Corlanor (ivabradine) is a prescription medication used to lower heart rate in people with chronic heart failure. It is FDA-approved for adults with heart failure whose hearts pump too weakly and beat too fast, and for children six months and older with heart failure caused by an enlarged, weakened heart muscle. It works differently from other heart rate medications because it slows the heart without reducing the force of each beat.
How Corlanor Works
Your heart’s natural pacemaker, a cluster of cells in the upper right chamber, generates electrical signals that set your heart rate. These cells rely on a specific electrical current to fire at a steady rhythm. Corlanor blocks that current in a targeted way, slowing the rate at which pacemaker cells fire. The result is a lower resting heart rate.
What makes Corlanor unusual is its selectivity. It only affects the electrical current responsible for heart rate, leaving other cardiac electrical activity untouched. That means it doesn’t weaken the heart’s pumping strength or change blood pressure the way many other heart rate medications do. For someone with heart failure, where the heart is already struggling to pump enough blood, preserving that pumping power matters.
Approved Uses in Adults
In adults, Corlanor is approved to reduce the risk of hospitalization for worsening heart failure. The criteria are specific: you need to have stable, symptomatic chronic heart failure with a left ventricular ejection fraction of 35% or lower (meaning your heart pumps out roughly a third or less of the blood in its main chamber with each beat), be in a normal heart rhythm (sinus rhythm), and have a resting heart rate of 70 beats per minute or higher. You also need to either be taking the highest dose of beta-blockers you can tolerate or have a reason you can’t take beta-blockers at all.
The American Heart Association and American College of Cardiology give Corlanor a Class 2a recommendation for this use, meaning it’s considered reasonable and likely beneficial for reducing heart failure hospitalizations in patients who meet these criteria.
Approved Use in Children
Corlanor is also approved for children aged six months through 17 years who have stable, symptomatic heart failure caused by dilated cardiomyopathy, a condition where the heart muscle stretches and thins, making it harder to pump blood effectively. As with adults, the child must be in sinus rhythm with an elevated heart rate. This makes Corlanor one of the few heart failure medications with a specific pediatric indication.
Off-Label Uses
Because Corlanor specifically targets heart rate without affecting blood pressure or heart muscle strength, doctors sometimes prescribe it off-label for conditions involving an inappropriately fast heart rate. Two of the most common are inappropriate sinus tachycardia (IST), where the heart beats too fast for no clear reason, and postural orthostatic tachycardia syndrome (POTS), where heart rate spikes dramatically upon standing.
Research published in the Journal of the American Heart Association has shown that ivabradine improves both heart rate and symptoms in IST patients and may also help people with POTS. For both conditions, treatment guidelines suggest trying beta-blockers first and considering ivabradine when beta-blockers alone aren’t enough or aren’t tolerated.
How You Take It
The standard starting dose for adults is 5 mg taken twice daily with meals. For people with a history of heart rhythm problems or those at higher risk for a dangerously slow heart rate, the starting dose is lower at 2.5 mg twice daily.
After two weeks, your doctor will check your resting heart rate and adjust the dose to keep it between 50 and 60 beats per minute. If your heart rate is still above 60, the dose goes up by 2.5 mg (twice daily) to a maximum of 7.5 mg twice daily. If it drops below 50 or you develop symptoms of a slow heart rate like dizziness or fatigue, the dose comes down. If you’re already on the lowest dose and your heart rate is still too slow, the medication is stopped.
Common Side Effects
The most notable side effect of Corlanor is bradycardia, or an excessively slow heart rate. In a large clinical trial called SHIFT, 10% of people taking ivabradine experienced bradycardia compared to 2.2% on placebo. Most cases are mild, but this is the main reason for the dose-titration approach and regular heart rate monitoring.
The other distinctive side effect is visual disturbances called phosphenes. These are brief flashes of enhanced brightness, halos, colored lights, or image decomposition in a limited area of your visual field. They’re triggered by sudden changes in light, like walking from a dark room into bright sunlight. About 2.8% of patients in the SHIFT trial experienced them, compared to 0.5% on placebo. Phosphenes typically appear within the first two months of treatment, are mild to moderate, and usually resolve on their own even if you keep taking the medication. They happen because Corlanor also affects a similar electrical current in the retina that helps your eyes adjust to changes in brightness.
Who Should Not Take Corlanor
Corlanor is not appropriate for everyone with a fast heart rate or heart failure. It is contraindicated in several situations:
- Unstable or decompensated heart failure, where symptoms are actively worsening
- Low blood pressure below 90/50 mmHg
- Resting heart rate below 60 bpm before starting treatment
- Certain heart rhythm disorders, including sick sinus syndrome, specific types of heart block, or pacemaker dependence
- Severe liver impairment
- Pregnancy
- Use of strong CYP3A4 inhibitors, a class of drugs that includes certain antifungals and antibiotics, because they cause ivabradine levels in the blood to rise to dangerous concentrations
If you have a functioning pacemaker controlling your heart rate, certain conduction problems may no longer be a barrier, but this requires careful evaluation.
How Corlanor Differs From Beta-Blockers
Beta-blockers are the most widely used medications for slowing heart rate, and they remain first-line therapy for heart failure. But they work by blocking adrenaline’s effects throughout the body, which lowers heart rate, reduces the force of heart contractions, and drops blood pressure. For people who can’t tolerate those broader effects, whether because of fatigue, low blood pressure, asthma, or other reasons, Corlanor offers a more targeted alternative.
Corlanor doesn’t replace beta-blockers. In most cases, it’s added on top of the highest tolerable beta-blocker dose when heart rate remains elevated. For the subset of patients who truly can’t take beta-blockers, it serves as a standalone option for heart rate control. The key distinction is that Corlanor lowers heart rate and only heart rate, giving doctors a precision tool when broader medications cause too many unwanted effects.