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