MTW NHS Trust West Kent CCG

Drug Status Key

  • Preferred
  • Second Line
  • Third Line
  • Specialist Initiation
  • Hospital Only
  • Not Approved for Formulary

Arrhythmias

Choice of anti-arrhythmic agent depends on the type of arrhythmia - see BNF and NICE guidance. These would mainly be initiated in secondary care.

Drug safety Update

  October 2011: Dronedarone (Multaq®): cardiovascular, hepatic and pulmonary adverse events - new restrictions and monitoring requirements

NICE Guidance (also see drug-specific links below)

  CG180: Atrial fibrillation - the management of atrial fibrillation, June 2014

 NG106: Chronic heart failure in adults: diagnosis and management, Sept 2018

 NICE heart failure treatment pathway

SIGN Guidance

 Guidance 147 Management of chronic heart failure, March 2016

Local Guidance

 Shared care guidelines for prescribing dronedarone (Multaq)

Drug level monitoring of digoxin is recommended because it has a narrow therapeutic index and therefore should be used with caution in the elderly and in renal impairment. Therapeutic concentrations of digoxin are quoted as 0.8 - 2.2 micrograms/L, but results should be interpreted alongside clinical findings and serum potassium levels. Measurement of digoxin levels should be taken at least 6 hours post dose. See local Therapeutic Drug Monitoring Guidance.

Patients are at an increased risk of digoxin toxicity if hypokalaemia occurs.

Administration route: When changing from tablets to elixir, the dose must be reduced by 25%.

Amiodarone requires careful monitoring. See BNF for cautions, side effects, interactions and monitoring

Dronedarone is a derivative of amiodarone. It must be used second line to other anti-arrhythmic agents including amiodarone. See BNF for cautions, side effects, interactions and monitoring. There is a shared care guideline for prescribing

***Note: Beta-adrenoceptor blockers atenolol and bisoprolol, Calcium Channel Blockers Diltiazem and Verapamil are also used for arrhythmias. ***

Pack Price
28 tablet £1.63
500 tablet
Pack Price
28 tablet £1.67
500 tablet
Pack Price
28 tablet £1.67
500 tablet
Pack Price
60 ml £5.35
Pack Price
5 ampoule £3.30

Treatment of ventricular or prophylaxis of supraventricular arrhythmias

Pack Price
100 tablet
28 tablet £1.35
56 tablet
Pack Price
100 tablet
28 tablet £1.43
30 tablet
56 tablet

Supraventricular and ventricular arrhythmias

Pack Price
28 tablet £2.02
Pack Price
28 tablet £1.96
30 tablet
60 tablet
Pack Price
5 ampoule £7.75
Pack Price
120 capsule
40 capsule
84 capsule £26.51
90 capsule
Pack Price
84 capsule £33.09
Pack Price
40 tablet
56 tablet
60 tablet £32.08

Discontinued in 2013

Pack Price
5 ampoule

Supraventricular and ventricular arrhythmias

Pack Price
60 tablet £4.40
Pack Price
100 tablet
60 tablet £4.51
Pack Price
5 ampoule £21.99

Consultant cardiologist initiation only, shared care guidelines available.

Pack Price
20 tablet £22.50
60 tablet

First choice in paroxysmal supraventricular tachycardia

Pack Price
6 vial £6.45
Pack Price
6 vial £16.05

Used for provocation testing in the diagnosis of Brugada syndrome