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

March 2022: Amiodarone (Cordarone X): reminder of risks of treatment and need for patient monitoring and supervision

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

NICE Guidance (also see drug-specific links below)

NG196: Atrial fibrillation: diagnosis & management, April 2021 (updated June 2021)

Local Guidance

Shared care guideline 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, ONE 62.5micrograms tablet is approximately equivalent to 50micrograms(1mL) elixir.

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 £2.41
500 tablet
Pack Price
28 tablet £2.49
500 tablet
Pack Price
28 tablet £2.36
500 tablet
Pack Price
60 ml £6.95
Pack Price
5 ampoule £3.30

Treatment of ventricular or prophylaxis of supraventricular arrhythmias

Pack Price
28 tablet £0.85
56 tablet
100 tablet
Pack Price
28 tablet £0.93
30 tablet
56 tablet
100 tablet

Supraventricular and ventricular arrhythmias

Pack Price
28 tablet £1.86
Pack Price
28 tablet £1.67
30 tablet
60 tablet
Pack Price
5 ampoule £7.75

Supraventricular and ventricular arrhythmias

Pack Price
40 capsule
84 capsule £14.14
90 capsule
120 capsule
Pack Price
84 capsule
Pack Price
40 tablet
56 tablet
60 tablet £32.08

Consultant cardiologist initiation only, shared care guidelines available.

Pack Price
20 tablet £22.50
60 tablet

Supraventricular and ventricular arrhythmias

Pack Price
60 tablet £2.36
Pack Price
60 tablet £3.67
100 tablet
Pack Price
5 ampoule

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

Pack Price
5 ampoule

Life threatening ventricular arrhythmias

Pack Price
84 capsule