For acute therapy of focal atrial tachycardia,
ibutilide may be considered.
* IV procainamide or
ibutilide are the agents of choice for AF with pre-excitation.
Intravenous vernakalant, which is recently included in the guidelines for rhythm control, is recommended as an alternative to
ibutilide in patients who have congenital heart disease and newly diagnosed AF.
Other antiarrhythmic drugs such as propafenone, flecainide, or
ibutilide can rarely be used in ICU patients with AF, because they are contraindicated in patients with structural heart disease due to a high risk of proarrhythmic side effects [8, 9].
Table 1--Causes of Long QT Syndrome Congenital Acquired Inherited Metabolic chairnelopathies Roman o-Ward Hypocalcernia, Syndrome hypokalemia, hypomagnesemia Jervell and Lange-Nielsen Syndrome Idiopathic Anti-Arrytbmics Amiodarone, Diospyramide, Dofetilide,
ibutilide, Quinidine, Procainamide, Sotalol Antibistarnines Asteinizole, Terfenidine Anti-Infectives Clan thromycin, Erythrornycin, Pentamidine, Sparfi oxcin Anti-Malarial Chioroquine, Halofantrinc Psychotropics Chiorprornazine, Flaloperidol, Thioridazone, SSRIs Heart Disease Left ventricular hvpertrop hy, heart failure, invocardial isehemia Common presentations of LQTS include palpitations, presyncope, syncope, or cardiac arrest.
Ibutilide fumarate injection, 0.1 mg/ Bioniche Pharma USA
Common Herb-Drug Interactions Herb Drug or drug class Interaction Echinacea Amiodarone or
ibutilide Increases QT interval Statins, fibrates, niacin Increases risk of hepatotoxic effects Garlic Aspirin, clopidogrel, Increases bleeding risk warfarin, or heparinoid drugs Ginkgo Antidiabetes drugs Increases hypoglycemia biloba Aspirin Increases bleeding Warfarin Inhibits PAF hemorrhage Ginseng Antidiabetes drugs Increases hypoglycemia Digoxin Interferes with digoxin assay, leading to falsely increased levels Warfarin Decreases effectiveness of warfarin St.
Three ionic mechanisms could lead to increased repolarization: (1) activation of delayed Na current can occur early in repolarization and has been implicated in
ibutilide QT prolongation [3]; (2) increase in inward [Ca.sup.2+] current; (3) most drug-induced QT prolongation is due to a reduction in or blockade of the rapid delayed rectifier current ([I.sub.Kr]) resulting in prolonged cardiac repolarization [4].
The newer antiarrhythmics like dofetilide and
ibutilide are more potent as well as highly selective for [K.sub.v] channels (Table IV).
Drugs that triggered Torsades de Pointes Antibiotic agents Anti-arrhythmics Psychotropic agents Erythromycin (n=4) Sotalol (n=3) Amitryptiline (n=1) Roxithromycin (n=2)
Ibutilide (n=1) Haloperidol (n=1) Gatifloxacin (n=2) Quinidine (n=1) Fluoxetine (n=1) Clarithromycin (n=1) Amiodarone (n=1) Risperidone (n=1) Levofloxacin (n=1) Antibiotic agents Anti-histamines Erythromycin (n=4) Astemisol (n=2) Roxithromycin (n=2) Terfanidine (n=1) Gatifloxacin (n=2) Clarithromycin (n=1) Levofloxacin (n=1)
With a few hundred patients treated so far, conversion of atrial fibrillation using RSD1235 has not led to any cases of torsades de pointes, which makes the drug more attractive than
ibutilide, the only drug with Food and Drug Administration approval for conversion of atrial fibrillation, said Dr.