Ibutilide
Indications
Ibutilide is used for:
Atrial Fibrillation, Atrial Flutter
Adult Dose
Atrial Fibrillation/Flutter
<60 kg: 0.01 mg/kg (0.1 mL/kg) IV infusion repeat after 10 minutes PRN
>60 kg: 1 mg (one vial) IV infusion, repeat after 10 minutes PRN
Hepatic Impairment
Dose adjustment not necessary
Child Dose
Renal Dose
Renal Impairment
Dose adjustment not necessary
Administration
IV Preparation
Dilute in 50 mL NS or D5W to make 0.017 mg/mL solution
IV Administration
IV infusion over 10 min diluted or undiluted
Contra Indications
Prolongs QT interval: concurrent QT-prolonging drugs or congenital long QT patients; QTc >440 msec
Precautions
Administer in a setting of continuous ECG monitoring and by personnel trained in treating arrhythmias such as polymorphic ventricular tachycardia
ANTICIPATE ARRHYTHMIAS, have all materials at hand to handle potential lethal arrhythmias for at least 4-6 hr
A-Fib >2-3 days duration requires anticoagulation prior to therapy
Hypokalemia, hypomagnesemia other electrolyte disturbances must be corrected prior and throughout therapy
Caution in bradycardia, CHF, electrolyte abnormalities, history of polymorphic VT after antiarrhythmic therapy, liver disease, proarrhythmic events, recent MI
Monitor for heart block
Drugs that prolong the QT interval and other class I or class III antiarrhythmic agents should not be given concurrently with ibutilide (or within 4 hours after infusion), other antiarrhythmics should be withheld prior to conversion with ibutilide (eg, 5 half-lives)
Pregnancy-Lactation
Pregnancy Category: C
Lactation: enters breast milk; contraindicated
Interactions
Adverse Effects
Side effects of Ibutilide :
1-10%
Headache (4%)
Bradycardia (2%)
HTN (2%)
Hypotension (2%)
Palpitations (2%)
QTc interval prolongation (<2%)
Nausea (>2%)
< 1%
Heart failure
Erythematous bollous lesions
Nodal arrythmia
Renal failure
Ventricular tachycardia
Syncope
Heart block
Torsades de pointes
Potentially lethal arrhythmias: sustained polymorphic V-Tach (Torsades de Pointes), AV block
Mechanism of Action
Prolongs action potential duration and increase both atrial and ventricular refractoriness (class III effects)
Markedly prolongs action potential and repolarization