Mount Carmel Health Partners Clinical Guidelines Atrial Fibrillation | Page 5

Rhythm Control Medications
Medication
Dosage
Monitoring & Usage Contraindications and
Potential Adverse Drug
Reactions (ADRs) Drug-drug Interactions
ADRs: photosensitivity,
pulmonary fibrosis/toxicity, GI
upset, bradycardia, hepatic
toxicity, thyroid dysfunction,
eye complications, skin
discoloration Use caution with drugs that
prolong QT interval;
CYP3A4 inhibitors may
increase concentrations of
amiodarone.
Amiodarone
(Cordarone,
Pacerone) 100 to 400 mg,
once daily Monitoring: periodic eye
exams, thyroid function
tests, pulmonary function
tests, chest x-rays Dofetilide
(Tikosyn) 125 mcg to 500
mcg, twice daily Initiate as inpatient.
Monitoring: CrCl
potassium levels ADRs: torsades de pointes,
heart block, and arrhythmias Use caution with drugs that
prolong QT interval. Avoid
meds that inhibit renal
tubular secretion.
400 mg,
twice daily Monitoring: periodic liver
function tests, ECG Contraindications: persistent/
chronic AF, bradycardia (<50
bpm), recently
decompensated or Class IV
HF, second or third degree
heart block
ADRs: liver failure, CVA,
prolonged QT interval, new or
worsening HF, diarrhea,
nausea, abdominal pain,
pulmonary toxicity May interact with CYP3A
inhibitors and drugs that
prolong QT interval.
Reduce concurrent CCB/BB
dose to reduce bradycardia
risk. Hypokalemia and
hypomagnesemia with
diuretics that deplete K+
Flecainide
(Tambocor) 50 to 150 mg,
twice daily Start beta blocker or
calcium channel blocker.
Monitoring: ECG, HR,
liver function, CrCl,
periodic trough plasma
levels Contraindications: ischemic
heart disease, second or third
degree AV block, right bundle
branch block.
ADRs: cardiac arrest, other
dysrhythmias, heart failure Use caution with drugs that
prolong QT interval.
Beta blockers carry the
potential to increase
negative inotropic effects.
Propafenone
(Rythmol) IR: 150 to 225 mg,
every 8 hours
SR: 225 to 425
mg, every 12
hours Start beta blocker or
calcium channel blocker.
Monitoring: ECG, heart
rate, CBC, ANA titer, CrCl,
liver function Contraindication: ischemic
heart disease
ADRs: ventricular tachycardia,
heart failure, first degree AV
block, bradyarrhythmia, chest
pain Use caution with drugs that
prolong QT interval.
Avoid potent CYP2D6
inhibitors (bupropion, some
SSRIs, terbinafine)
80 to 160 mg,
twice daily Initiate as inpatient for
patients at increased risk
of torsades de pointes:
- elderly women
- renal dysfunction
- borderline QT interval
- persistent AF
Monitoring: CrCl, ECG,
potassium, magnesium
levels ADRs: QT prolongation,
bradycardia, dyspnea, fatigue CCBs, digoxin, use caution
with drugs that prolong QT
interval, caution with
catecholamine-depleting
drugs (reserpine and
guanethidine)
Dronedarone
(Multaq)
Sotalol
(Betapace
AF)
AFib - 5