubitril and valsartan that is commonly used in the management of heart failure with reduced ejection fraction.
