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All about: Ibutilide Fumarate

Big Image Pronouncation: (ih-BYOO-tih-lide FEW-muh-rate)
Class: Antiarrhythmic agent

Trade Names:
Corvert
- Solution 0.1 mg/mL

Mechanism of Action

Pharmacology

Prolongs atrial and ventricular action potential duration and refractoriness by activation of a slow inward current (predominantly sodium).

Pharmacokinetics

Distribution

Vd at steady state is approximately 11 L/kg. Approximately 40% is protein bound.

Metabolism

8 metabolites are formed via oxidation. Only the ω-hydroxy metabolite possesses activity similar to ibutilide.

Elimination

Cl is 29 mL/min/kg. Approximately 82% is excreted in the urine (7% unchanged) and approximately 19% in feces. The mean t ½ is approximately 6 h (range is 2 to 12 h).

Indications and Usage

Rapid conversion of recent onset atrial fibrillation or atrial flutter to sinus rhythm.

Contraindications

Standard considerations.

Dosage and Administration

Adults

IV Initial infusion: At least 60 kg (at least 132 lbs) 1 mg (1 vial) infused over 10 min; less than 60 kg (less than 132 lbs) 0.01 mg/kg (0.1 mL/kg) infused over 10 min. If the arrhythmia does not terminate within 10 min after the end of the initial infusion, a second 10 min infusion of equal strength may be administered 10 min after completion of the first infusion.

General Advice

  • For IV administration only.
  • May be administered undiluted or further diluted in 50 mL of either normal saline or D5W.

Storage/Stability

  • Store unopened vials at room temperature (59° to 86°F).
  • Diluted medication may be stored for up to 24 h at room temperature (59° to 86°F), or for 48 h refrigerated (36° to 46°F).

Drug Interactions

Concomitant Class Ia and III antiarrhythmic agents (eg, amiodarone, disopyramide, procainamide, quinidine, sotalol)

Do not give concurrently. Withhold for 5 half-lives prior to and for 4 h after ibutilide infusion.

Medications that prolong the QT interval (eg, phenothiazines, tricyclic and tetracyclic antidepressants)

Potential for proarrhythmia may be increased.

Digoxin

Cardiotoxicity (supraventricular arrhythmia) due to excessive digoxin concentrations may be masked.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Nonsustained monomorphic ventricular extrasystoles and ventricular tachycardia (VT); sinus; supraventricular sustained and nonsustained polymorphic VT; hypotension; postural hypotension; hypertension; bundle branch block; sustained polymorphic VT; AV block; sinus bradycardia; QT segment prolongation; palpitations.

CNS

Headache.

GI

Nausea.

Precautions

Warnings

Experienced physician/equipped facility.

Potentially fatal arrhythmias have occurred and require administration in a setting of continuous ECG monitoring and personnel trained in identification and treatment of acute ventricular arrhythmias, particularly polymorphic ventricular tachycardia.

Patient selection

Patients with chronic atrial fibrillation have a strong tendency to revert after conversion to sinus rhythm, and treatment to maintain sinus rhythms carry risks. Patients for ibutilide therapy should be carefully selected.


Pregnancy

Category C .

Lactation

Undetermined.

Children

Safety and efficacy not established.

Elderly

No age-related differences in safety and efficacy have been observed.

Hypokalemia/Hypomagnesemia

Correct hypokalemia/hypomagnesemia to reduce potential for proarrhythmia.

Anticoagulation

Patients with atrial fibrillation more than 2 to 3 days must be adequately anticoagulated, generally for at least 2 wk before attempted conversion.

Overdosage

Symptoms

CNS toxicity, rapid gasping breathing, convulsions, ventricular ectopy, ventricular tachycardia, AV block.

Patient Information

  • Advise patient that this is a short-term treatment for arrhythmia, and long-term oral medications will likely be required for control if this therapy is successful.
  • Teach patient and family how to take blood pressure and pulse for home management with medications.
  • Advise patient to report any chest pain, shortness of breath, palpitations, fluttering in the chest, headache, or faintness immediately to the health care provider while the medication is infusing.

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