New Heart Failure Drug – Ivabradine
Ivabradine (Corlanor® – Amgen) is indicated to reduce the risk of hospitalization in patients with stable, symptomatic chronic heart failure with left ventricular ejection fraction ≤ 35%, who are in sinus rhythm with a resting heart rate ≥ 70 beats per minute and who are either on maximum doses of beta-blockers (i.e. metoprolol , carvedilol), or have a contraindication to beta-blocker use.
Increased heart rate in patients with heart failure, leads to an increase in cardiac workload, an increase in myocardial oxygen demand, and a decrease in myocardial perfusion which can lead to exacerbations and working heart failure over time. The drug has a unique mechanism of action that results in the lowering of the heart rate without reducing cardiac contractility. In fact, ivabradine exhibits this effect more in patients with higher heart rates. This leads to increased cardiac output and improved symptoms of heart failure including dyspnea, fatigue, and fluid retention including exercise tolerance, pulmonary congestion and peripheral edema.
Ivabradine is contraindicated in patients with acute decompensated heart failure, blood pressure < 90/50 mmHg, and resting heart rate < 60 beats per minute prior to treatment. Dose-dependent adverse drug reactions include bradycardia, hypertension, atrial fibrillation, and phosphenes (deficient retinal response to changes in light creating visual changes including halos, colored bright lights, and multiple images).
The recommended starting dose is 5mg twice daily with meals. Increase dose by 2.5mg bid to maximum dose of 7.5mg bid if HR is greater than 60 bbm. Decrease dose by 25mg bid for HR <50. If HR remains <50bbm on 2,5mg bid, discontinue the drug. Projected cost is $450 for 30 days of treatment.
This article was originally published in our monthly issue of From the Front Lines – a monthly publication that shares best practices and medication-related challenges faced by “front line” staff in long-term care and post-acute (LTCPAC) facilities.