Therefore, initial dosing must be adjusted based on the calculated cl cr see pages 15 and 38. Ten pearls for the use of antiarrhythmic drugs for atrial fibrillation. Recommended dofetilide dosing guidelines the recommended initial dofetilide dosage for treating atrial fibrillation or atrial flutter is usually between 125 mcg 0. Renal excretion of dofetilide accounts for approximately 80% of its elimination.
For consideration of a lower dose, see special considerations below. Dosing info and administration of tikosyn dofetilide. Both studies randomized patients to placebo or to doses of tikosyn 125 mcg, 250 mcg, 500 mcg, or in one study a comparator drug, given twice a day these doses were lowered based on calculated creatinine clearance and, in one of the studies, for qt interval. Qt interval should be used if the heart rate is 500 msec 550 msec with ventricular conduction abnormalities. Dosing guidelines book school of medicine university of. Similarly, dofetilide can be used with lv dysfunction so long as renal. It is an oral medication containing dofetilide as the active ingredient. Dofetilide, which must be started inhospital, is dosed according to a detailed renal and qtresponse dependent algorithm that starts at 500. Benefit from dofetilide use must be individualized and weighed against the side effects and the role of other available treatment options. This information does not take the place of talking with your doctor about your condition or treatment. Dofetilide is a highly selective ikr blocker without known active metabolites that distinctly prolongs the qt. Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Dosing guidelines book dosing guidelines for children dosing guidelines for adults.
Dofetilide dofetilide dose, indications, adverse effects. This guide succeeds at providing busy healthcare providers with updated and evidencebased information on dosing and monitoring commonly used medications in patients with renal dysfunction. Tikosyn is metabolized to a small extent by the cyp3a4 isoenzyme of the cytochrome p450 system. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon. Drugs known to inhibit the cationic transport system and reduce renal. In order to provide you with relevant and meaningful content we need to know more about you. For nonprescription products, read the label or package ingredients carefully.
Hydroxychloroquine oral route before using mayo clinic. Please choose the category that best describes you. Drug dosing adjustments in patients with chronic kidney disease myrna y. When choosing the initial dose of an antiarrhythmic drug, generally, the. Calculation of creatinine clearance and qtc for all patients must precede administration of the first dose of tikosyn. Dofetilide is used in people with atrial fibrillation or atrial flutter dofetilide may also be used for purposes not listed in. Dofetilide gets eliminated in the kidney by cationic secretion. Excretion of about 80% of a single dose of dofetilide is in urine with.
This antiarrhythmic agent prolongs cardiac action potential duration and effective refractory period due to delayed repolarization without affecting conduction velocity. Dofetilide selectively blocks cardiac ion channels of the rapid component of the delayed rectifier potassium current ikr. However, elderly patients are more likely to have kidney problems, which may require caution and an adjustment in the dose for patients receiving dofetilide. Drug dosing adjustments in patients with chronic kidney. Dofetilide daviss drug guide for rehabilitation professionals f. Read the medication guide before you start taking tikosyn and each time you get a refill. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Tikosyn definition of tikosyn by medical dictionary. Dofetilide is used to help keep the heart beating normally in people with certain heart rhythm disorders of the atrium the upper chambers of the heart that allow blood to flow into the heart. Dofetilide is safe and effective in preventing atrial fibrillation.
This new book addresses the persistent and challenging problem of dosing medications for patients with renal insufficiency and dysfunction. Increase in qt interval is directly related to dofetilide dose and plasma concentration. Find out what health conditions may be a health risk when taken with dofetilide oral. Major drugs that are actively secreted via cationic secretion e. Reviews australian association of clinical biochemists 322. Competition for renal elimination may increase plasma concentrations of dofetilide. Qt interval should be used if the heart rate is dose of tikosyn is 500 mcg bid, as modified by the dosing algorithm. Dofetilide has also been used in an offlabel manner to treat paroxysmal supraventricular tachycardias. Tikosyn, dofetilide dosing, indications, interactions.
Dofetilide dose reductions and discontinuations in women. Excretion of about 80% of a single dose of dofetilide is in urine with 80% as unchanged drug and the remaining 20% consisting of inactive or minimally active metabolites. This book is distributed under the terms of the creative commons attribution. A total of 996 patients with a 1week to 2year history of afafl were enrolled. Inhibitors of renal cationic secretion are contraindicated with dofetilide. The renal drug handbook the st georges hospital, adult critical. Drug dosing in renal disease article pdf available in the clinical biochemist. Tikosyn is indicated for the maintenance of normal sinus rhythm delay in time to recurrence of atrial. In the united states it is only available by mail order or through specially trained local pharmacies.
Dofetilide is a heart rhythm medicine, also called an antiarrhythmic. The information on dosage adjustments in renal impairment given in this book is based on. The mostreported halflife in the literature is 10 hours for dofetilide. If you are unsure about anything related to your dosage or dofetilide dosing in general, please talk with your healthcare provider or pharmacist. Serum potassium should be maintained within the normal range before tikosyn treatment is initiated and should be maintained within the normal range while the patient. A collaborative dofetilide initiation and dosing programme was jointly. C indications maintenance of normal sinus rhythm delay in time to recurrence of atrial fibrillationatrial flutter afafl in patients with afafl lasting more than one week, and who have been converted to normal. Webmd provides common contraindications for dofetilide oral.
Adult drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in. Dofetilide definition of dofetilide by medical dictionary. Our study demonstrates that longterm use of dofetilide, with the dose adjusted according to renal function, is not associated with an increased risk of death among patients with congestive heart. The usual recommended dose of tikosyn is 500 mcg bid, as modified by the dosing algorithm described below. This prescription medicine can help treat certain types of an irregular heart rate, but it is not safe for everyone. The dose of tikosyn must be individualized according to calculated creatinine clearance and qtc. Dofetilide in patients with congestive heart failure and. Dofetilide is a sulfonamide class iii antiarrhythmic agent and potassium channel blocker. Dofetilide is a class iii antiarrhythmic agent available for use in the united states and other countries for the acute termination of atrial fibrillation or flutter as well as prevention of atrial fibrillation or flutter recurrence.