Ivabradine

Corlanor 

Corlanor is a prescription medication used to treat adults with chronic heart failure, thus reducing the risk of hospitalizations. It can also be used in children having heart failure due to dilated cardiomyopathy. The dosage for adults and children varies as prescribed by a medical professional. It is important to note that the medication is not for use if you have already faced heart failure symptoms that got worse before taking Corlanor. One can notice side effects like dizziness or tiredness when taking this medication. If these effects worsen, consult a healthcare provider immediately to avoid any risks.

Product Overview

Corlanor contains the active ingredient ivabradine, which is significantly used to manage symptoms of stable chronic heart failure, a condition where your heart finds difficulty pumping blood. With the use of Corlanor, patients get relief from such conditions. The medication acts by blocking hyperpolarization-activated cyclic nucleotide-gated channels, which helps reduce the heart rate in specific heart conditions.

Corlanor is available in tablet form with 5 to 7.5 mg strengths. It should be taken orally as prescribed by a doctor twice daily with meals. This medication is suitable for adults with stable, symptomatic heart failure who have an LVEF (left ventricular ejection fraction) of 35 percent or less, are in sinus rhythm with a resting heart rate of 70 bpm or more, and are either on maximally tolerated doses or have a contraindication to the use of beta-blockers.

Potential side effects include but are not limited to, vision disturbances, high blood pressure, and bradycardia. Patients are advised to monitor for symptoms and consult their healthcare provider if these effects occur. Precautions should be taken to avoid use in pregnancy and to adjust doses for those with severe liver impairment. If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose, in which case the missed dose should be skipped. In cases of overdose, seek immediate medical attention. Store Corlanor at room temperature, away from moisture and light.

Uses of Corlanor

It is used to treat:

• Adults suffering from chronic heart failure with symptoms to reduce their chances of hospitalizations.
• Children having stable heart failure, with symptoms because of an enlarged heart. 

How to Use Corlanor?

Dosage

Strengths and Forms

The medication comes in two strengths:

• Corlanor 5 mg 
• Corlanor 7.5 mg 

Recommended Dosage for Different Patients

• Adults and Children Weighing More Than 40 Kg: Take 2.5 or 5 mg tablets twice a day with meals. After 2 weeks, the doctor will adjust the dose depending on heart rate. The maximum dose is usually 7.5  mg two times a day.
• Children Weighing Less Than 40 Kg: Take 0.05 mg twice daily with meals. The doctor will adjust the dose at 2-week intervals based on the heart rate. The maximum dose varies from 0.2 mg (patients within the age group of 6 months to less than 1 year) to 0.3 mg (patients 1 year or above), up to 7.5 mg twice a day.

[Note: These recommendations may vary from person to person. Discuss them with your doctor; they’ll customize your dosage accordingly.]

How to Take It?

• Follow the guidelines as directed by your healthcare provider.
• Follow the directions on your product’s prescription label.
• The medication is generally taken 2 times a day with meals. 
• Avoid consuming grapefruit or grapefruit juice while taking the medication. 
• Do not crush or chew the tablet.
• Swallow the medication as a whole for effective results.
• Consult with your physician if you are having problems while swallowing the tablets.
• If a child spits out the medicine shortly after taking it, do not give them another tablet. Wait for the next scheduled dose time before giving the medication again.
• You may need to take other medications called beta blockers. Use these medicines together as directed by the doctor.
• Do not alter or discontinue the medication immediately without expert assistance.
• Make frequent doctor visits and get your electrocardiogram or ECG done to check the proper functioning of your heart.
• Use the medication regularly for best results.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Corlanor Work?

Corlanor (ivabradine) works by targeting and blocking the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel, which is crucial for regulating the heart’s natural pacemaker and setting the rhythm and rate of heartbeats. By blocking these channels, the drug effectively slows down the heart rate without affecting the strength of the heart’s contractions. This reduced heart rate allows the heart to work more efficiently, helping relieve symptoms and prevent worsening heart failure in patients with certain conditions. This mechanism makes it an essential treatment option for patients who cannot take standard medications like beta-blockers or who do not achieve sufficient heart rate reduction alone.

Important Safety Information

Side Effects

Common side effects of Corlanor may include:

• Increased blood pressure
• Luminous phenomena 
• Chest pain
• Irregular heartbeat
• Headache
• Fainting
• Nervousness
• Pounding in the ears
• Tiredness
• Sensitivity towards light

Serious side effects of Corlanor may include:

• Shortness of breath
• Chest pressure
• Bradycardia
• Lack of energy
• Poor feeding
• Turning blue

[Note: This list may not cover all possible side effects. Always consult with your healthcare provider for medical advice about side effects.]

Warnings

• Fetal Toxicity: Corlanor can cause fetal toxicity when taken by pregnant women. Research-based on animal studies finds embryo-fetal toxicity and cardiac teratogenic effects in fetuses of pregnant rats. These effects occurred at drug levels similar to those used in humans at the highest recommended dose. So, women who are thinking of getting pregnant or are pregnant should consult with their doctors before making a decision.
• Atrial Fibrillation: The medication may have an increased risk of atrial fibrillation. In the SHIFT clinical trial, the rate of atrial fibrillation in patients receiving Corlanor was 5.0% per patient-year, compared to 3.9% per patient-year for those on a placebo. Therefore, it is important to regularly check heart rhythm and discontinue the use of this medication if atrial fibrillation occurs.
• Bradycardia and Conduction Disturbances: Studies have shown that Corlanor can lead to a slow heartbeat, sinus arrest, and heart block. Factors that increase the risk of bradycardia include sinus node dysfunction, conduction defects, mismatched heart contractions, and the use of other medications that reduce heart rate. It is advised to avoid Corlanor in combination with heart rate-lowering drugs like verapamil or diltiazem, as they can increase Corlanor levels and lower heart rates further. 

Precautions

• Tell your doctor or pharmacist about any allergies you have before taking Corlanor. Even if you are allergic to any of the medication’s ingredients, tell your doctor immediately, as the product may contain certain inactive ingredients that can cause various allergic reactions.
• Before using this medicine, consult with your healthcare professional about any medical history, especially if you have low blood pressure, liver or heart problems such as heart block, sick sinus syndrome, slow/irregular heartbeat, or pacemaker use. 
• If you consume alcohol or take marijuana, communicate with your doctor, as these substances can make you dizzy or result in vision changes. 
• Avoid driving or operating any machinery that requires alertness.
• Be cautious while driving at night as you might face light brightness, which may set off vision changes. 
• If you are having surgery or undergoing any medical procedure, tell your doctor once about all the products you use (prescription and nonprescription drugs or herbal products).
• It is still unsure whether the drug passes into the breastmilk or not. However, due to possible risks to the infant, avoid breastfeeding while using Corlanor.

Contraindications

Corlanor is contraindicated in patients who have:

• Acute decompensated heart failure (ADHF)
• Blood pressure below 90/50 mmHg
•  Sinoatrial block, sick sinus syndrome, or 3rd-degree atrioventricular block unless a functioning demand pacemaker is installed.
• Resting heart rate below 60 bpm before treatment
• Severe hepatic impairment
• Pacemaker dependence
• Simultaneously using strong cytochrome P450 3A4 (CYP3A4) inhibitors  

Missed Dose

• Do not take another dose to make up for the missed one.
• Take the next dose at your scheduled time.
• Consider taking expert advice to avoid any complications.

[Note: If you have missed a medication dose and are unsure when to take the next one, consult your doctor or pharmacist immediately.]

Overdose 

An overdose of Corlanor may lead to severe bradycardia for a prolonged period of time. If any patient has bradycardia with a lack of hemodynamic tolerance, temporary cardiac pacing may be required for the treatment. Additionally, supportive treatments are available to the patients, which include atropine, IV fluids, and IV beta-stimulating agents such as isoproterenol.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

Storage

• Store the medication at 25°C (77°F) with an extension permitted to  15° – 30°C (59° – 86°F).
• Keep the tablets in a closed container away from direct sunlight, moisture, and heat.
• Keep it from freezing in the refrigerator.
• Store the medication out of children’s and pet’s reach.
• Do not keep expired medication. 
• Do not flush the medication.
• Discard the medication when not in use. You can ask your pharmacist or a professional how to dispose of any medicine.
• Read the packaging of your product carefully for detailed storage instructions.

[Note: Discuss with your healthcare professional the proper disposal of unused medicine and any questions you may have regarding its storage.]

Corlanor Interactions

There are certain drugs that can interact with Corlanor that you may be taking. Some of the examples are: 

• Cytochrome P450-Based Interaction: Corlanor is mainly metabolized by CYP3A4, and the concomitant use of this medication with cytochrome P450 may increase ivabradine plasma concentrations while CYP3A4 inducers reduce these levels. As a result of increased plasma concentrations, this interaction may worsen bradycardia and conduction disturbances. Therefore, it is advised not to use these drugs together. Examples of strong CYP3A4 inhibitors include azole antifungals, macrolide antibiotics, HIV protease inhibitors, and nefazodone.
• Negative Chronotropes: Most patients taking Corlanor are also treated with a beta-blocker. The risk of bradycardia increases when drugs that slow the heart rate (such as digoxin, amiodarone, and beta-blockers) are used together. It’s important to monitor the heart rate when Corlanor is used with other negative chronotropes.
• Pacemakers: Ivabradine aims to reduce the heart rate to between 50 and 60 beats per minute in adults. Patients with demand pacemakers set to a rate of 60 beats per minute or higher can not reach a target heart rate under 60 beats per minute. Therefore, the use of Corlanor is not recommended for patients with pacemakers set at 60 beats per minute or higher.

[Note: This isn’t a complete list, and there could be other drugs that interact with Corlanor. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Corlanor Alternatives

• Furosemide
• Carvedilol
• Lasix
• Spironolactone
• Lisinopril
• Metoprolol
• Coreg
• Entresto
• Coralan
• Ivazine

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

Is Corlanor and beta-blocker the same?

No, these medications are not the same. While both are used to manage heart conditions, their working mechanisms differ. Corlanor targets the heart’s pacemaker cells to reduce heart rate. The medication works by blocking the hyperpolarization-activated cyclic nucleotide-gated (HCN) channel, which primarily affects the heart rate without significantly altering blood pressure. In contrast, beta-blockers lower heart rate along with blood pressure by blocking the action of adrenaline on beta receptors in the heart.

Is it safe to use Corlanor for the long term?

Ivabradine is considered safe for long-term use in specific patients, such as those with chronic heart failure and a high resting heart rate who cannot use beta blockers. However, one should visit their medical professional regularly to monitor any side effects, including bradycardia and visual disturbances. Regular healthcare consultations are essential to adjust doses and manage risks effectively.

How much time does Corlanor take to work?

Do not expect Corlanot to work immediately, as the medication needs time to get absorbed into your bloodstream. While the time may vary from person to person, the usual time it takes is about 2 hours. For the best results, continue the medication for prolonged periods of time.

Which one is better, ivabradine or beta blockers?

The choice between ivabradine and beta blockers depends on specific patient needs and conditions. Beta-blockers are versatile, reducing heart rate and blood pressure and offering protection after heart attacks. Ivabradine is preferred for patients with chronic heart failure who cannot tolerate beta blockers, as it specifically reduces heart rate without affecting blood pressure. Ultimately, a healthcare provider can best determine the most suitable option based on individual health profiles.

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