Corlanor (U.S. brand name) or ivabradine (chemical name) is a new heart rate medication used for heart failure. It works by targeting a specific channel in your heart that determines your heart rate.
Why is Ivabradine Used Off-Label for People with Dysautonomia?
Because of its ability to lower heart rate without lowering blood pressure, like beta blockers or calcium channel blockers do, it has also been used for patients with IST or inappropriate sinus tachycardia. In other words, people who have a very fast heart rate, even at rest and when asleep.
IST is a form of dysautonomia, a group of syndromes that occur when the autonomic nervous system decides to go rogue on the body. Symptoms of dysautonomia usually include heart rate problems, digestion dysregulation, abnormal sweating, and blood pressure fluctuations.
Naturally, success with ivabradine for patients with IST has sparked interest in the POTS, or postural orthostatic tachycardia syndrome, community. POTS, unlike IST, is usually characterized by a high heart rate only when standing.
Since ivabradine is contraindicated for individuals with a resting heart rate lower than 70 BPM, it can be quite tricky to take if you have a resting heart rate of 60 BPM with POTS, for example, but you also have a standing heart rate of 120+ BPM.
Although ivabradine may not be possible for individuals with low resting heart rates, it can be a powerful medication for many individuals struggling with POTS. Because many people with POTS struggle with low blood pressure, having a medication that lowers your overall heart rate without affecting blood pressure is, for some people, a miracle drug.
How I Started Ivabradine for POTS
In April 2017 I was diagnosed with POTS after flying back from India with a strange illness no one could figure out. Many cardiologists in New Delhi thought it was just a bad case of SVT (a heart arrhythmia) and wanted to do a cardiac ablation. Other cardiologists thought I had both IST and SVT, which would explain the high heart rates.
Because my body pumped so full of adrenaline throughout this period, my resting heart rate was elevated, making IST seem… possible, but it still did not make complete sense since my heart rate would drop to 75-80 BPM when laying.
I had tried metoprolol and developed breathing problems and rashes on it, so it was soon discontinued. They then offered ivabradine, which I decided not to try because it was so hard to get in the U.S. (By the way, ivabradine costs PENNIES in India).
After flying back home I ended up in the ER with another bad SVT and tried diltiazem, which had absolutely no effect on my heart rate. We then tried propranolol, which I had another allergic reaction to and discontinued after the first dose.
I was then offered atenolol, to which I said, are you crazy? I’m pretty sure my body hates beta blockers at this point.
Finally, we came to the decision that I would treat my POTS without medication and through exercise, hydration, salt, and compression alone and I was discharged. Having a 100+ BPM difference sitting to standing was scary, but I made it work.
About a year later I had a major POTS flare and was going from 65 BPM laying to 180+ BPM standing in a matter of seconds. I had to crawl to the bathroom and I thought, what about ivabradine?
Ivabradine was never offered to me in the U.S. but I decided to investigate it as a possibility with my cardiologist. My resting heart rate when my body is not full of adrenaline is about 65-70 BPM, so I wasn’t sure if I would be a good candidate.
We agreed to try it a few months before my February flare, but my body typically hates all medications and I was too afraid to try. My mom had Stevens Johnsons Syndrome when I was younger, so naturally, trying a newly approved medication by the FDA is quite terrifying.
I had run out of almost every other heart rate lowering medication to try and I knew this was one of my last options. I tried ⅛ of a 5mg pill to start and from that dose alone, I saw relief.
My body is so sensitive to medication that the tiny slivers I tried brought my standing heart rate down from 180+ BPM to 130 BPM. I was amazed, but I was also terrified. What would have happened if I started on the 5mg twice a day dose?
My body is strange in that it also responds to ivabradine differently. It takes about 3-4 hours for ivabradine to start working for me, but it also works for about 12-18 hours. These effective half-lives are much shorter for most people on ivabradine.
My Experience with Ivabradine
I have now been on ivabradine for six months and it is amazing what this potent miracle drug can do for you.
I take 2.5mg a day and it usually keeps my standing heart rate under 105 BPM. If I flare up, I take up to 5mg a day. I have had zero side effects so far, which is probably due to the small dose that I am on. I can still feel like trash with a lower heart rate and ivabradine doesn’t prevent those symptoms.
Sometimes, it does lower my resting heart rate below 60 BPM, which for me, feels awful. Having low blood pressure without a higher heart rate to compensate because of medication is what I believe makes me feel symptomatic at lower rates. So I eat some jelly beans to raise the heart rate and down a bottle with TRIORAL to raise my blood pressure.
The biggest downfall of ivabradine is that it has absolutely no effect on adrenaline and heart rate increases due to anxiety and panic attacks. If I am anxious or I am having constant adrenaline dumps, I will still have a resting heart rate near 100 BPM. I can’t take more ivabradine for those moments, because as soon as the stressful moment is over, my heart rate will then fall too low from the excess medication.
Ivabradine doesn’t work like beta blockers do against adrenaline, so it is no surprise that adrenaline dumps still occur. However, it is interesting that the adrenaline seems to make the medication ineffective for me.
I can be sitting on my couch watching a movie and have my heart rate be 65 BPM then go out and sit in my car to drive and suddenly it is 95 BPM. There is no doubt that my adrenaline is very potent on my heart.
Many people complain about the floaters and visual disturbances they have on ivabradine. I have only experienced it once at the gym with the bright lights. However, I think that it is a dose-dependent side effect, so I am less likely to experience it because of my low dose.
The only major problem I have with ivabradine is the price. With insurance, it costs about $90 for 60 5mg pills. Because of my low dose, it ends up being affordable enough. However, if my insurance weren’t to cover it, I know it can cost some people up to $1000/month until they reach their deductible on insurance.
This ridiculous cost is why many people on ivabradine mail order it to the U.S. from Canada.
Ivabradine also interacts with MANY MANY drugs. If you have problems with QT prolongation, taking ivabradine may not be an option for you and if it is, you may have to avoid other QT-prolonging drugs. Most drugs you may take for POTS can have this effect.
I have a lot of anxiety about the QT prolongation effects, but ivabradine is really the only medication other than Xyzal (which does not have this effect), so I’m not too concerned about polypharmy negative effects.
All in all, I wish I tried ivabradine when it was offered to me in India!
My Final Take on Ivabradine
- Ivabradine can be a very potent and effective drug to lower heart rates in the absence of adrenaline or anxiety.
- Ivabradine can be obnoxiously expensive but can be mail ordered in from other countries for more reasonable costs.
- Ivabradine interacts with many drugs and cannot be taken, generally, with other QT-prolonging drugs (i.e. Zofran, Z-paks, Atarax, Calcium channel blockers, etc).
- Ivabradine generally cannot be taken with low resting heart rates, which can be problematic for some people with POTS.
- If your main complaint with POTS is the high heart rate, ivabradine can be an amazing drug.
- If you have major problems with low blood pressure, ivabradine could be a good option for you.
- If you use an Epi-Pen or have diabetes and beta blockers are not options for you, ivabradine could be a good alternative.
As with anything concerned medication or supplements, be sure to talk with your doctor about ivabradine before taking it. Ivabradine is generally prescribed by a cardiologist or an electrocardiologist and may require EKGs to monitor your heart before and after starting treatment. Some people start ivabradine under medical observation. Also be sure to call your insurance about coverage before discussing it with your doctor.
I am not a physician and cannot give you advice about dosage or ivabradine treatment, but this is an article to share my experience with ivabradine as a possible option to discuss with your provider.
It’s Dysautonomia Awareness month!
I haven’t tried thsi drug yet but I’ve heard it actually works by inhibiting the SA nodes (pacemaker cells) so can result in bradycardia.
Yes that is how corlanor works, but any heart rate lowering drug can result in bradycardia.
Hi, do you take it at night or morning? Thanks
Hello! I take it morning only and sometimes after lunch but everyone is different. The typical dose is twice a day
Thank you for the article. Has been a journey for me. This is kinda the last option for me. Hoping it helps. Heart rate is usually very high, pressure is normal a lot of the time, but can get pretty low, especially when standing. Did not “pass” tilt table test, so still a quandary. I have been on it for a week, 5MG a day, but have not seen results. Doctor said I will go to twice a day shortly. A little nervous.
Checking in, is it still working well for you? I am still trying to see what a low heart rate will feel like. Mine averages 110+ while resting, but usually much higher. I am hoping not to be winded for no apparent reason, more blackouts, and able to do things with my kids. Living like this for close to 20 years with no explanation.
Hello! Thanks for the read! It still works pretty well! But it is definitely not a fix-all for POTS
My daughter has been on ivabradine for 2 months. Although it helps lower her heart rate, she still has significant adrenaline rushes followed by severe fatigue, especially during the premenstrual phase and the closer she gets to menstruation. Anyone else have this? She a
So has POTS with low blood pressure and has been on midodrine for about 6 months. A lot of what you have gone through is all too familiar. But, we wondered if you’d ever thought about using midodrine to control the fluctuations in BP?
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Hello! The low BP is not what bothers me but rather the adrenaline rushes and hr. Ivabradine works differently than a beta blocker as beta blocks “block” the adrenaline essentially that makes your hr go wild with pots. Ivabradine does not do this and I find it has no effect on my hr when I’m anxious or having adrenaline surges. I also have a ton more issues a few days before my period and I’ve found that bioidentical progesterone has helped A LOT (I have estrogen dominance). Functional doctors are usually the best to tackle that problem or perhaps an OBGYN who is willing to do hormone panels (but as I’ve found, that’s rare).
You are not alone, I’m also very sensitive to drugs. My doctors and nurses are always stunned. I will cut down most pills before I try them. Otherwise I can be in bed for days. I find Zoloft has been helpful but only a tiny 2/6 pill (25mg). I first cut it in half then 2/3 of the half. It’s crazy if I don’t cut down the half my day is ruined.
Same with Metoprolol, I starting 1/4 of (50mg) which has been so great at lowering my HR. Now my heart rate is under 100, and I can have a more normal day, which is such a relief!
I wish you all the best!
Thanks Elisabeth! Glad something has helped you too 🙂
Im on Ivabradine and i just need help because its not working i dont think but my doctosrs wont listen and just tell me to take more which i have been for two weeks and i sitll dont think its working. I thought Ivabradine was supposed to keep you heart rate from going high, yes? OIff of it i have hr soikes at rest anywhere from 120-195. And then standing or sitting up, i also have spikes as high as 120-200. ON ivabradine I cam still having these spikes. I thought it was supposed to stop them. Standing and walking upstairs my hr is stilll going to 170s, or getting stuck in 150s at rest etc. I have uppped the dose to 5mg twice a day like they asked and its still not stoppping this high heart rates. Ppl i tlak to have said Ivabradine keeps their standing hr low for lik 11 hours. If i take it at 10am, it is sill soiking to these high heart rates at the medication’s peak, even thiough i will have low stand hr for a few hours or so, but also have high standing heart rates and/or spilkes standing or at rest dyring taht time. After 5 hours it seems to completely havestopped working so I take 2.5 mg more. Just now. i was stanidng and my hr just wouldnt stop going up, it was 170 and i made myself sit down, terrifed. I though this mdication capped the hr. I do not understand. Thyeve told me this is my lasthope as far as meds and nothing else has worked. SO i dont get it it. I must have something else. Ive been dianosed with post viral pots and IST but at this point it has to be an arryhtmia cuz the meds arent working. Ive had 4 holters, ecgs, and they calim its all mbeen sinus, and not svt but if it were snius this mefication would be wiorking. I dont know why it works for eveyrone but me and the doctors seem to just not believe me and tell me im jsut not taking enough. please help