Dofetilide Brand Name– Tikosyn
What is Dofetilide
Dofetilide is a class III antiarrhythmic used for the conversion and maintenance of normal sinus rhythm in atrial fibrillation/flutter.
It should be reserved for highly symptomatic patients. Although studied in ventricular tachycardia and ventricular fibrillation, dofetilide is primarily effective for supraventricular arrhythmias.
Dofetilide results in selective and potent blockade of potassium channels and thereby prolongs ventricular refractoriness (i.e., widens the QT interval), the action potential duration, and the effective refractory period; it does not affect the ventricular conduction time.
Dofetilide has negative chronotropic effects but lacks negative inotropic properties.
Dofetilide is more potent and a more ‘pure’ Class III agent than sotalol; exhibits less organ toxicity than amiodarone; and is not associated with negative inotropic effects which occurs with amiodarone and sotalol. In contrast to increased mortality documented with d-sotalol (pure class III antiarrhythmic, devoid of beta-blocking properties) in high-risk post-MI patients,dofetilide has been shown to have a neutral effect on the mortality from arrhythmias post-MI and in severe CHF. In this population, dofetilide effectively converts atrial fibrillation, prevents its recurrence and reduces the risk of hospitalization for worsening heart failure.
Drugs that inhibit dofetilide metabolism or renal elimination may increase the risk of dofetilide-induced proarrhythmias.
In addition, dofetilide should not be coadministered with drugs associated with QT prolongation or torsade de pointes.
Dofetilide was approved by the FDA in October 1999.
Indications
- atrial fibrillation
- atrial flutter
Side Effects
- abdominal pain
- angina
- angioedema
- anxiety
- arrhythmia exacerbation
- arthralgia
- asthenia
- AV block
- back pain
- bradycardia
- cardiac arrest
- chest pain (unspecified)
- cough
- diaphoresis
- diarrhea
- dizziness
- dyspnea
- edema
- elevated hepatic enzymes
- headache
- hypertension
- infection
- influenza
- insomnia
- migraine
- muscle paralysis
- myocardial infarction
- nausea
- palpitations
- paresthesias
- peripheral edema
- QT prolongation
- rash
- stroke
- syncope
- torsade de pointes
- ventricular fibrillation
- ventricular tachycardia
Monitoring Parameters
- ECG
- serum creatinine/BUN
- serum electrolytes
- serum magnesium
- serum potassium
Contraindications
- apheresis
- AV block
- bradycardia
- breast-feeding
- cardiomyopathy
- celiac disease
- children
- dialysis
- females
- fever
- geriatric
- heart failure
- hepatic disease
- human immunodeficiency virus (HIV) infection
- hyperparathyroidism
- hypocalcemia
- hypokalemia
- hypomagnesemia
- hypothermia
- hypothyroidism
- infants
- long QT syndrome
- myocardial infarction
- pheochromocytoma
- pregnancy
- QT prolongation
- renal disease
- renal failure
- renal impairment
- requires a specialized care setting
- requires an experienced clinician
- rheumatoid arthritis
- sick sinus syndrome
- sickle cell disease
- sleep deprivation
- stroke
- systemic lupus erythematosus (SLE)
- torsade de pointes
Interactions
- Abacavir; Dolutegravir; Lamivudine
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- Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
- Abarelix
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- Alfuzosin
- Aliskiren; Amlodipine
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- Alogliptin; Metformin
- Amiloride
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- Amiodarone
- Amitriptyline
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- Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
- Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
- Amlodipine; Olmesartan
- Amlodipine; Telmisartan
- Amlodipine; Valsartan
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