ivabradine
Brand: Corlanor
Prototype Drug
Drug Class: HCN channel blocker
Drug Family: antiarrhythmic
Subclass: funny current (If) inhibitor
Organ Systems: cardiovascular
Mechanism of Action
Selectively inhibits the If (funny) current in the SA node, reducing heart rate without affecting blood pressure, myocardial contractility, or AV conduction.
HCN channels (If funny current) in SA node
Indications
- HFrEF with HR ≥70 bpm in sinus rhythm (SHIFT trial)
- stable angina (Europe)
Contraindications
- sick sinus syndrome
- SA block
- severe hepatic impairment
- AF or flutter
- HR <60 bpm
- strong CYP3A4 inhibitors (relative contraindication)
Adverse Effects
Common
- bradycardia
- visual phosphenes (luminous phenomena)
- hypertension
- atrial fibrillation
Serious
- severe bradycardia
- AF
Pharmacokinetics (ADME)
| Absorption | ~40% bioavailability (first-pass) |
| Distribution | moderate |
| Metabolism | extensive hepatic CYP3A4 |
| Excretion | fecal |
| Half-life | 11 hours |
| Onset | 1 hour |
| Peak | 1.5 hours |
| Duration | 12 hours |
| Protein Binding | 70% |
| Vd | moderate |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| strong CYP3A4 inhibitors | markedly increases ivabradine — avoid or use with caution | major |
| verapamil/diltiazem | additive bradycardia | major |
Nursing Considerations
- Works ONLY in sinus rhythm — do not use in AF
- Check HR before each dose; hold if <50 bpm
- Visual phosphenes (brief luminous flashes) common but benign; usually occur in first 2 months
- SHIFT trial: reduces HF hospitalization when HR ≥70 bpm in sinus rhythm
Clinical Pearls
- SHIFT trial: 18% relative risk reduction in HF hospitalization at HR ≥70 bpm in sinus rhythm
- Pure HR reduction without BP or inotropy effect — unique mechanism
- Visual phosphenes in 14.5%: describe as brief window blindness/light flashes — benign, often resolve
Safety Profile
Pregnancy avoid
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.