For something like that though, id personally call first. Find out what health conditions may be a health risk when taken with dofetilide oral. Dofetilide is a highly selective ikr blocker without known active metabolites that distinctly prolongs the qt. Dofetilide dosage could be adjusted downward if the qt or qtc interval. Renal function and qtc should be reevaluated every 3 months or as medically warranted. Adult drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in. Measure qtc 23 hours after first 5 doses during inpatient stay.
Dofetilide has relative selectivity for blocking the rapidlyactivating component of the delayed rectifier potassium current ikr at concentrations of 10 to 30 nanomoll 2,3. Drug dosing adjustments in patients with chronic kidney. More important, dofetilide is eliminated by cationic renal secretion, and three inhibitors of this process have been shown to increase systemic dofetilide exposure. Renal dosage adjustment guidelines for antimicrobials the pharmacists will automatically adjust the doses of any of the antimicrobials included in the protocol according to the estimated creatinine clearance generally using the cockroftgault equation for patients. Qt interval should be used if the heart rate is dosing algorithm. Dofetilide dose calculation errors in elderly associated with use of the modification of diet in renal disease equation. To establish the right dose of dofetilide, treatment with dofetilide must be started in a hospital where your heart rate and kidney function will be checked for the first 3 days of treatment. Abacavir abacavir lamivudine abacavir lamivudine zidovudine acarbose acebutolol acetaminophen acetazolamide acetohexamide acetohydroxamic acid acetylsalicylic acid aspirin acrivastine acyclovir adefovir adenosine albuterol inhaled albuterol oral alfentanil alfentanil allopurinol alprazolam alteplase tissuetype plasminogen activator. The information on dosage adjustments in renal impairment given in this book is based on. Advise patients to immediately report any symptoms that may be associated with electrolyte imbalance e.
You will need to be in a hospital or another place where you can be monitored closely by your doctor for at least 3 days when you are started or restarted on dofetilide. This emedtv page examines how your individual dosage of dofetilide will be determined. Welcome to the fifth edition of the renal drug handbook. Ranolazine is an antianginal drug whose major mechanism of action is blockade of the late sodium current. Bentyl dicyclomine hydrochloride dose, indications, adverse. Dofetilide is an oral class iii antiarrhythmic agent used for treatment and prevention of atrial fibrillation and flutter. May 05, 2020 dofetilide is a specific class iii antiarrhythmic agent approved for use in the conversion of atrial fibrillation and atrial flutter and the maintenance of normal sinus rhythm. In the united states it is only available by mail order or through specially trained local pharmacies. Dose adjustments are typically made based on stages of ckd, with gfr 90, 6089, 3059, 1529, 40 mgday rarely more effective. Excretion of about 80% of a single dose of dofetilide is in urine with. 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. Tikosyn is contraindicated in patients with congenital or acquired long qt syndromes, a baseline qt interval or qtc 440 msec 500 msec in patients with ventricular conduction abnormalities, severe renal impairment calculated creatinine clearance dofetilide if at any time after second dose, qtc 500 msec 550 msec with ventricular conduction abnormalities.
Drug dosing adjustments in patients with chronic kidney disease. Dofetilide side effects, uses, dosage, overdose, pregnancy. It is marketed under the trade name tikosyn by pfizer, and is available in the united states in capsules containing 125, 250, and 500 g of dofetilide. May be initiated at lower doses based on physician discretion. Webmd provides common contraindications for dofetilide oral.
Tikosyn, dofetilide dosing, indications, interactions. Dofetilide is used in people with atrial fibrillation or atrial flutter. If the patients renal function has deteriorated since dofetilide was started, dosage reduction may be necessary, and, once again, continuous ecg monitoring should be performed for the first three. As a result, and as seen in clinical studies, the halflife of dofetilide is. If the qtc 15% of baseline, or if the qtc is 500 msec 550 msec in patients with ventricular conduction abnormalities, dofetilide should be adjusted. Wed automatically dose adjust per renal adjustment protocol. If initial dose 125 mcg q12hr, decrease to 125 mcg qday. The authors make no claims of the accuracy of the information contained herein. Inhibitors of renal cationic secretion are contraindicated with dofetilide.
A total of 996 patients with a 1week to 2year history of afafl were enrolled. Total dofetilide clearance in patients without severe renal insufficiency. Munar, pharmd, bcps, and harleen singh, pharmd oregon state university college of pharmacy, portland, oregon. Dofetilide dose calculation errors in elderly associated with. Pretty specific dosing guidelines, using cgactual bw. Prolongs cardiac repolarization class iii antiarrhythmic properties. Dofetilide is metabolized to a small degree by the cyp3a4 isoenzyme of the cytochrome p450 system and an inhibitor of this system could increase systemic dofetilide exposure. At 23 hours after administering the first dose of tikosyn, determine the qtc or qt if heart rate is less than 60 beats per minute. Dofetilide is a class iii antiarrhythmic agent that blocks the delayed rectifier cardiac potassium channel and prolongs repolarization.
Considerations for use from the atrial fibrillation toolkit. Renal excretion of dofetilide accounts for approximately 80% of its elimination. Dofetilide is a heart rhythm medicine, also called an antiarrhythmic. Renal function prior to first dose and every 3 months or as medically warranted patient advice. Renal dosage adjustment guidelines for antimicrobials. Drug dosing adjustments in patients with chronic kidney disease myrna y. This page also offers suggestions on when and how to take this medication, and explains why at least your first three days on this drug will take place in a hospital.
Qt prolongation can rarely cause serious rarely fatal fastirregular heartbeat and other symptoms such as. Dofetilide is classed as an antiarrhythmic medication because it seeks to restore the hearts normal sinus rhythm. If the qtc has increased by greater than 15% compared to the baseline established in step 1 or if the qtc is greater than 500 msec 550 msec in patients with ventricular conduction abnormalities, subsequent dosing should be. Click here for a specialized list of other renal medication dosing not listed in the alphabetical main section simple renal dosing guidelines. 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. Pediatric drugs analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Administer the adjusted tikosyn dose and begin continuous ecg monitoring.
This book is distributed under the terms of the creative commons attribution. Analgesics antihypertensive and cardiovascular agents antimicrobial agents miscellaneous agents sedatives, hypnotics, and other drugs used in psychiatry. Therefore, initial dosing must be adjusted based on the calculated cl cr see pages 15 and 38. Calculation of creatinine clearance and qtc for all patients must precede administration of the first dose of tikosyn. Dofetilide has also been used in an offlabel manner to treat paroxysmal supraventricular tachycardias. Tikosyn dofetilide dose, indications, adverse effects. Dosing guidelines book school of medicine university of. As a result, and as seen in clinical studies, the halflife of dofetilide is longer in patients with lower creatinine clearances. Dofetilide gets eliminated in the kidney by cationic secretion.
Sep 16, 2019 dofetilide is metabolized to a small degree by the cyp3a4 isoenzyme of the cytochrome p450 system and an inhibitor of this system could increase systemic dofetilide exposure. 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. It is important to read the patient information provided to you every time you begin therapy with dofetilide. 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. Dosing guidelines book dosing guidelines for children dosing guidelines for adults. A collaborative dofetilide initiation and dosing programme was jointly. Dofetilide is used in people with atrial fibrillation or atrial flutter dofetilide may also be used for purposes not listed in. It is an oral medication containing dofetilide as the active ingredient. Tikosyn is metabolized to a small extent by the cyp3a4 isoenzyme of the cytochrome p450 system. The magnitude of the effect on renal elimination by cimetidine, trimethoprim, and ketoconazole all contraindicated concomitant uses with dofetilide suggests that all renal. If initial dose 250 mcg q12hr, decrease to 125 mcg q12hr. Dosing info and administration of tikosyn dofetilide.
Discontinue dofetilide if at any time after second dose, qtc 500 msec 550 msec with ventricular conduction abnormalities. If md still wants to push it, document md aware and move on. Initiate dosage at the lower end of the adult range. The most common adverse events reported were headache, chest pain, dizziness, respiratory tract infection, dyspnea, and nausea. Dofetilide is safe and effective in preventing atrial fibrillation.
Lets learn about its general dosage information and side effects in this lesson. Dofetilide dose calculation errors in elderly associated. Increase in qt interval is directly related to dofetilide dose and plasma concentration. Ten pearls for the use of antiarrhythmic drugs for atrial. In its pivotal trials for approval for angina, ranolazine was found to reduce ventricular and atrial arrhythmias in patients with acute coronary syndrome. Qtc interval should be measured 23 hours after the initial dose. The pharmacists will automatically adjust the doses of any of the antimicrobials included in the protocol according to the estimated creatinine clearance generally using the cockroftgault equation for patients. In volunteers with varying degrees of renal impairment and patients with arrhythmias, the clearance of dofetilide decreases with decreasing creatinine clearance. At 23 hours after administering the first dose of tikosyn, determine the qtc. Dose adjustments are typically made based on stages of ckd, with gfr 90, 6089, 3059, 1529, renal function, but if gfr dofetilide, with the dose adjusted according to renal function, is not associated with an increased risk of death among patients with congestive heart. Bentyl dicyclomine hydrochloride dose, indications. Dofetilide may cause a condition that affects the heart rhythm qt prolongation.
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