From the Guidelines
Corlanor (ivabradine) and Inspra (eplerenone) are two distinct medications used for different cardiovascular conditions, with Corlanor primarily used to treat heart failure in patients with stable, symptomatic chronic heart failure with reduced ejection fraction, and Inspra used to treat high blood pressure and improve survival in patients with heart failure after a heart attack. The main difference between these two medications lies in their mechanism of action and the conditions they are used to treat. Corlanor works by slowing the heart rate through inhibition of the If current in the sinoatrial node, which helps reduce the workload on the heart, as seen in the SHIFT trial 1. On the other hand, Inspra is an aldosterone receptor antagonist that blocks the action of aldosterone, a hormone that can cause salt and water retention, leading to increased blood pressure. Some key points to consider when prescribing these medications include:
- The dosing, side effects, and monitoring requirements differ significantly between Corlanor and Inspra, so they should only be taken as prescribed by a healthcare provider familiar with the patient's specific medical history and condition.
- According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure, ivabradine can be beneficial to reduce HF hospitalizations and cardiovascular death in patients with symptomatic (NYHA class II to III) stable chronic HFrEF (LVEF ≤35%) who are receiving GDMT, including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of ≥70 bpm at rest 1.
- The 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure also recommends ivabradine for patients with symptomatic (NYHA class II-III) stable chronic HFrEF (LVEF ≤35%) who are receiving GDEM, including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of ≥70 bpm at rest 1. It is essential to note that these medications are not interchangeable, and their use should be guided by the specific needs of the patient and the latest clinical guidelines.
From the Research
Difference between Ivabradine and Other Medications
- Ivabradine is a medication used to treat heart failure with reduced ejection fraction, whereas other medications like spironolactone (INSPRA) are used to treat conditions such as heart failure, hypertension, and edema 2, 3.
- Ivabradine works by reducing the heart rate, which can help improve symptoms and reduce hospitalizations in patients with heart failure 2, 4.
- Spironolactone, on the other hand, is a potassium-sparing diuretic that helps remove excess fluid from the body and reduce blood pressure 5.
Ivabradine vs. Spironolactone
- Ivabradine has been shown to be effective in reducing hospitalizations and improving symptoms in patients with heart failure with reduced ejection fraction, particularly those with a heart rate above 70 beats per minute 2, 4.
- Spironolactone has been shown to be effective in reducing mortality and morbidity in patients with heart failure, but its effects on heart rate are not as well established as those of ivabradine 5.
- A meta-analysis comparing the effects of ivabradine in heart failure patients with reduced versus preserved ejection fraction found that ivabradine had a stronger bradycardic effect in patients with reduced ejection fraction 5.
Clinical Use of Ivabradine
- Ivabradine is indicated for use in patients with heart failure with reduced ejection fraction who are in sinus rhythm and have a heart rate above 70 beats per minute 2, 3.
- The medication has been shown to be safe and effective in reducing hospitalizations and improving symptoms in these patients, and is often used in combination with other medications such as beta blockers and ACE inhibitors 2, 4.
- However, ivabradine may not be effective in patients with heart failure preserved ejection fraction, and its use in these patients is not well established 5.