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Dofetilide

    Brands

    DEA Class; Rx

    Common Brand Names; Tikosyn

    • Antidysrhythmics, III

    Class III antiarrhythmic; converts and maintains NSR in AFIB/Flutter; reserved for highly symptomatic patients; proarrhythmic (torsade de pointes); selectively blocks potassium channels; prolongs QT, APD, and ERP; does not affect ventricular conduction time; has negative chronotropy; lacks negative inotropy; renally eliminated; numerous drug interactions.

    Indicated for use in the conversion of atrial fibrillation/atrial flutter to normal sinus rhythm; or, for maintenance therapy of patients with highly symptomatic atrial fibrillation/atrial flutter of 1 week or more duration.

    Hypersensitivity

    Congenital or acquired long QT syndromes; do not use with baseline QTc >440 msec (500 msec with ventricular conduction abnormalities)

    Concomitant use of cation transport system inhibitors (eg, verapamil, cimetidine, trimethoprim, ketoconazole, prochlorperazine, dolutegravir and megestrol); each of these drugs cause a substantial increase in dofetilide plasma concentrations

    Severe renal impairment: CrCl <20 mL/min

    • Headache (11%)
    • Chest pain (10%)
    • Dizziness (8%)
    • Insomnia (4%)
    • Respiratory tract infection (7%)
    • Dyspnea (6%)
    • Rash (3%)
    • Flu-like syndrome (4%)
    • Back pain (3%)
    • Ventricular tachycardia (3-4%)
    • Torsade de pointes (3% in HF patients and 0.9% in patients with recent MI)
    • Nausea (5%)
    • Diarrhea (3%)
    • AV block, QTc interval prolongation, torsades de pointes, ventricular arrhythmias
    • Difficulty sleeping
    • Liver damage
    • Cough
    • Paresthesia
    • Angioedema

    Atrioventricular block, bradycardia, electrolyte imbalance, patients taking potassium-depleting diuretics, moderate QT interval prolongation prior to treatment, proarrhythmic events, liver disease, renal impairment

    Coadministration of drugs that prolong QT interval and other antiarrhythmic agents: phenothiazines, cisapride, bepridil, TCAs, oral macrolides, class I or class III antiarrhythmics & amiodarone

    Grapefruit juice may increase levels; avoid concurrent use

    Magnesium and potassium serum levels should be maintained within normal range to avoid QTc prolongation

    Pregnancy Category: C

    Lactation: excretion in milk unknown/not recommended

    Adults

    1000 mcg/day PO.

    Elderly

    1000 mcg/day PO.

    Adolescents

    Safety and efficacy have not been established.

    Children

    Safety and efficacy have not been established.

    Dofetilide

    capsule

    • 125mcg
    • 250mcg
    • 500mcg