Meet Corlanor: A New Drug for Heart Failure

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Advances in medicine have led to longer lives—but as we live longer, there has also been an increasing incidence of heart failure. Despite some improvements in the available treatments, the mortality rate in people with heart failure is still unacceptably high. Now, the first in a new class of drugs has just been approved for use in heart failure, and it may be able to help.

Here are 10 things to know about Corlanor (ivabradine), the new medication for heart failure:

  1. How does it work? Corlanor works by inhibiting specific channels within the body’s natural pacemaker—the sinoatrial (SA) node. This leads to slow firing in the SA node and a slower heart rate.
  2. Corlanor’s benefit to people with heart failure with reduced ejection fraction (less squeezing power) is likely related to lowering their heart rate.
  3. Who should use it? People who have three things: chronic stable heart failure with an ejection fraction (measured by echocardiogram) of less than or equal to 35 percent, a resting heart rate greater than 70,  and who are either on a maximum dose of a beta blocker (carvedilol or metoprolol) or who can’t use a beta blocker.
  4. Does it work? In patients who can use it, Corlanor (ivabradine) has been shown to reduce the risk of hospitalization for worsening heart failure.
  5. Am I still taking my other heart failure meds? Yes. Treatment of heart failure should still include an ACE inhibitor or angiotensin II receptor blocker (ARB) and sometimes spironolactone if your doctor has you on that.
  6. Why does my resting heart rate have to be greater than 70 to start on Corlanor? In the studies demonstrating the benefit of Corlanor in preventing hospital admission for heart failure, that was the entry criteria. So it’s only been studied and approved for use in people with a resting heart rate over 70.
  7. Tell me more. The study that led to Corlanor’s approval in the U.S. included 6,558 people and found that Corlanor reduced deaths from heart failure and hospital admission for worsening heart failure.
  8. When can I start taking Corlanor? If you meet the criteria, you must also have no or minimal evidence of fluid retention. You should be taking an ACE inhibitor (lisinopril, benazepril, ramipril, etc) and a beta blocker prior to starting Corlanor. Corlanor is NOT meant to replace your beta blocker medication which is usually carvedilol or metoprolol.
  9. How do I take Corlanor? The initial dose is 5 mg twice daily and it is taken with food.
  10. What is the downside? Low heart rate. You’ll stop taking Corlanor if your heart rate is below 50 and you have symptoms. Oh, and cost. It’s new, brand-name only, and expensive.

Dr O.

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