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 (updated August 2014)

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 £1.56
500 tablet
Pack Price
28 tablet £1.55
500 tablet
Pack Price
28 tablet £1.55
500 tablet
Pack Price
60 ml £5.35
Pack Price
5 ampoule £3.30

Treatment of ventricular or prophylaxis of supraventricular arrhythmias

Pack Price
28 tablet £1.26
56 tablet
100 tablet
Pack Price
28 tablet £1.38
30 tablet
56 tablet
100 tablet

Supraventricular and ventricular arrhythmias

Pack Price
28 tablet £2.21
Pack Price
28 tablet £2.46
30 tablet
60 tablet
Pack Price
5 ampoule £7.75

Supraventricular and ventricular arrhythmias

Pack Price
40 capsule
84 capsule £26.51
90 capsule
120 capsule
Pack Price
84 capsule £33.09
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 £3.45
Pack Price
60 tablet £4.20
100 tablet
Pack Price
5 ampoule £21.99

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

Ventricular arrhythmias

Pack Price
1 capsule