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: 

 

 

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