ibutilide


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ibutilide

 [ĭ-bu´tĭ-līd]
a cardiac depressant used in treatment of atrial arrhythmias; administered by intravenous infusion as the fumarate salt.

ibutilide

(eye-byoo-ti-lide) ,

Corvert

(trade name)

Classification

Therapeutic: antiarrhythmics
Pregnancy Category: C

Indications

Rapid conversion of recent-onset atrial flutter or fibrillation to normal sinus rhythm, including management of atrial flutter or fibrillation occurring within 1 wk of coronary artery bypass or cardiac valve surgery.

Action

Activates slow inward current of sodium in cardiac tissue, resulting in delayed repolarization, prolonged action potential duration, and increased refractoriness.
Mildly slows sinus rate and AV conduction.

Therapeutic effects

Conversion to normal sinus rhythm.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Unknown.
Metabolism and Excretion: Highly metabolized by the liver, one metabolite is active; metabolites excreted by kidneys.
Half-life: 6 hr (2–12 hr).

Time/action profile (antiarrhythmic effect)

ROUTEONSETPEAKDURATION
IVwithin 30–90 minunknownup to 24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.
Use Cautiously in: HF or left ventricular dysfunction (↑ risk of more serious arrhythmias during infusion); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <18 yr (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • headache

Cardiovascular

  • arrhythmias (most frequent)

Gastrointestinal

  • nausea

Interactions

Drug-Drug interaction

Amiodarone, disopyramide, procainamide, quinidine, and sotalol should not be given concurrently or within 4 hr because of additive effects on refractoriness.Proarrhythmic effects may be ↑ by phenothiazines, tricyclic and tetracyclicantidepressants, some antihistamines, and histamine H2-receptor blocking agents ; concurrent use should be avoided.

Route/Dosage

Atrial Fibrillation/Flutter
Intravenous (Adults ≥60 kg) 1 mg infusion; may be repeated 10 min after end of first infusion.
Intravenous (Adults <60 kg) 0.01 mg/kg infusion; may be repeated 10 min after end of first infusion.
Atrial Fibrillation/Flutter After Cardiac Surgery
Intravenous (Adults ≥60 kg) 0.5 mg infusion, may be repeated once.
Intravenous (Adults <60 kg) 0.005 mg/kg infusion, may be repeated once.

Availability (generic available)

Solution for injection: 0.1 mg/mL

Nursing implications

Nursing assessment

  • Monitor ECG continuously throughout and for 4 hr after infusion or until QT interval normalizes. Discontinue if arrhythmia terminates or if sustained ventricular tachycardia, prolonged QT, or QT develops. Ibutilide may have proarrhythmic effects. These arrhythmias may be serious and potentially life threatening. Clinicians trained to treat ventricular arrhythmias, medications, and equipment (defibrillator/cardioverter) should be available during therapy and monitoring of patient.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)

Implementation

  • Oral antiarrhythmic therapy may be instituted 4 hr after ibutilide infusion.
  • Intravenous Administration
  • pH: 4.6.
  • Intermittent Infusion: Diluent: May be administered undiluted or diluted in 50 mL of 0.9% NaCl or D5W. Diluted solution is stable for 24 hr at room temperature or 48 hr if refrigerated.Concentration: Undiluted: 0.1 mg/mL; Diluted: 0.017 mg/mL.
  • Rate: Administer over 10 min.
  • Additive Incompatibility: Information unavailable; do not admix with other solutions or medications.

Patient/Family Teaching

  • Inform patient of the purpose of ibutilide.

Evaluation/Desired Outcomes

  • Conversion of recent-onset atrial flutter or fibrillation to normal sinus rhythm.

ibutilide

/ibu·ti·lide/ (ĭ-bu´tĭ-līd) a cardiac depressant used as an antiarrhythmic agent in the treatment of atrial arrhythmias; administered by intravenous infusion as the fumarate salt.

ibutilide

[ĭbu′tĭlīd]
a cardiac depressant used in treatment of atrial arrhythmias, administered by IV infusion as the fumarate salt.
References in periodicals archive ?
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
Cordarone), Propranolol, Ibutilide (Corvert) and Other
The newer antiarrhythmics like dofetilide and ibutilide are more potent as well as highly selective for [K.
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.
Amiodarone, dofetilide, and ibutilide are the commonly used class III drugs.
Intravenous ibutilide or flecainide is an option for cardioversion of irregular wide complex tachycardia.
12 /PRNewswire/ -- Bioniche Pharma, a leading developer and manufacturer of injectable pharmaceuticals announced today the launch of Ibutilide Fumarate Injection, the generic equivalent of Corvert from Pfizer Inc.
Procainamide and amiodarone are available in both intravenous and oral forms, and ibutilide is available only in intravenous form.
Based on this observation, a more efficient approach to cardioversion might be to routinely treat large patients--those who weigh more than 100 kg--with an adjunctive drug, such as ibutilide, before cardioversion and to start with a high-energy shock--360 J, Dr.
Treatment with CORVERT resulted in significantly higher conversion rates to normal heart rhythm than placebo, and success rate was dose related (placebo, 15 percent; ibutilide 0.