Antiarrhythmic Therapy for Atrial Fibrillation

Laura V. Tsu, PharmD, BCPS

US Pharmacist. 2013;38(2):20-23.

The Pharmacist's Role

Pharmacists in the community setting are ideally situated to participate in the management of antiarrhythmic therapy in patients with atrial fibrillation. As evidenced by the multitude of interactions, adverse effects, and monitoring parameters listed above, there are many opportunities for pharmacists to provide patient education and to advise prescribers. The initiation or discontinuation of medications that affect concentrations of antiarrhythmic therapy is common, and potentially serious effects could ensue without involvement by the pharmacist. In addition to medication education, the pharmacist also can discuss with patients the indication and purpose of antiarrhythmic medications in the prevention of atrial fibrillation events. In this manner, pharmacists can be involved in the overall management of patients with atrial fibrillation.

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Table 1. Properties of Selected Antiarrhythmic Agents
Agent	Dosing	Adverse Effects	Drug Interactions
Flecainide (Tambocor)	50–150 mg bid; decrease by 50% if GFR ≤50 mL/min; 200–300 mg once^a	Dizziness, tremors, HF exacerbation	Digoxin
Propafenone (Rythmol)	600 mg once^a; IR: 150–300 mg tid; SR: 225–425 mg bid	Asthma exacerbation, dizziness	Digoxin, warfarin
Amiodarone (Cordarone, Pacerone)	1.2–1.8 g/day until 10 g total,^a then lowest effective dose (usually 100–400 mg/day)	Hyperthyroidism, hypothyroidism, retinal deposits, pulmonary fibrosis, hepatopathy	Numerous; substrates of 3A4, 2D6, 2C9, 2C19, P-glycoprotein
Dronedarone (Multaq)	400 mg bid	Abdominal pain, worsening HF, QT prolongation	3A4 inhibitors, digoxin, statins
Sotalol (Betapace)	80–160 mg bid; 80 mg/day if CrCl 40–60 mL/min	HF exacerbation, bradycardia, bronchospasm, TDP	NA
Dofetilide (Tikosyn)	125–500 mcg bid^a based on renal function	TDP, dizziness, diarrhea	3A4 inhibitors, verapamil, trimethoprim, hydrochlorothiazide, cimetidine

^a Dosing for atrial fibrillation cardioversion.
CrCl: creatinine clearance; GFR: glomerular filtration rate; HF: heart failure; IR: immediate-release; NA: not applicable; SR: sustainedrelease; TDP: torsades de pointes.
Source: References 1, 7–10, 13, 14.

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Antiarrhythmic Therapy for Atrial Fibrillation

The Pharmacist's Role

Tables

References

Authors and Disclosures

Authors and Disclosures

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