Coralan (Ivabradine)
Generic Coralan (Ivabradine) is a heart rate-lowering medicine used to treat chronic stable angina and heart failure. It works by selectively inhibiting the I_f current in the sinoatrial node, reducing heart rate without affecting blood pressure or myocardial contractility.

Generic Coralan (Ivabradine Hydrochloride)

Ivabradine Hydrochloride
Brand Name Equivalent: Coralan (original by Servier)
Therapeutic Class: Heart rate-lowering agent
Common Terms: Ivabradine tablets, Generic Coralan, Heart failure heart rate control
Pharmacological Class: Selective sinus node I_f channel inhibitor
Therapeutic Class: Cardiovascular agent
Regulatory Class (AU): Schedule 4 (S4) – Prescription Only Medicine
Ivabradine selectively inhibits the I_f (funny) current in the sinoatrial (SA) node—the heart’s natural pacemaker. This results in heart rate reduction without affecting contractility, intracardiac conduction, or ventricular repolarization. It improves oxygen balance and reduces myocardial workload, making it effective in chronic angina and heart failure.

Chronic Stable Angina in patients with normal sinus rhythm who cannot tolerate or are inadequately controlled on beta-blockers

Chronic Heart Failure with reduced ejection fraction (HFrEF) in combination with standard therapy (ACE inhibitors, beta-blockers, diuretics)

Adults: 5 mg orally twice daily with meals
Adjusted to 7.5 mg twice daily if heart rate >60 bpm; reduced to 2.5 mg twice daily if <50 bpm
Monitoring:
Resting heart rate, ECG, blood pressure
Elderly: Start at 2.5 mg twice daily
Hepatic impairment: Use with caution
Renal impairment: No adjustment required for mild to moderate cases
Form: Oral tablets
Strengths Available: 2.5 mg, 5 mg, 7.5 mg
Packaging: Blister pack of 14 or 28 tablets

Storage: Store below 25°C, keep in original packaging

Resting heart rate <60 bpm

Acute decompensated heart failure
Sinoatrial block, sick sinus syndrome
Pacemaker dependence
Severe hypotension (BP <90/50 mmHg)
Severe hepatic impairment
Pregnancy and breastfeeding
Hypersensitivity to ivabradine or excipients
Use with caution in atrial fibrillation risk
Monitor for bradycardia

Avoid in patients with congenital QT syndrome

Not recommended in combination with strong CYP3A4 inhibitors (e.g., ketoconazole, diltiazem)
Bradycardia
Luminous phenomena (phosphenes)
Headache
Dizziness
Visual disturbances
Less Common:
Atrial fibrillation
Hypertension
Gastrointestinal discomfort
Severe bradycardia
QT prolongation

AV block

Allergic reactions
Regular heart rate monitoring is essential

Discontinue if atrial fibrillation occurs

Avoid grapefruit juice (CYP3A4 inhibitor)

Not a replacement for beta-blockers unless contraindicated or not tolerated

Avoid in pregnancy (Category D – embryotoxic in animal studies)

Contraindicated with:
Potent CYP3A4 inhibitors: Clarithromycin, ketoconazole, itraconazole

Diltiazem, verapamil (risk of bradycardia)
Antiarrhythmics (increased QT risk)
Grapefruit juice (CYP3A4 inhibition)
SHIFT Trial (The Lancet, 2010): Ivabradine reduced the composite endpoint of cardiovascular death or heart failure hospitalization in patients with symptomatic HFrEF.

BEAUTIFUL Study: Demonstrated efficacy in stable coronary artery disease with left ventricular dysfunction.

Meta-analyses confirm reduction in hospitalization and mortality when added to standard heart failure therapy in select patients.

Frequently Asked Questions (FAQs)
Q: How quickly does Generic Coralan work?
A: Ivabradine begins lowering heart rate within 2 hours of administration, with steady effects in 3–4 days.

Q: Can I take Ivabradine with food?
A: Yes, it should be taken with meals for optimal absorption and tolerance.

Q: Can Ivabradine replace beta-blockers?
A: No. It's used when beta-blockers are contraindicated or not tolerated. It's often added to existing therapy.

Q: Does Ivabradine cause fatigue like beta-blockers?
A: It is less likely to cause fatigue or hypotension as it doesn’t affect contractility.

Q: Can I use this in pregnancy?
A: No. Ivabradine is contraindicated in pregnancy due to embryotoxicity risk.

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