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 (updated August 2014)
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