Moricizine Brand Name– Ethmozine
What is Moricizine
Moricizine is an oral class I antiarrhythmic agent. It is chemically unrelated to any other antiarrhythmic and is indicated for the treatment of life-threatening ventricular arrhythmias.
Although chemically related to phenothiazines, moricizine has no central or peripheral dopamine blocking activity.
Moricizine was originally synthesized in the Soviet Union in 1964 and has been in use there since 1971.
Although sometimes referred to as a class IC agent, classification of moricizine within the class I antiarrhythmics is difficult since the drug has electrophysiologic features of all three subclasses, class IA, IB, and IC.
Flecainide, encainide, and moricizine were evaluated in post-MI patients in the Cardiac Arrhythmia Suppression Trial (CAST).
The number of patients receiving moricizine, however, were too few for meaningful analysis.
Subsequently, a second CAST study (CAST II) compared moricizine to placebo in patients with asymptomatic or mildly symptomatic ventricular arrhythmias post myocardial infarction.
Because lack of benefit was demonstrated early, CAST II was terminated prematurely.
The results of both CAST studies indicate that moricizine should be reserved for treatment of patients with life-threatening ventricular arrhythmias. Moricizine was FDA approved in June 1990.
It is currently only available as oral tablets. After December 31, 2007, moricizine will no longer be available in the US. Discontinuation is not due to safety or efficacy concerns but rather diminished market demand.
Clinicians are urged to stop prescribing moricizine to new patients. Patients currently being treated with moricizine should be transferred to alternate therapy in anticipation of the lack of available supply of moricizine after December 31, 2007.
Indications
- ventricular tachycardia
For the treatment of sustained ventricular tachycardia that is deemed to be life-threatening
NOTE: Dosage should be initiated in the hospital setting. In general, previous antiarrhythmic therapy should be withdrawn for at least 1 to 2 plasma half-lives before initiating moricizine therapy.
Side Effects
- abdominal pain
- angina
- anxiety
- arrhythmia exacerbation
- blurred vision
- diarrhea
- dizziness
- dyspepsia
- dyspnea
- elevated hepatic enzymes
- fatigue
- fever
- headache
- heart failure
- nausea
- palpitations
- premature ventricular contractions (PVCs)
- QT prolongation
- sinus tachycardia
- thrombocytopenia
- torsade de pointes
- urinary retention
- ventricular fibrillation
- ventricular tachycardia
- vomiting
Monitoring Parameters
- ECG
- LFTs
- serum creatinine/BUN
- serum magnesium
- serum potassium
Contraindications
- AV block
- breast-feeding
- bundle-branch block
- cardiac arrhythmias
- cardiogenic shock
- children
- coronary artery disease
- electrolyte imbalance
- geriatric
- heart failure
- hepatic disease
- hyperkalemia
- hypokalemia
- hypomagnesemia
- myocardial infarction
- pregnancy
- renal disease
- renal failure
- renal impairment
- sick sinus syndrome
Interactions
- Acetaminophen; Propoxyphene
- Amiodarone
- Cimetidine
- Class IA Antiarrhythmics
- Class IB Antiarrhthmics
- Colesevelam
- Dextromethorphan; Quinidine
- Diltiazem
- Disopyramide
- Dofetilide
- Ginger, Zingiber officinale
- Ibutilide
- Lacosamide
- Nifedipine
- Paroxetine
- Procainamide
- Propoxyphene
- Quinidine
- Sertraline
- Terbinafine
- Tetracaine
- Theophylline, Aminophylline
- Warfarin
