DRONEDARONE

Indications & Dose:

Maintenance of sinus rhythm after cardioversion in clinically stable patients with paroxysmal or persistent atrial fibrillation, when alternative treatments are unsuitable (initiated under specialist supervision)

% BY MOUTH

% Adult: 400 mg twice daily

Contraindications:

Atrial conduction defects

. bradycardia . complete bundle branch block . distal block . existing or previous heart failure or left ventricular systolic dysfunction . haemodynamically unstable patients . liver toxicity associated with previous amiodarone use

. lung toxicity associated with previous amiodarone use . permanent atrial fibrillation . prolonged QT interval . second- or third- degree AV block . sick sinus syndrome (unless pacemaker fitted) . sinus node dysfunction

Side Effects:

Common or very common Bradycardia . gastro-intestinal disturbances . heart failure . malaise . pruritus . QT-interval prolongation . raised serum creatinine . rash

% Uncommon Dermatitis . eczema . erythema . interstitial lung disease (investigate if symptoms such as dyspnoea or dry cough develop and discontinue treatment if confirmed) . photosensitivity . pneumonitis (investigate if symptoms such as dyspnoea or dry cough develop and discontinue treatment if confirmed) . pulmonary fibrosis (investigate if symptoms such as dyspnoea or dry cough develop and discontinue treatment if confirmed) . taste disturbance

% Rare Liver injury (including life-threatening acute liver failure)

SIDE-EFFECTS, FURTHER INFORMATION Liver injury, including life-threatening acute liver failure reported rarely; discontinue treatment if 2 consecutive alanine aminotransferase concentrations exceed 3 times upper limit of normal.

New onset or worsening heart failure reported. If heart failure or left ventricular systolic dysfunction develops, discontinue treatment.

PREGNANCY Manufacturer advises avoid— toxicity in animal studies.

BREAST FEEDING Manufacturer advises avoid—present in milk in animal studies. HEPATIC IMPAIRMENT Avoid in severe impairment.

RENAL IMPAIRMENT Avoid if eGFR less than 30 mL/minute/1.73m2.

Cautions:

Coronary artery disease . correct hypokalaemia and hypomagnesaemia before starting and during treatment

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