2025 Guidelines for the Evaluation and Management of Adults With Congenital Heart Disease
December 19, 2025
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Brand Name :
Corlanor
Synonyms :
ivabradine
Class :
I(f) Current Inhibitors
Brand Name :
Corlanor
Synonyms :
ivabradine
Class :
I(f) Current Inhibitors
Dosage Forms & Strengths
Tablet
5mg
7.5mg
Oral solution
5mg/5ml
Congestive Heart Failure (CHF)
Initially, 5 mg orally each day with meals
2 weeks later, assess the patients and arrange the dose to get a resting heart rate- of 50-60 bpm
After the dose adjustment as required based on tolerance and rest heart rate, do not exceed the dose of more than 7.5 mg twice daily
Congestive Heart Failure (CHF)
Initially, 5 mg orally each day with meals
2 weeks later, assess the patients and arrange the dose to get a resting heart rate- of 50-60 bpm
After the dose adjustment as required based on tolerance and rest heart rate, do not exceed the dose of more than 7.5 mg twice daily
Dose Adjustment
In case of heart rate is more than 60 bpm- Increase the dose by 2.5 mg twice daily to a maximum of 7.5
When the heart rate is 50-60 bpm, maintain the dose
When the heart rate is less than 50 bpm, decrease the dose by 2.5 mg
If the current dose is 2.5 mg twice daily, discontinue the therapy
Congestive Heart Failure (CHF)
Initially, 5 mg orally each day with meals
2 weeks later, assess the patients and arrange the dose to get a resting heart rate- of 50-60 bpm
After the dose adjustment as required based on tolerance and rest heart rate, do not exceed the dose of more than 7.5 mg twice daily
Dose Adjustment
In case of heart rate is more than 60 bpm- Increase the dose by 2.5 mg twice daily to a maximum of 7.5
When the heart rate is 50-60 bpm, maintain the dose
When the heart rate is less than 50 bpm, decrease the dose by 2.5 mg
If the current dose is 2.5 mg twice daily, discontinue the therapy
Dosage Forms & Strengths
Tablet
5mg
7.5mg
Oral solution
5mg/5ml
Congestive Heart Failure (CHF)
For more than 6 months
<40 kg- Initially 0.05 mg/kg orally as a solution twice daily
Assess the patients every fortnight and adjust the dose by 0.05 mg/kg to target the reduction in heart rate of at least one-fifth based on tolerance
Maximum dose for 6 months-1 year- Do not exceed more than 0.2mg /kg twice daily
Maximum dose for more than 1 year- 0.3 mg/kg twice daily
Do not exceed more than 7.5 mg twice daily
≥40 kg- Initially 2.5 mg orally as a tablet twice daily
Assess the patients every fortnight and adjust the dose by 2.5 mg to target the reduction in heart rate of at least one-fifth based on tolerance
Do not exceed the dose of more than 7.5 mg twice daily
Congestive Heart Failure (CHF)
For more than 6 months
<40 kg- Initially 0.05 mg/kg orally as a solution twice daily
Assess the patients every fortnight and adjust the dose by 0.05 mg/kg to target the reduction in heart rate of at least one-fifth based on tolerance
The maximum dose for 6 months-1 year
Do not exceed more than 0.2mg /kg twice daily
Maximum dose for more than 1 year- 0.3 mg/kg twice daily
Do not exceed more than 7.5 mg twice daily
≥40 kg- Initially 2.5 mg orally as a tablet twice daily
Assess the patients every fortnight and adjust the dose by 2.5 mg to target the reduction in heart rate of at least one-fifth based on tolerance
Do not exceed the dose of more than 7.5 mg twice daily
Refer to the adult dosing
when both drugs are combined, there may be an increased effect of ivabradine by affecting hepatic or intestinal enzyme cyp3a4 metabolism
ivabradine: they may diminish the serum concentration of CYP3A4 Inducers
ivabradine: they may diminish the serum concentration of CYP3A4 Inducers
ivabradine: they may diminish the serum concentration of CYP3A4 Inducers
ivabradine: they may diminish the serum concentration of CYP3A4 Inducers
ivabradine: they may diminish the serum concentration of CYP3A4 Inducers
may enhance the concentration of serum when combined with ivabradine
may enhance the concentration of serum when combined with ivabradine
may enhance the concentration of serum when combined with ivabradine
may enhance the concentration of serum when combined with ivabradine
may enhance the concentration of serum when combined with ivabradine
ivabradine: they may enhance the serum concentration of CYP3A Inhibitors
ivabradine: they may enhance the serum concentration of CYP3A Inhibitors
ivabradine: they may enhance the serum concentration of CYP3A Inhibitors
ivabradine: they may enhance the serum concentration of CYP3A Inhibitors
ivabradine: they may enhance the serum concentration of CYP3A Inhibitors
nafcillin will decrease the effect of action of ivabradine by affecting enzyme CYP3A4 metabolism.
ivabradine increases the effect of lapatinib by altering the intestinal or hepatic CYP3A4 enzyme metabolism
CYP3A strong enhancers of the small intestine may reduce the bioavailability of ivabradine
it increases the concentration of ivabradine in serum
may enhance the serum concentration of CYP3A4 Inhibitors
bradycardia-causing agents increase the efficacy of ivabradine
bradycardia-causing agents increase the efficacy of ivabradine
bradycardia-causing agents increase the efficacy of ivabradine
bradycardia-causing agents increase the efficacy of ivabradine
bradycardia-causing agents increase the efficacy of ivabradine
may have an increased bradycardic effect when combined with ivabradine
may have an increased bradycardic effect when combined with ivabradine
may have an increased bradycardic effect when combined with ivabradine
may have an increased bradycardic effect when combined with ivabradine
may have an increased bradycardic effect when combined with ivabradine
ivabradine: they may increase the arrhythmogenic effect when combined with thiazides
ivabradine: they may increase the arrhythmogenic effect when combined with thiazides
ivabradine: they may increase the arrhythmogenic effect when combined with thiazides
ivabradine: they may increase the arrhythmogenic effect when combined with thiazides
It may enhance the risk of adverse reactions when combined with Coronary Vasodilators
It may enhance the risk of adverse reactions when combined with Coronary Vasodilators
It may enhance the risk of adverse reactions when combined with Coronary Vasodilators
It may enhance the risk of adverse effects when combined with coronary vasodilators
It may enhance the risk of adverse effects when combined with coronary vasodilators
It may enhance the risk of adverse effects when combined with coronary vasodilators
It may enhance the risk of adverse effects when combined with coronary vasodilators
when both drugs are combined may enhance the bradycardia effect and raise blood pressure
when both drugs are combined may enhance the bradycardia effect and raise blood pressure
may increase the vasodilatory effect
may increase the vasodilatory effect
may increase the vasodilatory effect
may increase the vasodilatory effect
may increase the vasodilatory effect
Actions and Spectrum:
ivabradine is a medication used to treat certain heart conditions, specifically angina and heart failure.
Contraindication/Caution:
Contraindications:
Precautions:
Pregnancy consideration:
The drug is not indicated for treatment during pregnancy.
Breastfeeding warnings:
Information about the excretion of drugs in the breastmilk is unknown
Pregnancy category:
Pharmacology:
Its pharmacology involves selective inhibition of the If current in the sinoatrial node of the heart, which reduces heart rate without affecting blood pressure or contractility.
Pharmacodynamics:
Pharmacokinetics:
Absorption
The bioavailability is 40%
Peak plasma concentration is achieved in1 an hour (for fasting)
Food delays the absorption by 1 hour and increases the plasma exposure by 20-40%
Distribution
Protein-bound is 70%
The volume of distribution is 100L
Metabolism
The drug is extensively metabolized in the liver and the intestines by CYP3A4-mediated oxidation
Primary metabolites formed are N-desmethylated derivative (S 18982),
CYP3A4 also metabolizes the N-desmethylated derivative.
Elimination and Excretion
The distribution half-life is 2 hours
Effective half-life is 6 hours
The rate of total clearance is 24 L/hr
The rate of renal clearance is 4.2 L/hr
4% of the drug is excreted unchanged in the urine; The metabolites get excreted through feces and urine
Administration:
ivabradine is administered orally as tablets and should be taken with food.
ivabradine should be taken with food to ensure adequate absorption. Take the tablets simultaneously each day, typically in the morning and evening.
ivabradine should not be taken with potent CYP3A4 inhibitors, as they can increase plasma concentrations and risk-averse effects. Patients taking moderate CYP3A4 inhibitors or CYP3A4 inducers should have their ivabradine dose adjusted.
Patient information leaflet
Generic Name: ivabradine
Pronounced: eye-VAB-ra-deen
Why do we use ivabradine?
ivabradine is used primarily to reduce heart rate in patients with certain cardiovascular conditions, such as chronic stable angina and heart failure and sinus tachycardia.
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