Classes
DEA Class; Rx
Common Brand Names; Tikosyn
- Antidysrhythmics, III
Description
Class III antiarrhythmic; converts and maintains NSR in AFIB/Flutter; reserved for highly symptomatic patients; proarrhythmic (torsade de pointes); selectively blocks potassium channels; prolongs QT, APD, and ERP; does not affect ventricular conduction time; has negative chronotropy; lacks negative inotropy; renally eliminated; numerous drug interactions.
Indications
Indicated for use in the conversion of atrial fibrillation/atrial flutter to normal sinus rhythm; or, for maintenance therapy of patients with highly symptomatic atrial fibrillation/atrial flutter of 1 week or more duration.
Contraindications
Hypersensitivity
Congenital or acquired long QT syndromes; do not use with baseline QTc >440 msec (500 msec with ventricular conduction abnormalities)
Concomitant use of cation transport system inhibitors (eg, verapamil, cimetidine, trimethoprim, ketoconazole, prochlorperazine, dolutegravir and megestrol); each of these drugs cause a substantial increase in dofetilide plasma concentrations
Severe renal impairment: CrCl <20 mL/min
Adverse Effects
- Headache (11%)
- Chest pain (10%)
- Dizziness (8%)
- Insomnia (4%)
- Respiratory tract infection (7%)
- Dyspnea (6%)
- Rash (3%)
- Flu-like syndrome (4%)
- Back pain (3%)
- Ventricular tachycardia (3-4%)
- Torsade de pointes (3% in HF patients and 0.9% in patients with recent MI)
- Nausea (5%)
- Diarrhea (3%)
- AV block, QTc interval prolongation, torsades de pointes, ventricular arrhythmias
- Difficulty sleeping
- Liver damage
- Cough
- Paresthesia
- Angioedema
Warnings
Atrioventricular block, bradycardia, electrolyte imbalance, patients taking potassium-depleting diuretics, moderate QT interval prolongation prior to treatment, proarrhythmic events, liver disease, renal impairment
Coadministration of drugs that prolong QT interval and other antiarrhythmic agents: phenothiazines, cisapride, bepridil, TCAs, oral macrolides, class I or class III antiarrhythmics & amiodarone
Grapefruit juice may increase levels; avoid concurrent use
Magnesium and potassium serum levels should be maintained within normal range to avoid QTc prolongation
Pregnancy and Lactation
Pregnancy Category: C
Lactation: excretion in milk unknown/not recommended
Maximum Dosage
1000 mcg/day PO.
1000 mcg/day PO.
Safety and efficacy have not been established.
Safety and efficacy have not been established.
How supplied
Dofetilide
capsule
- 125mcg
- 250mcg
- 500mcg
