Drugs used not listed here:

• Mexiletine, see section 4.9.3 Drugs used in essential tremor, chorea, tics and related disorders

NICE TA324 Dual chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome without atrioventricular block (November 2014)

See NICE TA314 Implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure (June 2014) (NHS England commissioned)

2.3.2 Drugs for arrhythmias

Supraventricular arrhythmias

Adenosine

• Solution for injection vial 6mg/2ml

Ajmaline

• Solution for injection ampoule 50mg/10ml (unlicensed preparation)

Dronedarone

• Tablets 400mg

Notes

1. NICE TA197: Dronedarone (Multaq) is recommended as an option for the maintenance of sinus rhythm after successful cardioversion in people with paroxysmal or persistent atrial fibrillation, only if the criteria specified in the NICE TA are met (August 2010)

Supraventricular and ventricular arrhythmias

Amiodarone

• Tablets 100mg, 200mg (£1.85 = 200mg daily)
• Sterile concentrate for infusion 50mg/1ml
• Solution for injection 30mg/1ml

Indications

• Arrhythmias

Dose

• Oral, 200mg 3 times daily for 1 week reduced to 200mg twice daily for a further week; maintenance, usually 200mg daily or the minimum required to control the arrhythmia

Notes

1. Amiodarone has a very long half-life (extending to several weeks).
2. Monitoring of patients taking amiodarone is required. Liver function and thyroid function (T3, T4 and TSH) should be monitored before treatment and then every 6 months during treatment.
3. Ophthalmological examination (by an optician) is recommended annually.
4. Please refer to the current BNF and SPC for full monitoring requirements and potential side effects and significant drug interactions, including digoxin and warfarin.
5. MHRA Drug Safety Update (March 2022): Amiodarone (Cordarone X): reminder of risks of treatment and need for patient monitoring and supervision:
   1. Review patients regularly during long-term treatment
   2. Monitor liver and thyroid function
   3. Updated advice on amiodarone lung imaging during treatment
   4. Advice to give to patients
   5. Patient alert card

Disopyramide

• Capsules 100mg (£14.14 = 84 capsules)
• Modified-release tablets 250mg (£32.08 = 60 tablets)
• Injection 10mg in 1ml, 5ml amp

Indications

• Ventricular and supraventricular arrhythmias, including after myocardial infarction
• Maintenance of sinus rhythm after cardioversion

Dose

• Capsules: 300–800mg daily in divided doses
• Modified-release tablets: 250-375mg every 12 hours

Flecainide acetate

• Tablets 50mg, 100mg (£3.36 = 100mg twice daily)

Indications

• Ventricular arrhythmias
• Supraventricular arrhythmias

Dose

• Ventricular arrhythmias, initially 100mg twice daily (maximum 400mg daily usually reserved for rapid control or in heavily built patients), reduced after 3–5 days to the lowest dose that controls arrhythmia
• Supraventricular arrhythmias, 50mg twice daily, increased if required to maximum 300mg daily

Propafenone

• Tablets 150mg, 300mg (£8.72 = 300mg twice daily)

Indications

• Ventricular arrhythmias
• Paroxysmal supraventricular tachyarrhythmias which include paroxysmal atrial flutter or fibrillation and paroxysmal re-entrant tachycardias involving the AV node or accessory pathway, where standard therapy ineffective or contra-indicated

Dose

• See current BNF

Procainamide

• Injection 100mg in 1ml

Notes

1. For use within Plymouth Hospitals NHS Trust

Ventricular arrhythmias

Lidocaine

• Infusion 1g in 5% glucose (500ml)
• Pre-filled syringe 100mg in 5ml