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Ivabradine
Ivabradine, also known under the brand names Corlanor or Procoralan, is a medication that slows down the heart rate. As a consequence, the relaxation phase of the heart lasts longer and the heart does not have to work as hard. [1] It is approved for treating chronic heart failure[2][3] while off-label use includes, e.g., POTS and inappropriate sinus tachycardia.
Theory
The heart rate is mainly controlled by the electric impulses from the sinus, or sinoatrial, node. This natural pacemaker is situated in the upper back wall of the right atrium and controlled by the so-called funny ion current, If.[4] Ivabradine acts by inhibiting the If channels and thereby, reduces the pacemaker's activity. This leads to a slowing of the heart rate and thus, extends the diastolic or relaxation phase of the heart, allowing more blood to flow into the heart. Additionally, a lower heart rate reduces the workload and stress on the heart and results in a lower need for oxygenated blood.[3]
Ivabradine is a specific agent, i.e., it acts on the sinus node only. In contrast to other cardiac medications like beta-blockers or calcium channel inhibitors, it does not affect the heart's contractility or the blood pressure[5], and provides a more substantial blocking of the If channels at higher heart rates.[6]
Evidence
A 2026 review and meta-analysis of nine studies investigating ivabradine for use in POTS, including post COVID19, found "a meaningful heart rate reduction and symptomatic improvement in POTS with a favorable safety profile. However, evidence is limited by small, heterogeneous, predominantly observational studies, underscoring the need for large, multicenter randomized controlled trials."[5]
Risks and safety
Ivabradine should not be used along with potent inhibitors of CYP3A4, since this may result in an increased or decreased availability of the drug in the blood and thus, an increased or decreased effect. Among others, these substances include azole antifungals (e.g., ketoconazole), macrolide antibiotics, nefazodone as well as the antiretroviral drugs nelfinavir and ritonavir.
Ivabradine is contraindicated in patients suffering from specific heart problems such as bradycardia, sick sinus syndrom, acute heart failure, unstable angina pectoris, myocardial infarction, or liver disease. It should not be used during pregnancy, breast-feeding, or in patients with a history of allergies against its ingredients.[7]
Reported side effects of ivabradine include, among others, blurred vision, low heart rate, low blood pressure, headache, sensation of spinning, and unusual nervousness or tiredness.[7] In a review study including 245 patients, adverse events were rare and mild, with the most commonly reported being short-term visual disturbances.[5]
Cost and availability
Ivabradine is available upon prescription only.
See also
Learn more
WebMD: https://www.webmd.com/drugs/ivabradine-corlanor#interactions
Wikipedia: https://en.wikipedia.org/wiki/Ivabradine
MayoClinic: https://www.mayoclinic.org/drugs-supplements/ivabradine-oral-route/description/drg-20138533
References
- ↑ "Ivabradine (Corlanor): Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD". www.webmd.com. Retrieved June 15, 2026.
- ↑ "FDA Medication Guide: Corlanor (Ivabradine Hydrochloride)". Retrieved June 15, 2026.
- ↑ 3.0 3.1 "Ivabradine Accord | European Medicines Agency (EMA)". www.ema.europa.eu. Retrieved June 15, 2026.
- ↑ "Sinoatrial node - Wikipedia". en.wikipedia.org. Retrieved June 15, 2026.
- ↑ 5.0 5.1 5.2 "Ivabradine in the Treatment of POTS Before and After COVID-19 Pandemic: A Systematic Review and Meta-Analysis". Journal of Cardiovascular Pharmacology. May 11, 2026.
- ↑ Khan, A.; Ling, J.; Parikh, V.K.; Bekheit, S (June 2, 2025). "Should Ivabradine be First-Line Therapy for Inappropriate Sinus Tachycardia?". Pacing Clin Electrophysiol. 48: 725–732. doi:10.1111/pace.15214.
- ↑ 7.0 7.1 MayoClinic. "Ivabradine (Oral Route)". www.mayoclinic.org. Retrieved June 15, 2026.
