Drugs used not listed here:
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
- Patients with a heart transplant are very sensitive to effects of adenosine, see BNF for details.
- 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
- Tablets 100mg, 200mg (£2.00 = 200mg daily)
- Sterile concentrate for infusion 50mg/ml
- Amiodarone has been identified as a drug where particular care needs to be exercised on initiation of therapy. Prescribers who are unfamiliar with the prescribing of this drug are strongly advised to read the full SPC.
- Thyroid function and liver function tests should be checked prior to therapy and then every six months.
- A chest x-ray should be taken if one taken within the last 12 months is not available.
- Measure serum potassium concentration before treatment.
- Please refer to the current BNF and SPC for full monitoring requirements and potential side effects and significant drug interactions, including digoxin and warfarin.
- Capsules 100mg, 150mg (£27.58 = 150mg, 84 capsules)
- Modified release tablets 250mg (£32.08)
- Injection 10mg/ml, 5ml amp
- Oral: 300–800mg daily in divided doses
- M/R: 250-375mg every 12 hours
- Tablets 50mg, 100mg (£6.75 = 100mg twice daily)
- 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
- Tablets 150mg, 300mg (£8.768 = 300mg twice daily)
- 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
- Intravenous injection 1%, 2%
2. Cardiovascular >
2.3 Anti-arrhythmic drugs
- First line
- Second line