What is the recommended dose of Ivabradine (Corlanor)?

From the Guidelines

Ivabradine should be initiated at a dose of 5 mg twice daily and titrated up to a maximum of 7.5 mg twice daily as needed and tolerated, with careful monitoring of heart rate and potential adverse effects, as recommended by the 2015 ACC/AHA/HRS guideline 1.

Key Considerations

• The initial dose of 5 mg twice daily is recommended for most adults with heart failure or inappropriate sinus tachycardia.
• The dose can be increased to 7.5 mg twice daily after 2 weeks if the heart rate remains above 60 beats per minute.
• If the heart rate is too low (below 50 beats per minute) or if symptoms of bradycardia occur, the dose should be reduced to 2.5 mg twice daily.
• Elderly patients (over 75 years) should start at a lower dose of 2.5 mg twice daily before any titration.

Mechanism and Benefits

• Ivabradine works by selectively inhibiting the If current in the sinoatrial node, which slows the heart rate without affecting blood pressure or cardiac contractility.
• This makes it particularly useful for patients who cannot tolerate beta-blockers or who remain symptomatic despite optimal beta-blocker therapy.

Administration and Monitoring

• The medication should be taken with meals to reduce the risk of visual disturbances like phosphenes, which are a common side effect.
• Patients should have their heart rate monitored regularly during dose adjustment and treatment.

Potential Adverse Effects and Interactions

• Phosphenes, atrial fibrillation, and bradycardia are potential adverse effects of ivabradine.
• Concomitant use with strong CYP3A4 inhibitors or inducers, as well as certain other medications, should be avoided or used with caution, as recommended by the guidelines 1.

From the FDA Drug Label

The recommended starting dose of ivabradine tablets is 5 mg twice daily with food. Assess patient after two weeks and adjust dose to achieve a resting heart rate between 50 and 60 beats per minute (bpm) as shown in Table 1. Thereafter, adjust dose as needed based on resting heart rate and tolerability. The maximum dose is 7.5 mg twice daily.

The recommended dose of ivabradine is:

• Starting dose: 5 mg twice daily
• Maximum dose: 7.5 mg twice daily
• Dose adjustment: based on resting heart rate and tolerability, as shown in Table 1 2 Key points to consider when adjusting the dose:
• Heart rate > 60 bpm: increase dose by 2.5 mg (given twice daily) up to a maximum dose of 7.5 mg twice daily
• Heart rate 50 to 60 bpm: maintain dose
• Heart rate < 50 bpm or signs and symptoms of bradycardia: decrease dose by 2.5 mg (given twice daily); if current dose is 2.5 mg twice daily, discontinue therapy

From the Research

Ivabradine Dosing Information

• The typical dose of ivabradine varies depending on the condition being treated, with studies indicating the following dosages:
  • For inappropriate sinus tachycardia: 5-7.5 mg twice daily 3, 4
  • For heart failure with reduced ejection fraction: 5-7.5 mg twice daily, with some studies using a prolonged-release formulation of 10-15 mg once daily 5, 6
• The dose of ivabradine may need to be adjusted based on the patient's response to treatment and the presence of any side effects, such as phosphenes 5, 6
• Some studies have used a starting dose of 2.5 mg twice daily, which may be safer than higher starting doses 6

Key Considerations

• Ivabradine is a selective inhibitor of the cardiac pacemaker If current, which reduces heart rate without affecting myocardial contractility or vascular tone 7
• The efficacy and safety of ivabradine have been demonstrated in various studies, including those for inappropriate sinus tachycardia and heart failure with reduced ejection fraction 3, 5, 4, 6
• Ivabradine may be an effective alternative to conventional treatments, such as beta blockers and calcium channel blockers, in certain patient populations 7, 4