Dronedarone

From Ganfyd

Contents 1 Introduction 2 Clinical Use 2.1 Indications 2.2 Administration 3 Clinical Issues 3.1 Contra-indications 3.2 Cautions and Interactions 3.3 Side effects 3.4 Special advice 4 Pharmacology 5 References

Introduction

A drug based on amiodarone without the iodine. It does work to prevent atrial fibrillation with some potential for hepatic and renal toxicity and is known to be poorly tolerated in heart failure^[1]. The mortality increase in severe heart failure seems to be from heart failure itself as no pro-arrhythmic has as yet been shown^[2]. In elderly patients in permanent atrial fibrillation at increased risk of vascular disease the increased incidence of heart failure, stroke, and death outweighed any anti-arrhythmic benefit of the drug.

Clinical Use

Indications

• Clinically stable adult patients with a history of, or current non-permanent atrial fibrillation to prevent recurrence, or to lower ventricular rate

Administration

Oral 400mg tab

Clinical Issues

Contra-indications

• Permanent atrial fibrillation in elderly with risk of vascular disease

Cautions and Interactions

• Heart failure

Side effects

• Diarrhoea
• Nausea
• Bradycardia
• QT interval prolongation
• Rash
• Hepatitis - use has been related to hepatic failure

Special advice

Pharmacology

Little evidence of effect on QT interval. It belongs to all four Vaughan-Williams classes being a multi-channel blocker inhibiting the potassium currents (including IK (Ach), IKur, IKr, IKs) and thus prolonging cardiac action potential and refractory periods (Class III), an inhibitor of the sodium currents (Class Ib) and the calcium currents (Class IV) as well as being a non-competitive antagonist of adrenergic activity (Class II).

References