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2.3 Anti-arrhythmic drugs

2.3 Anti-arrhythmic drugs
Management of arrhythmia, apart from the treatment associated with heart failure, requires precise diagnosis of the type of
arrhythmia and electrocardiography is essential.
            2.3.2 Drugs for arrhythmias
                          In the management of arrhythmias, beta-blockers should also be considered.
                          Supraventricular arrhythmias 
                          RED           Adenosine injection 6mg/2mL
                          Digoxin      see section 2.1.1
                          Verapamil  see section 2.6.2
                          Appraised by NICE in TA197 (August 2010, updated December 2012)as follows:
                          Before starting treatment with dronedarone, prescribers should perform liver function tests. Tests should be
                          repeated  monthly for six months, at months 9 and 12, and periodically thereafter.  Prescribers should
                          stop treatment with dronedarone in patients with raised levels of the liver enzyme alanine aminotransferase

                    (more than three times above the upper limit of normal).

                          Appropriate  investigation and close observation of patients should continue until the enzyme levels return to 
                          MHRA Drug Alert (October 2011) advises of new evidence of cardiovascular, hepatic and pulmonary risk associated
                          with use of dronedarone, such that regular monitoring of cardiac, liver and renal function is recommended during
                          treatment and that patients should be reviewed at their next routine appointment to ensure that they remain
                          eligible for dronedarone treatment according to the revised prescribing information. 
                          AMBER     Dronedarone tablets f/c 400mg
                          Supraventricular and ventricular arrhythmias
                          AMBER     Amiodarone
                                                 tablets 100mg, 200mg
                          RED          Amiodarone   
                                                injection 150mg/3mL
                                                pre-filled syringe 300mg in 10mL
                          AMBER     Flecainide tablets 100mg 
                          RED          Flecainide injection 150mg/15mL
                     Ventricular arrhythmias 
                          RED        Lidocaine / lignocaine 
                                            Min-I-Jet® 2% (20mg/mL) (5mL)
                                            Infusion 0.1% (1mg/mL) and 0.2% (2mg/mL) in glucose intravenous infusion 5% (500mL containers)  

                          Reduction of left ventricular outflow tract gradient [unlicensed use]
                           AMBER     Dispoyramide 100mg capsules
                           Specialist initiation, for use in patients with hypertrophic obstructive cardiomyopathy in cases where beta-blockers/
                           calcium-channel blockers are ineffective.
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