Table 1.
Generic Name | Sacubitril/Valsartan | Ivabradine |
---|---|---|
Brand Name (US) | Entresto | Corlanor |
FDA-approved Indications | To reduce the risk of cardiovascular death or heart failure hospitalization. | To reduce the risk of hospitalization for worsening heart failure in patients with LVEF ≤ 35% and HR ≥ 70bpm (sinus) on maximally tolerated dose of beta-blockers |
Dosing |
Starting: 49/51mg BID or 24/26mg BID if any of the following: moderate hepatic impairment (Child-Pugh B), severe renal impairment (eGFR < 30), or currently on low-dose or no ACE inhibitor or ARB Goal: Double the dose every 2–4 weeks to target dose of 97/103mg BID |
Starting: 5mg BID or 2.5mg BID if either: conduction defects or concerns of potential hemodynamic compromise from bradycardia Goal: After 2 weeks, if HR > 60bpm, increase by 2.5mg BID to a maximum of 7.5mg BID, if HR 50–60bpm, maintain current dose, and if HR < 50bpm, reduce by 2.5mg BID |
Contraindications | Pregnancy, history of angioedema with ACE/ARB, concomitant use of ACE (must stop 36 hours before sacubitril/valsartan start), concomitant use of aliskiren in patients with diabetes | Decompensated heart failure, severe hepatic impairment, resting HR < 60bpm, pacemaker dependent (i.e. near 100% pacing burden), sick sinus syndrome, SA block, or 3rd degree AV block without a pacemaker, BP < 90/50 mmHg, pregnancy |
Adverse Effects | Hypotension, hyperkalemia, renal impairment, cough, | Bradycardia, hypertension, atrial fibrillation, and luminous phenomena (phosphenes) |