Drugs used not listed here:

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

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 6mg in 2ml

Dose

• See current BNF

Notes

1. Patients with a heart transplant are very sensitive to effects of adenosine, see BNF for details.

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 (£1.67 = 200mg daily)
• Sterile concentrate for infusion 50mg/ml

Indications

• Arrhythmias

Notes

1. 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.
2. Thyroid function and liver function tests should be checked prior to therapy and then every six months.
3. A chest x-ray should be taken if one taken within the last 12 months is not available.
4. Measure serum potassium concentration before treatment.
5. Please refer to the current BNF and SPC for full monitoring requirements and potential side effects and significant drug interactions, including digoxin and warfarin.
6. 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

• Oral: 300–800mg daily in divided doses
• M/R: 250-375mg every 12 hours

Flecainide acetate

• Tablets 50mg, 100mg (£3.43 = 100mg twice daily)

Indications

• 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 hydrochloride

• 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

Ventricular arrhythmias

Lidocaine hydrochloride

• Intravenous injection 1%, 2%

Dose

• See current BNF