Bretylium

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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

  1. abdominal pain
  2. angina
  3. anxiety
  4. arrhythmia exacerbation
  5. bradycardia
  6. confusion
  7. conjunctivitis
  8. diaphoresis
  9. diarrhea
  10. dizziness
  11. dyspnea
  12. emotional lability
  13. flushing
  14. hiccups
  15. hypertension
  16. hyperthermia
  17. hypotension
  18. lethargy
  19. nasal congestion
  20. nausea
  21. orthostatic hypotension
  22. premature ventricular contractions (PVCs)
  23. psychosis
  24. rash
  25. syncope
  26. vertigo
  27. 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

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