Vaughn

Williams Classification of Antiarrhythmic Medications Chart

e b m c o n s u l t . c o m
Class Mechanism Drug Name Dosage Form Indications Adult Dose Compatibility Elimination Side Effects & Warnings
Ia Net effect: Depress Disopyramide Caps: Approved: VT 150 mg q6h or 300 mg N/A Renal: Dose adjust SE: Hypotension, HF, widened QRS, QT
st
conduction & (Norpace; 100 mg, Non- q12h (if using CR) if CrCl < 40 ml/min prolongation; 1 degree HB (reduce dose),
prolong Norpace CR) 150 mg Approved: anticholinergic effects
repolarization. st nd
AFib Warnings: 1 /2 degree HB
MOA: Moderately Pregnancy Risk: C
blocks fast Na+ Procainamide Inj: 100 mg/ml; Approved: VT 20 to 50 mg/min IV up 0.9% NS Renal: Dose SE: Hypotension, widened QRS, rash,
channels; ↓
500 mg/ml. Oral Non- to maximum of 17 D5%W adjust if CrCl < 50 agranulocytosis, drug induced lupus.
membrane
is discontinued Approved: mg/kg; (Can be given ml/min Warnings: Complete heart block, SLE, Torsades de
responsiveness by ↓
AFib IM) Maintenance: 1-6 Pointes. Monitor N-acetylprocainamide (NAPA)
conduction velocity;
mg/min levels. Pregnancy Risk: C
↑ APD; and ↓ gK+
Quinidine Tab: Approved: PO: 300 mg q8-12h Diluted in 50 Liver: (Sub): SE: QT prolongation, paradoxical ↑ pulse in
thereby ↑ refractory
period. 200 mg AFib, Aflutter, IV: 5-10 mg/kg given ml of D5W CYP3A4; OCTN1/2, AFib/AFlutter, bradycardia in sick sinus syndrome,
Tab XR: 300 mg VT, malaria at Note: binds to Pgp; (Inhib): 2D6, hypotension, diarrhea, vertigo, vision changes
& 324 mg 0.25 mg/kg/min IV tubing (use OCT1, Pgp Warnings: heart block especially without pacemaker
Inj: 80 mg/ml short tubing) Pregnancy Risk: C

Ib Net effect: Depress Lidocaine Inj: Approved: VF, 1-1.5 mg/kg IV/IO x 1; D5W Liver: Half-life is SE: Hypotension; neuro (↓ CNS, dizziness,
conduction with NO (Xylocaine) 0.5% (5mg/ml) VT 0.5-0.75 mg/kg IV D10W less than 30 min drowsiness, and seizures at high levels).
change in or 1% (10 mg/ml) repeat in 3-5 min (max 0.9%NS Warnings: Prophylactic use in AMI; (Warning:
shortened APD 1.5% (15 mg/ml) 3 mg/kg). reduce maintenance dose if liver disease or left
(repolarization) 2% (20 mg/ml) Maintenance: 30-50 ventricular dysfunction); Adam-Stokes Syndrome.
MOA: Weakly blocks µg/kg/min Pregnancy Risk: B
fast Na+ channels; ↓
Mexiletine Caps: VT 200 mg po q8h (max N/A Liver: (Sub): 1A2, SE: Acute liver injury, leukopenia, agranulocytosis,
membrane
(Mexitil) 150 mg, dose 1200 mg/day) 2D6; tremor, blurry vision, lethargy and nausea
responsiveness; may
200 mg, No renal Warnings: sick sinus syndrome, heart block,
shorten APD & end
resting membrane 250 mg hypotension, HF; Pregnancy Risk: C
potential (ERP) by Tocainide Tabs: VT 400 mg po q8h up to N/A Renal: Lower SE: Agranulocytosis, bone marrow suppression,
↑ K+ conductance. (Tonocard) 400 mg, max of 1800 mg/day doses if impaired leukopenia, thrombocytopenia; pulmonary fibrosis;
600 mg renal function worsen HF. Warnings: sick sinus syndrome, heart
block, hypotension, HF; Preg Risk: C

Ic Net effect: Depress Flecainide Tabs: Approved: 50-100 mg q12h (max N/A Liver: SE: New or worsened arrhythmias, worsen HF
membrane (Tambocor) 50 mg PSVT & PAF 400 mg/d) (Sub): CYP2D6 (negative inotropic effects); dose-related ↑ in PR,
responsiveness with 100 mg without Renal: Dose adjust QRS, & QT intervals, heart block.
less tendency to 150 mg Structural if CrCl < 35 ml/min Warnings: Bradycardia, shock, prolonged QT
prolong Heart Disease, interval, CAD; Pregnancy Risk: C
repolarization. VT
MOA: Strongly blocks
Propafenone (IR Tab)s: Approved: IR dosage formulation: N/A Liver: (Sub): SE: New or worsened arrhythmias, worsen HF
fast Na+ channels; ↓
(Rythmol; 150 mg; 225 mg; PSVT & PAF 150 mg q8h with dose CYP1A2, 2D6, 3A4; (negative inotropic effects); dose-related ↑ in PR,
membrane
Rythmoll SR) 300 mg without increased q3-4days up (inhib): Pgp; Dose QRS intervals, heart block, neutropenia and/or
responsiveness by ↓
(SR Tabs): Structural to max of 900 mg/d. adjust with severe agranulocytosis.
conduction velocity;
225 mg; 325 mg; Heart Disease, SR formulation: 225 liver disease Warnings: Bradycardia, shock, prolonged QT
↑ APD; but less ↓ gK+
as compared to class 425 mg VT mg bid (up to 425 mg Renal: Dose adjust interval, CAD
Ia. bid). for CRI Pregnancy Risk: C

II Net effect: Esmolol Premixed bag: Approved: Doses vary based on 0.9%NS RBC esterases: SE: Bradycardia, hypotension, exacerbation of heart
↓chronotropy & (Brevibloc) & 2,500mg/250ml VT, AFib, indication. Please see D5W half-life is 9 min failure, bronchospasm
inotropy by inhibition other β- 2000mg/100ml Aflutter, ST, prescribing Warning: Asthma (especially moderate to severe),
of β1-receptors blockers Inj: 100mg/10ml Intraoperative recommendations. decompensated HF
MOA: ↓gCa++, ↑ gK+ 100mg/5ml HTN Pregnancy Risk: C
 Class Mechanism Drug Name Dosage Form Indications Adult Dose Compatibility Elimination Side Effects & Warnings
III Net effect: Prolong Amiodarone Inj: 50mg/ml Approved: Inj: Pulseless VT/VF: D5W Liver: (Sub): 2C8, Note: Can be used in patients with impaired left
repolarization (Cordarone, PO: 100, 200, VT, VF 300 mg IV/IO push in 0.9%NS 3A4, Pgp; and ventricular dysfunction and WPW.
(recovery) by ↑ Nexterone, 300, 400 mg Other Uses: 20 cc D5W; Other Use non-PVC (Inhib): 1A2, 2C9, SE: Hypo & hyperthyroidism (inj & tab contain 37%
effective refractory Pacerone) tabs AFib, Aflutter, VT/VF: 150 mg IV x 10 bag 2D6, 3A4; Pgp iodine), pulmonary fibrosis, liver toxicity, blue
period and APD. PSVT min, then 360 mg IV x discoloration of skin, optic neuropathy/neuritis, QT
MOA: Inhibition of 6h, then 540 mg x 18h prolongation.
K+ conductance. Warning: heart block; Pregnancy Risk: D
Bretylium Inj: 50 mg/ml, Approved: 5-10 mg/kg IV over > 8 D5W Renal: Consider SE: Hypotension, transient ↑BP & PVCs due to
100mg/100ml, VT, VF min followed by 1-2 0.9%NS dose reductions release of NE, dizziness, hyperthermia
200mg/100ml, mg/min infusion. with CKD Warnings: Aortic stenosis, pulmonary HTN, Digoxin
400mg/100ml toxicity. Pregnancy Risk: C
Dofetilide PO: 0.125 mg, Approved: Dosing ranges: 0.125 – N/A Renal: Dose adjust Note: Prescriber/pharmacy must be registered to
(Tikosyn) 0.25 mg, 0.5 mg Conversion of 0.5 mg bid based on if CrCl < 60ml/min use
caps AFib, AFlutter CrCl and QTc. Liver: (Sub) 3A4 SE: ↑QT interval, Torsade de pointes,
Warnings: Bradycardia with pulse < 50 bpm; CrCl <
20 ml/min, QT interval >440 msec, CYP3A4
inhibitors; Pregnancy Risk: C
Ibutilide Inj: 0.1 mg/ml Approved: >60kg: 1 mg IV x 10 D5W Renal: No dosing SE: ↑QT interval, Torsade de pointes,
(Corvert) Conversion of min; <60kg: 0.1mg/kg 0.9%NS reductions Warnings: Bradycardia with pulse < 50 bpm; CrCl <
AFib, Aflutter IV x 10 min; may needed. 20 ml/min, QT interval >440 msec
repeat x 1 in 20 min Pregnancy Risk: C
Sotalol PO: 80 mg, 120 Approved: VT, Initially: 80 mg bid, N/A Renal: Dose adjust ↑QT interval, Torsade de pointes,
(Betapace AF; mg, 160 mg, 240 AFib, AFlutter then up to 120-160 if <60 ml/min Warnings: Bradycardia, HF, hypokalemia
Sorine) mg tabs mg bid Pregnancy Risk: B

IV Net effect: ↓ Diltiazem Inj: 5 mg/ml, Approved: 15-20 mg IV x 2 min; D5W Liver: (Sub): 3A4, SE: Bradycardia, HB, worsening of HF, ↓BP
chronotropy & (Cardizem, 10 mg/ml AFib, AFlutter repeat in 15 min at 20- 0.9%NS Pgp; (Inhib): 1A2, Warnings: WPW, sick sinus syndrome, HB
inotropy; MOA: ↓ SA Cartia) with RVR 25 mg 3A4, Pgp Pregnancy Risk: C
& AV nodal Verapamil Inj: 2.5 mg/ml Approved: 2.5-5 mg IV over 2 Compatible in Liver: (Sub): 2C8, SE: Bradycardia, HB, worsening of HF, ↓BP
conduction of Ca+ (Calan, Angina, AFib, min; then 5-10 mg (if NS or D5W up 3A4, Pgp; (Inhib): Warnings: WPW, sick sinus syndrome, HB, other AV
through a blockade Covera-HS, Aflutter with needed) q15-30min to 0.16 mg/mL 3A4, Pgp nodal blockers
of voltage gated Ca+ Isoptin, RVR (max dose 20mg). Pregnancy Risk: C
channels.
Verelan

Misc Net effect: ↓ AV Adenosine Inj: 3 mg/ml Approved: 6 mg IV rapid bolus 0.9%NS N/A; SE: AV Block, flushing, chest “burning” due to
node conduction (Adenocard) PSVT over 1-3 sec & a 20 ml half-life < 10 secs bronchospasm (respiratory alkalosis via stimulation
velocity, ↑ refractory bolus of NS; repeat of respirations), brief period of asystole on monitor.
period; MOA: ↑gK with 12 mg in 1-2 min Warnings: HB, wide-complex VT
Pregnancy Risk: C
Net effect: ↓ Digoxin Inj: 0.1 mg/ml, Approved: 0.4-0.6 mg IV over ≥ 5 4-fold volume Renal: (Sub): SE: Arrhythmias, N/V
chronotropy & ↑ (Lanoxin) 0.25 mg/ml AFib, AFlutter min; may repeat 0.1- of D5W or OATP1B3, Pgp, Warnings: Bradycardia, HB, renal failure,
inotropy; MOA: ↑ with RVR; HF 0.3 mg IV over ≥ 5min 0.9%NS to MDR3 hypokalemia.
PNS; ↑gK & ↓gCa. ↓precipitation Pregnancy Risk: C
Net effect: Combined Dronedarone PO: 400 mg tabs Approved: 400 mg bid with meals N/A Liver: (Sub): 3A4; Note: Stop class I or III agents first.
effects of classes I-IV (Multaq) AFib/Aflutter (Inhib): 2D6, 3A4 SE: heart failure, heart block, bradycardia, QT
prolongation. Warnings: Use with 3A4 inhibitors,
Class IV heart failure, liver disease. Pregnancy Risk:
X;
Note: Doses provided are general recommendations for acute care situations and should be verified for the indication being treated. Use of this chart does not replace clinical judgement. AFib = atrial fibrillation, Aflutter = atrial flutter, APD = action
potential duration, Caps = capsule, CrCl = creatinine clearance, HB = heart block, HTN = hypertension, Inj = injection, IR = immediate release; IV = intravenous, NS = normal saline, Pgp = P-glycoprotein, MDR3 = multidrug resistant protein 3, PAF =
paroxysmal atrial fibrillation, PNS = parasympathetic nervous system; PO = by mouth, SR = sustained release; Tabs = tablets, VT = ventricular tachycardia, VF = ventricular fibrillation, WPW = Wolf-Parkinson-White.
Version 3.2016. Created & Reviewed by: Anthony Busti, MD, PharmD, FNLA, FAHA; Krystal Haase, PharmD, BCPS, FCCP; Sarah Dehoney, PharmD, BCPS. Please go to www.ebmconsult.com for current legends, updated versions & disclaimer. The
user is responsible to verify the accuracy of the information as it relates to their practice.