Key takeaways:
Corlanor (ivabradine) is a medication used to treat heart failure. It works to slow your heart rate by blocking specific channels within the body’s natural pacemaker — the sinoatrial node.
Corlanor has been shown to reduce the risk of hospitalization for certain adults with symptomatic heart failure. It’s also approved for children with heart failure that’s caused by an enlarged and weakened heart muscle (called dilated cardiomyopathy).
Corlanor isn’t meant to replace your beta blocker medication. But if you’re taking the maximum beta blocker dosage, Corlanor may be added on. It may also be an option if you can’t take a beta blocker at all.
Corlanor is only available as a brand-name medication, but there are ways to save. Manufacturer copay cards and patient assistance programs can make your prescription more affordable.
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In recent years, there have been advances in heart failure treatments. One of those treatments is Corlanor (ivabradine). It’s an oral medication that has been shown to lower the risk of hospitalization in certain adults with symptomatic heart failure. Children with heart failure caused by an enlarged and weakened heart muscle (dilated cardiomyopathy) can also take Corlanor.
Corlanor works by slowing down your heart rate. But it does this differently than other heart failure medications that have the same effect, like beta blockers. Corlanor isn’t meant to replace your beta blocker. But it may be added on if you’re taking a maximum beta blocker dosage or can’t take one at all.
Because Corlanor works differently compared to other heart failure treatments, it can have some unique benefits. Here’s what you need to know about it.
What is Corlanor, and what is it used for?
The FDA approved Corlanor in 2015, making it the first medication in a class called hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers. It’s approved to lower the risk of hospitalization in certain adults with symptomatic heart failure.
Corlanor isn’t a first-choice medication for heart failure. It’s most often used if standard heart failure medications aren’t working well enough on their own. You may be prescribed Corlanor if you meet the following criteria:
You’re taking the maximum tolerated dose of a beta blocker, or you can’t take a beta blocker at all.
Your heart rhythm is normal.
Your resting heart rate is 70 beats per minute or higher.
Your ejection fraction is 35% or lower. Ejection fraction is how much blood your heart pumps with each beat. Less than 40% is considered to be heart failure with reduced ejection fraction (HFrEF).
Corlanor is also approved for use in children ages 6 months and older. In this case, it’s used to treat heart failure caused by dilated cardiomyopathy. Corlanor may be prescribed if your child’s heart rhythm is normal and their heart rate is elevated.
Corlanor has also been used to treat tachycardia (fast heart beat). But it’s not approved for treating tachycardia, so this is an off-label use.
Can Corlanor be used to treat POTS?
Potentially. Postural orthostatic tachycardia syndrome, or POTS, is a heart condition that experts are still trying to understand. It causes your heart rate to increase when you stand and can cause dizziness or weakness, as well as heart palpitations, chest pain, and painful breathing.
Treatment for POTS includes careful, regular exercise, staying hydrated, and getting the right amount of salt in your diet. In some cases, medications may be needed.
Corlanor has been studied for treating POTS. In some cases, it helped improve symptoms. Currently, Corlanor isn’t approved for treating POTS, but it could be taken off-label.
How does Corlanor (ivabradine) work?
Corlanor (ivabradine) has a unique mechanism of action. It works by blocking specific channels within the body’s natural pacemaker — the sinoatrial (SA) node. This leads to slower electrical pulses in the SA node and a slower heart rate. This helps your heart pump blood throughout your body more effectively.
A heart rate below 70 beats per minute has been associated with better outcomes for people with HFrEF. For this reason, you may be prescribed a beta blocker to lower your heart rate.
But some people may not reach their heart rate goal, even while taking the maximum tolerated beta blocker dose. And others can’t take beta blockers at all. This is where Corlanor can provide a benefit by slowing down heart rate further.
Corlanor dosing information
Corlanor is an oral medication. It comes as a pill or liquid that’s taken twice daily with food. After taking a dose, it takes about 1 hour for it to reach maximum levels in the blood. But it may take longer, depending on how much food you have in your stomach at the time.
Corlanor dosage for adults
The usual starting dose of Corlanor for adults is 5 mg by mouth twice a day. Certain people may be advised to start with 2.5 mg twice a day instead. After 2 weeks, your healthcare provider should check your heart rate. Depending on your reading and where they want it to be, they may adjust your dose higher or lower, as follows:
Heart rate above 60 beats per minute: Your dose may be increased by 2.5 mg twice daily. The maximum Corlanor dosage is 7.5 mg twice daily.
Heart rate between 50 and 60 beats per minute: You’ll typically stay on your current dose. This is a common target for your resting heart rate reading.
Heart rate below 50 beats per minute: Your dose may be lowered by 2.5 mg twice daily. If your heart rate remains below 50 after lowering your dose, Corlanor should be stopped completely.
Corlanor dosage for children
Children weighing under 40 kg (88 lbs) may be prescribed Corlanor oral liquid, which comes in ampules. You’ll empty the ampule’s contents into a medicine cup and use an oral syringe to draw out your child’s dose. Your pharmacist can give you specific instructions. Children weighing more than 40 kg can take Corlanor tablets if they can swallow pills.
For children, the typical Corlanor dosage depends on their age, body weight, and formulation, as detailed in the table below.
Weight | Starting dosage | Maximum dosage |
Less than 40 kg | 0.05 mg/kg twice daily | 6 months to under 1 year old: 0.2 mg/kg twice daily Ages 1 year and up: 0.3 mg/kg twice daily, up to 7.5 mg twice daily |
Over 40 kg | 2.5 mg/kg twice daily | 7.5 mg twice daily |
Depending on how your child responds to treatment, their dosage may be adjusted every 2 weeks to reach a 20% reduction in heart rate.
How to avoid a Corlanor overdose
A Corlanor overdose is very rare. To avoid an overdose, make sure to take Corlanor as prescribed by your healthcare provider.
Corlanor slows down your heart rate. If you take too much, your heart rate may slow down too much (bradycardia). Other signs of Corlanor overdose are:
Dizziness
Nausea and vomiting
Pale appearance
If you experience a sudden onset of these symptoms, you should let your healthcare provider know right away. They may want you to seek emergency care.
Corlanor interactions
Before starting Corlanor, let your healthcare provider or pharmacist know if you take any other medications. They can check to see if Corlanor might interact with anything you take.
Some medications should be completely avoided with Corlanor because they can heighten its effects and raise your risk of side effects. Examples of these medications include:
Azole antifungals, such as itraconazole (Sporanox)
Macrolide antibiotics, such as clarithromycin
Some antiviral medications, such as nelfinavir (Viracept)
Some medications and substances don’t have as strong of an effect on Corlanor, but should generally be avoided with it. Examples of these include:
Other medications and supplements can make Corlanor less effective. It’s generally recommended to avoid taking them with Corlanor. Examples of these include:
Rifamycin antibiotics, like rifampin
Barbiturates, like phenobarbital
Phenytoin (Dilantin)
Since Corlanor lowers your heart rate, any medication that also lowers heart rate can interact with Corlanor. But sometimes, you may be prescribed one of these medications with Corlanor intentionally for the additive effects. Beta blockers are the most common example.
While taking Corlanor, your healthcare provider should monitor your heart rate to make sure it doesn’t drop too low. Always check with them before starting a new medication while taking Corlanor.
Corlanor side effects
As with any medication, you may experience side effects while taking Corlanor. Examples of these include:
Low heart rate
Higher blood pressure
Abnormal heart rhythm, including conditions such as atrial fibrillation
Bright spots in your vision (luminous phenomena)
Pregnant women should not take Corlanor because it can cause harm to the fetus. Anyone who could become pregnant while taking Corlanor should use contraception. It’s also not recommended to take Corlanor while nursing.
If you think you may be experiencing a side effect from Corlanor, talk to your healthcare provider. Don’t stop taking the medication unless instructed to do so.
Who should not take Corlanor?
There are certain people who are good candidates for Corlanor. But there are also situations where Corlanor may not be safe to take. If you have any of the following conditions, you should not take Corlanor:
Severe (decompensated) heart failure
Low blood pressure with symptoms
Certain types of conduction disturbances in the heart or “heart block”
Low heart rate with symptoms
Severe liver problems
A pacemaker
Depending on your health history, your healthcare provider can decide if Corlanor is a safe and effective option for you.
Do you have to wean off Corlanor?
It depends. One of the reasons you may need to stop Corlanor could be due to a low heart rate. If this happens, the manufacturer recommends lowering the dose first, to see if your heart rate comes back to a normal range (50 to 60 beats per minute). Then, once you’re on the lowest dose, your provider may instruct you to stop taking the medication.
You may already be taking the lowest adult dose (2.5 mg twice daily) before stopping it, based on the dose adjustments described above. So in a way, you may be “naturally weaned” off the medication if your heart rate gets too low from taking Corlanor.
Keep in mind that if you have serious side effects or an allergic reaction to Corlanor, your healthcare provider may have you stop the medication, regardless of your current dose. You shouldn’t stop taking the medication without their approval.
Are there alternative medications to Corlanor?
Corlanor is currently the only medication of its kind. And it works differently compared to other heart failure medications that also slow your heart rate. It’s also only recommended as an option in specific situations. In that sense, there are not any alternatives to Corlanor.
How to save on Corlanor
The FDA approved the first generic for Corlanor in late 2021. However, generic versions haven’t launched yet in the U.S. Until then, Corlanor is only available as a brand-name medication. Fortunately, there are a few ways you can save on your prescription.
If you’re eligible, you could pay as little as $20 for Corlanor with a copay savings card from the manufacturer. A patient assistance program is also available to provide the medication free of charge. Check with your pharmacist about your specific savings options.
The bottom line
Corlanor (ivabradine) is an oral medication used to treat heart failure in certain adults and children. It’s also the only medication of its kind. You’ll typically take Corlanor twice daily with food. And your dosage may be adjusted higher or lower based on how your heart rate responds to treatment.
For adults, Corlanor is usually used after you’re already taking other medications for heart failure. Most people are taking beta blockers before starting Corlanor and remain on them while taking Corlanor. Your healthcare provider can decide if Corlanor is a good option for you.
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References
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Maddox, T. M., et al. (2021). 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment: Answers to 10 pivotal issues about heart failure with reduced ejection fraction: A report of the American College of Cardiology solution set oversight committee. Journal of the American College of Cardiology.
Martino, A., et al. (2021). Ivabradine versus bisoprolol in the treatment of inappropriate sinus tachycardia: A long-term follow-up study. Journal of Cardiovascular Medicine.
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