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What is Bretylium
Bretylium is a parenteral Class III antiarrhythmic agent indicated for the treatment of ventricular arrhythmias.
Bretylium is associated with a high incidence of hypotension, particularly in the postresuscitation setting. Bretylium was originally introduced as an antihypertensive but was abandoned because of erratic oral absorption, rapid tolerance to its antihypertensive effects, and proclivity to cause significant orthostatic hypotension.
Bretylium was subsequently reintroduced as an antiarrhythmic agent.
Previous advanced cardiac life support (ACLS) guidelines included bretylium in the ventricular fibrillation (VF)/pulseless ventricular tachycardia (pVT) algorithm; however, due to raw material shortage and unreliable supply, bretylium was removed from the algorithm although noted to remain acceptable for use with some studies questioning its efficacy.
Current guidelines recommend amiodarone or lidocaine for VF/pVT that is unresponsive to defibrillation.
Indications
- ventricular fibrillation
- ventricular tachycardia
For the treatment of ventricular arrhythmias, such as ventricular fibrillation or ventricular tachycardia
Side Effects
- abdominal pain
- angina
- anxiety
- arrhythmia exacerbation
- bradycardia
- confusion
- conjunctivitis
- diaphoresis
- diarrhea
- dizziness
- dyspnea
- emotional lability
- flushing
- hiccups
- hypertension
- hyperthermia
- hypotension
- lethargy
- nasal congestion
- nausea
- orthostatic hypotension
- premature ventricular contractions (PVCs)
- psychosis
- rash
- syncope
- vertigo
- vomiting
Monitoring Parameters
- blood pressure
- ECG
Contraindications
- aortic stenosis
- breast-feeding
- digitalis toxicity
- geriatric
- pregnancy
- pulmonary hypertension
- renal disease
- renal failure
- renal impairment
- requires a specialized care setting
Interactions
- Acebutolol
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
- Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
- Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
- Acetaminophen; Dextromethorphan; Phenylephrine
- Acetaminophen; Dextromethorphan; Pseudoephedrine
- Acetaminophen; Dichloralphenazone; Isometheptene
- Acetaminophen; Guaifenesin; Phenylephrine
- Acetaminophen; Pseudoephedrine
- Acrivastine; Pseudoephedrine
- Amphetamine
- Amphetamine; Dextroamphetamine
- Articaine; Epinephrine
- Atenolol
- Atenolol; Chlorthalidone
- Bendroflumethiazide; Nadolol
- Benzphetamine
- Beta-adrenergic blockers
- Betaxolol
- Bisoprolol
- Bisoprolol; Hydrochlorothiazide, HCTZ
- Brimonidine; Timolol
- Brompheniramine; Carbetapentane; Phenylephrine
- Brompheniramine; Hydrocodone; Pseudoephedrine
- Brompheniramine; Pseudoephedrine
- Carbetapentane; Chlorpheniramine; Phenylephrine
- Carbetapentane; Diphenhydramine; Phenylephrine
- Carbetapentane; Guaifenesin; Phenylephrine
- Carbetapentane; Phenylephrine
- Carbetapentane; Phenylephrine; Pyrilamine
- Carbetapentane; Pseudoephedrine
- Carbinoxamine; Dextromethorphan; Pseudoephedrine
- Carbinoxamine; Hydrocodone; Phenylephrine
- Carbinoxamine; Hydrocodone; Pseudoephedrine
- Carbinoxamine; Phenylephrine
- Carbinoxamine; Pseudoephedrine
- Carteolol
- Carvedilol
- Cetirizine; Pseudoephedrine
- Chlophedianol; Dexchlorpheniramine; Pseudoephedrine
- Chlophedianol; Guaifenesin; Phenylephrine
- Chlorpheniramine; Dextromethorphan; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Phenylephrine
- Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
- Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Hydrocodone; Phenylephrine
- Chlorpheniramine; Hydrocodone; Pseudoephedrine
- Chlorpheniramine; Phenylephrine
- Chlorpheniramine; Pseudoephedrine
- Codeine; Phenylephrine; Promethazine
- Desloratadine; Pseudoephedrine
- Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine
- Dexmethylphenidate
- Dextroamphetamine
- Dextromethorphan; Diphenhydramine; Phenylephrine
- Dextromethorphan; Guaifenesin; Phenylephrine
- Dextromethorphan; Guaifenesin; Pseudoephedrine
- Diethylpropion
- Digoxin
- Dihydrocodeine; Guaifenesin; Pseudoephedrine
- Diphenhydramine; Hydrocodone; Phenylephrine
- Diphenhydramine; Phenylephrine
- Dobutamine
- Dofetilide
- Dopamine
- Dorzolamide; Timolol
- Ephedrine
- Epinephrine
- Esmolol
- Fexofenadine; Pseudoephedrine
- Fingolimod
- Guaifenesin; Hydrocodone; Pseudoephedrine
- Guaifenesin; Phenylephrine
- Guaifenesin; Pseudoephedrine
- Hydrochlorothiazide, HCTZ; Metoprolol
- Hydrochlorothiazide, HCTZ; Propranolol
- Hydrocodone; Phenylephrine
- Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
- Hydrocodone; Pseudoephedrine
- Ibuprofen; Pseudoephedrine
- Ibutilide
- Isocarboxazid
- Isoproterenol
- Labetalol
- Lacosamide
- Levobetaxolol
- Levobunolol
- Lisdexamfetamine
- Loratadine; Pseudoephedrine
- Mepivacaine; Levonordefrin
- Methamphetamine
- Methylphenidate
- Metoprolol
- Midodrine
- Monoamine oxidase inhibitors
- Nadolol
- Naproxen; Pseudoephedrine
- Nebivolol
- Nebivolol; Valsartan
- Norepinephrine
- Pemoline
- Penbutolol
- Phendimetrazine
- Phenelzine
- Phentermine
- Phentermine; Topiramate
- Phenylephrine
- Phenylephrine; Promethazine
- Pindolol
- Prilocaine; Epinephrine
- Propafenone
- Propranolol
- Pseudoephedrine
- Racepinephrine
- Ritodrine
- Selegiline
- Sotalol
- Sympathomimetics
- Timolol
- Tranylcypromine
