2.3 Anti-arrhythmic drugs

Drugs used not listed here:

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
  • Injection 3mg/ml, 2ml vial
Ajmaline
  • Solution for injection 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 (£2.00 = 200mg daily)
  • Sterile concentrate for infusion50mg/ml
  • Solution for injection 30mg/ml

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.
Disopyramide
  • Capsules 100mg, 150mg (£27.58 = 150mg, 84 capsules)
  • Modified release tablets 250mg (£32.08)
  • Injection 10mg/ml, 5ml amp

Indications

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

Dose

  • Oral: 300–800mg daily in divided doses
  • M/R: 250-375mg every 12 hours
Flecainide
  • Tablets 50mg, 100mg (£6.75 = 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 (£8.68 = 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

Procainamide
  • Injection 100mg in 1ml

Notes

  1. For use within Plymouth Hospitals NHS Trust

Ventricular arrhythmias

Lidocaine
  • Infusion 1g in 5% glucose (500ml)
  • Prefilled syringe 100mg in 5ml

 

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