Home Drug Guide Ivabradine

Drug Guide

Generic Name

Ivabradine

Brand Names Corlanor

Classification

Therapeutic: Antianginal agent, Heart failure drug

Pharmacological: Selective sinus node inhibitor

FDA Approved Indications

Chronic stable angina pectoris in patients who have a contraindication to or intolerance of beta-blockers
Heart failure with reduced ejection fraction (HFrEF) in patients who are stable on guideline-directed medical therapy

Mechanism of Action

Ivabradine selectively inhibits the funny current (I_f) in the sinoatrial node, leading to a reduction in heart rate without affecting myocardial contractility, blood pressure, or intracardiac conduction.

Dosage and Administration

Adult: Start with 5 mg twice daily; adjust dose based on response and tolerability, range 2.5-7.5 mg twice daily.

Pediatric: Not established.

Geriatric: Use with caution; start at lower dose and titrate as needed due to potential increased sensitivity.

Renal Impairment: Adjust dose in severe renal impairment; avoid in ESRD patients on dialysis.

Hepatic Impairment: Use with caution; dose adjustments recommended.

Pharmacokinetics

Absorption: Rapidly absorbed, with peak plasma concentrations in 1 hour.

Distribution: Bound approximately 70% to plasma proteins.

Metabolism: Primarily metabolized in the liver via CYP3A4 enzyme.

Excretion: Excreted mainly in feces (70%) and urine (30%).

Half Life: Approximately 6 hours.

Contraindications

Hypersensitivity to ivabradine or any component of the formulation.
On concomitant strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin).

Precautions

Use with caution in patients with severe hepatic impairment, sinoatrial block, sick sinus syndrome without pacemaker, or hypotension.

Adverse Reactions - Common

Bradycardia (Common)
Atrial fibrillation (Common)
luminous phenomena (phosphenes) (Common)
Hypertension or hypotension (Uncommon)

Adverse Reactions - Serious

Heart block, worsening heart failure, angina (Rare)
Severe bradycardia requiring intervention (Rare)

Drug-Drug Interactions

Strong CYP3A4 inhibitors (e.g., ketoconazole, erythromycin): Increase ivabradine levels, risk of bradycardia.
Strong CYP3A4 inducers (e.g., rifampin): Decrease ivabradine levels.
Other drugs affecting heart rate or conduction.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor heart rate prior to and during therapy; baseline and periodic blood pressure evaluation.

Diagnoses:

Risk for decreased cardiac output related to bradycardia.
Risk for hypotension.

Implementation: Administer with food to improve absorption; avoid sudden discontinuation; educate patient about symptoms of bradycardia and hypotension.

Evaluation: Evaluate for reduction in angina symptoms and hospitalization frequency; monitor for adverse effects.

Patient/Family Teaching

Take medication exactly as prescribed.
Report symptoms of unusual dizziness, fatigue, or slow heartbeat.
Avoid grapefruit and grapefruit juice, which may increase drug levels.
Inform about luminous phenomena; usually transient.

Special Considerations

Black Box Warnings:

Potential for severe bradycardia, atrial fibrillation, or heart block. Patients should be monitored closely.
Use only with concomitant stable heart failure therapy and when benefits outweigh risks.

Genetic Factors: None specified.

Lab Test Interference: None.

Overdose Management

Signs/Symptoms: Severe bradycardia, atrial fibrillation, hypotension.

Treatment: Discontinue drug; provide supportive care; monitor cardiac rhythm; administer atropine or temporary pacemaker if necessary.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable for the duration of use.