Department of Therapy

Presented by: Mohamed Fazneen LatheefGroup no:17

6th Year

Antiarrhythmic Drugs

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INTRODUCTIONDrugs that modify the rhythm and

conduction of the heart are used to prevent cardiac arrhythmias.

All such drugs may aggravate or produce arrhythmias and they may also depress ventricular contractility.

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Vaughan Williams classificationClass 1a

Class 1b

Class 1c

Class 2

Quinidine, Procainamide, Disopyramide

Lidocaine, Mexiletine, Tocainide

Flecainide,Propafanone

Beta adrenergic blocking agents

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Vaughan Williams classificationClass 3

Class 4

Others

Amiadarone, Sotalol, Bretylium, Ibutilide,Dofetilide

Verapamil, Diltiazem

Adenosine, Digoxin

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Class 1 Drugs• These are membrane depressant

drugs.• They reduce the rate of entry of

sodium into the cell• They may slow conduction,delay

recovery or reduce the spontaneous discharge of myocardial cells

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Class 2 Drugs• These anti-sympathetic drugs

prevent the effects of catecholamines on the action potential.

• Most are beta adrenergic antagonists• Cardioselective beta blockers

include,metoprolo,atenalol,acebutalol

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Class 3 Drugs• These prolong the action potential

and do not effect sodium transport through the membrane.

• Two major classes: Amiadarone and Sotalol(Beta blocker)

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Class 4 Drugs• The non-dihydropyridine calcium

antagonists that reduce the plateau phase of the action potential and particularly effective at slowing conduction in the nodal tissue.

• Verapamil n Diltiazem are the most important drugs in this group

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QuinidineClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

1a250-500mg orally75%6hours2-5microgram/mlAFPSVTVTVPBWPW

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Side effects of Quinidine• Nausea• Diarrhoea• Blood Dyscrasia• Rash• Fever• Cinchonism• Syncope

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DisopyramideClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

1a100-250mg thrice oral40-90%5hours3-6microgram/mlAFPSVTVTVPBWPW

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Disopyramide SE• Hypotension• Anticholinergic effects• Dry mouth• Urinary hesitancy• Blurred vision• Heart failure

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LidocaineClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

1b1-4mg/min50-80%1.5-2hours2-6microgram/mlVT/VFMIVPB

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Lidocaine SE• Confusion• Convulsion

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MexiletineClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

1b400-800mg orally70%15hours0.5-2microgram/mlVTMI

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Mexiletine SE• Confusion• Tremor• Bradycardia• Hypotension

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FlecainideClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

1c100mg twice orally50%18hours0.2-0.8microgram/mlVTPSVTWPW

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Flecainide SE• Dizziness• Visual disturbance• Arrhythmogenesis

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PropafenoneClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

1c150mg thrice85%6hours0.2-1.5microgram/mlVT/VFPSVTWPW

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Propafenone SE• Light headedness• Unusual taste• Headache• Constipation• Arrhythmogenesis

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AmiodaroneClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

3200mg twice orally98%50days plus0.2-5micrograms/mlVT/VFWPWPSVTAF

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Amiodarone SE• Corneal deposits• Photosensitivity• Skin pigmentation• Thyroid disturbance• Pulmonary alveolitis• Nightmares• Liver disease• Neurological

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SotalolClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

2/380-160mg thrice orally<10%24hours0.3-1.5micrograms/mlVTWPWPSVT

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Sotalol SE• Ventricular arrhythmias• Bradycardia• Heart failure• Bronchospasm• Hypotension

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VerapamilClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

40.1mg/kg IV90%6hours0.1-0.3micrograms/

mlPSVT

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Verapamil SE• Nausea• Vomiting• Constipation• Flushing• Headache• Bradycardia• Fluid retention• Hypotension

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DiltiazemClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

460-120mg thrice

orally80%2-8hours0.02-0.16microgm/mlPSVT

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Diltiazem SE• Nausea• Vomiting• Constipation• Flushing• Headache• Bradycardia• Fluid retention• Hypotension

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DigoxinClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication

N/A0.25mg once orally25%36hours1.3-2.6millimol/LAF/AFLPSVT

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Digoxin SE• Nausea• Anorexia• Vomiting• Visual disturbances• Bradycardia• Gynaecomastia