My Institutional Rotation At Mount Sinai St. Lukes Essay

My Institutional Rotation At Mount Sinai St. Lukes Essay

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During my institutional rotation at Mount Sinai St. Lukes, I was asked a drug information question on what is Corlanor (ivabradine) and whether heart failure patents would benefit from using this drug.
Corlanor use is indicated to reduce the risk of hospitalization for worsening heart failure in patients with stable, symptomatic chronic heart failure with left ventricular ejection fraction ≤ 35%, who are in sinus rhythm with resting heart rate ≥ 70 beats per minute and either are on maximally tolerated doses of betablockers or have a contraindication to beta-blocker use.
The recommended starting dose of Corlanor is 5 mg twice daily with meals. Assess patients after two weeks and adjust dose to achieve a resting heart rate between 50 and 60 beats per minute. Thereafter, adjust dose as needed based on resting heart rate and tolerability. The maximum dose is 7.5 mg twice daily. In patients with a history of conduction defects, or other patients in whom bradycardia could lead to hemodynamic compromise, initiate therapy at 2.5 mg twice daily before increasing the dose based on heart rate.
Heart Rate Dose Adjustment > 60 bpm Increase dose by 2.5 mg (given twice daily) up to a maximum dose of 7.5 mg twice daily. 50-60-bpm should maintain the dose. < 50 bpm or signs and symptoms of bradycardia Decrease dose by 2.5 mg (given twice daily); if current dose is 2.5 mg twice daily, discontinue therapy. No dose adjustment is required in patients with mild or moderate hepatic impairment. Corlanor is contraindicated in patients with severe hepatic impairment (Child-Pugh C) as it has not been studied in this population and an increase in systemic exposure is anticipated. No dosage adjustment is required for patients with creatinine clearance 15 t...


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...e any specific dosing targets for patients who were taking beta-blockers. Patients were randomized 1:1 to Corlanor or placebo at an initial dose of 5 mg twice daily with the dose increased to 7.5 mg twice daily depending on resting heart rate and tolerability. The primary endpoint was the composite of time to first cardiovascular death, hospitalization for AMI, or hospitalization for new-onset or worsening heart failure. Most patients were NYHA class II (61.4%) or class III (23.2%) - none were class IV. Through a median follow-up of 19 months, Corlanor did not significantly affect the primary composite endpoint.
In conclusion, The SHIFT and BEAUTIFUL trial showed that Corlanor has no benefit in morbidity or mortality in heart failure patients. However, it does have a significant role in the reduction of hospitalizations and re-hospitalizations, due to heart failure.

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