CHF and arrhythmias:
Indications for RYTHMOL:
Documented life-threatening sustained ventricular arrhythmias. To prolong recurrence of disabling paroxysmal atrial fibrillation/flutter or paroxysmal supraventricular tachycardia in patients without structural heart disease.
Individualize. Initially 150mg every 8hrs. May increase at intervals of at least 3–4 days (longer for elderly or marked myocardial damage) to 225mg every 8hrs; max 300mg every 8hrs. QRS widening, 2nd or 3rd degree AV block, or hepatic impairment: reduce dose.
Heart failure. Cardiogenic shock. SA, AV and intraventricular disorders of impulse generation or conduction (eg, sick sinus syndrome, AV block), unless paced. Known Brugada Syndrome. Bradycardia. Marked hypotension. Bronchospastic disorders. Severe obstructive pulmonary disease. Marked electrolyte imbalance.
Significant proarrhythmic risk in structural heart disease. Avoid in patients with non-life-threatening ventricular arrhythmias. Monitor ECG, pacemakers before and during therapy. May provoke overt heart failure. Discontinue if ECG changes are suggestive of Brugada Syndrome. Monitor for agranulocytosis. Hepatic or renal dysfunction: monitor. Elderly. Labor & delivery, fetal/neonatal: monitor. Pregnancy. Nursing mothers.
Class IC antiarrhythmic.
Avoid drugs that may prolong the QT interval (eg, antiarrhythmics, some phenothiazines, tricyclic antidepressants, oral macrolides). Avoid concomitant Class IA and III antiarrhythmics (including quinidine, amiodarone). Potentiates β-blockers, warfarin, digoxin (consider reducing their doses when starting propafenone). Potentiated by CYP2D6 inhibitors (eg, desipramine, paroxetine, ritonavir, sertraline) and CYP3A4 inhibitors (eg, ketoconazole, saquinavir, erythromycin, grapefruit juice); avoid simultaneous use with both. Antagonized by rifampin. May be antagonized by orlistat. Local anesthetics may increase CNS effects.
Unusual taste, nausea, vomiting, dizziness, constipation, headache, fatigue, 1st degree AV block, intraventricular conduction delay, palpitations, chest pain, dyspnea, anxiety, upper respiratory tract infection, edema, influenza, angina pectoris, atrial flutter, heart failure, bradycardia, blurred vision; new or worsened arrhythmias, conduction disturbances, elevated ANA titers, exacerbation of myasthenia gravis.
Generic Drug Availability:
Tabs—100; SR caps—60