Ivabradine (CORLANOR®) is approved by the Food and Drug Administration (FDA) to treat heart failure—a condition where the heart is not able to pump adequate amounts of blood through the body. Ivabradine is a class of drug called hyperpolarization-activated cyclic nucleotide-gated (HCN) channel blockers, which slow down the heart rate.
While ivabradine is used as a treatment for POTS, it has not yet been approved for that use by the FDA—partly because enough controlled studies have not been done.
The medication is now being explored as a potential treatment for COVID-19 “long-haulers"—people who experience lasting symptoms after having the virus. One of the study’s authors, Pam Taub, MD, a cardiologist and associate professor of medicine at the University of California San Diego School of Medicine, tells Verywell she has prescribed it for patients diagnosed with POTS following a COVID-19 infection and that some of her colleagues prescribe it as well.
Ivabradine Showed Improvement
Taub and her colleagues recently published a study comparing ivabradine to a placebo in 22 patients with hyperadrenergic POTS, a different form of the syndrome.
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The patients were randomly assigned to receive either ivabradine or placebo for a month. Then, after a one-week period with no drug or placebo, they were switched to the other treatment for another month. Each patient’s heart rate and other health metrics were measured, and they were asked about their quality of life throughout the study.
The results showed that all of these measures improved while the patients were taking ivabradine. Additionally, the patients did not experience any significant side effects such as a too-slow heartbeat or low blood pressure.
“Before the study, these patients would be living with elevated heart rates ranging between 100 to 115 beats per minute when standing," Taub said in a press release. “After taking ivabradine twice a day for one month, the standing heart rate decreased significantly to around 77 beats per minute compared to the placebo group. Participants also reported improvement in quality-of-life measures when on the drug.”
What Is POTS?
Taub describes POTS as a disruption of the autonomic nervous system, which controls automatic body functions like heart rate and blood pressure.
When they stand up from a lying down or sitting position, a person with POTS experiences symptoms such as racing heart rate, chest pain, lightheadedness, dizziness, brain fog, feeling faint, or fainting.
The change in position can cause their heart rate to soar to 100 or 120 beats a minute. In turn, the elevated heart rate means that the perfusion of blood to the brain is not as good, which causes brain fog and fatigue.
Taub says that between 500,000 and 3 million people have POTS, and it’s mostly young women. However, Taub notes that the incidence is rising, adding that “the reason we are seeing more of it is because of COVID.”
POTS can be debilitating and negatively affect a person’s quality of life. “They feel very on edge, can’t perform activities, and they have a difficult time exercising,” Taub says.
What Causes POTS?
The cause of POTS is not completely understood, but the condition can be triggered by viral or bacterial infections or trauma. Taub says that before the pandemic, it was most frequently seen after a person had Lyme disease or mononucleosis.
“We think what is happening is that antibodies attack certain aspects of the autonomic nervous system,” Taub says. She adds that the same thing could be happening in COVID-19 patients because it’s “an infection that causes a really robust immune response.”
Future Treatment
Taub says that while having a medication with an amendable side effect profile is good, medication is not the only treatment for POTS. The condition is most often treated with a combination of medication and a graduated exercise program.
“Patients start by doing little things that they can do from a sitting or lying position,” Taub says, adding that when you can control the heart rate, “you basically allow patients to stand up and engage in other activities.”
Essentially, this allows the patient to work on retraining the autonomic control of heart rate. “Then over time, hopefully, they can get back to doing the things there were doing before the disease," Taub says.
As for medication, Taub says that a month’s supply of ivabradine costs $480. Some health insurance companies will not cover a drug being used off-label, but many will if they are shown research demonstrating its effectiveness. To that end, Taub says that she’s “had pretty good success in getting it approved.”
The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.
