2.1 Arrhythmias
First line drugs | Second line drugs | Specialist drugs | Secondary care drugs |
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
Antiarrhythmics
Adenosine
- Injection 3mg/mL (2-mL vial)
Amiodarone
- Tablets 100mg, 200mg
- Injection 30mg/mL (10-mL amp - Pre-filled syringe)
- Infusion - Sterile concentrate 50mg/mL (3-mL amp)
Notes:
- Amiodarone has a very long half-life (extending to several weeks).
- Amiodarone usual oral loading dose regime, 200mg TDS for 1 week then BD for a further week. Maintenance doses, usually 200mg OD or minimum required to control the arrhythmia.
- Monitoring of patients taking amiodarone is required; LFT & TFT should be done 6-monthly and 12 months after stopping treatment.
Disopyramide
- Tablets - modified release 250mg
- Capsules 100mg
- Injection 10mg/mL (5-mL amp)
Dronedarone (Amber 3)
- Tablets 400mg
Notes:
- For Consultant Cardiologist use or recommendation only
- Use as per NICE TA197: Dronederone for the treatment of non-permanent atrial fibrillation (August 2010)
Flecainide (Amber 3)
- Tablets 50mg, 100mg
- Injection 10mg/mL (15-mL amp)
Lidocaine hydrochloride
- Injection 1% containing Lidocaine 10mg per 1mL (2-mL amp, 5-mL amp, 10-mL amp, 20-mL amp)
- Injection 2% containing Lidocaine 20mg per 1mL, (2-mL amp, 5-mL amp, 10-mL amp, 20-mL amp)
- Infusion 0.2% (2mg per 1mL in 500mL of 5% Glucose)
- Injection - Minijet 2% containing Lidocaine 20mg per 1mL (5-mL disposable syringe)
Sotalol
- Tablets 40mg, 80mg, 160mg
Notes:
- Sotalol is now indicated only for the treatment / prophylaxis of ventricular and supraventricular arrhythmias except torsade de pointes.
- It should no longer be used to treat angina, hypertension, thyrotoxicosis or used for secondary prevention following myocardial infarction unless one of these cardiac arrhythmias is also present.
Ajmaline (unlicensed)
- Injection 50mg/10mL
Notes:
- Ajmaline approved strictly for use in the diagnosis of Brugada syndrome by Consultant Cardiologists only.
- Recommended Dose: 1 mg/kg (actual body weight) up to a maximum dose of 100 mg
Mexiletine (unlicensed)
- Capsules 50mg and 200mg
Notes:
- Approved for unlicensed use by hospital consultant neurologist only in congenital myotonia
- Recommended dosage: initiate at 1.5 mg/kg and increase to 10 mg/kg (maximum daily dose of 600 mg)
Propafenone
- Tablets 150mg
- Injection
Cardiac glycosides
Digoxin-specific antibody
Digoxin
- Tablets 62.5 micrograms, 125 micrograms, 250 micrograms
- Elixir 50 micrograms/mL
- Injection 250 micrograms/mL, 2mL ampoule (Hospital only)
Digoxin Immune Fab
- Injection, DigiFab® 40mg per vial
Notes:
- Available on a named-patient basis only
- Manufacturer has no out of hours service
- For reversal of life-threatening Digoxin overdose.
Traffic light status (TLS) explained:
- Green: Routine prescribing within licensed indication
- Amber 1: specialist recommendation followed by GP initiation and continuation
- Amber 2: specialist or GP initiation in line with local guideline after 1st line failure followed by GP continuation
- Amber 3: specialist initiation and stabilisation followed by GP continuation
- Amber SCG: specialist initiation and stabilisation followed by GP continuation in line with an agreed shared care guideline
- Red: Hospital or specialist prescribing only
Return to Chapter: 2. Cardiovascular system
Last updated by: Dupe Fagbenro on 14-11-2018 11:54