Adult Dosing

Ventricular fibrillation or hemodynamically unstable ventricular tachycardia

• 1-2 mg/min continuous IV infusion
• Maintenance dose: 5-10 mg/kg IV over a period >8 minutes, q6hrs

Other ventricular arrhythmias

• Administer 5-10 mg/kg IV over a period >8 minutes
• If arrhythmia persists administer subsequent doses at 1-2 hr intervals
• Maintenance dose: 5 to 10 mg/kg IV q6hrs; Alt 1-2 mg/min continuous IV infusion

• Patient should be placed in supine position during treatment or should be monitored for postural hypotension
• Cardiopulmonary resuscitative procedures, including electrical cardioversion, should be used before initiating dose
• Rapid infusion may cause nausea and vomiting, and may increase risk of orthostatic hypotension in patients older than 65 years
• There is limited experience with administration of doses >40mg/kg/day, however clinical use of such doses has not been associated with adverse effects

Pediatric Dosing

• Safety and efficacy in pediatric patients have not been established

• Prophylaxis and management of ventricular fibrillation
• Ventricular arrhythmias refractory to first-line antiarrhythmic agents

• Hypersensitivity to any of the ingredients of the product

• N/A

Renal Dose Adjustment

• Renal impairment: Reduce the dose and increase dosage interval

Hepatic Dose Adjustment

• Hepatic impairment: Dose adjustments not defined

• Postural hypotension, dizziness, light-headedness, vertigo or faintnessin have been reported in patients during treatment. Hypotension may occur at doses lower than those required to suppress arrhythmias. Increased risk of orthostatic hypotension may occur in patient >65 yrs when the recommended rate of intravenous infusion is exceeded
• Transient hypertension or increased frequency of premature ventricular contractions and other arrhythmias may occur in patients treated with bretylium
• Use cautiously during use with digitalis glycosides. Bretylium should be used only if the cause of the arrhythmia does not appear to be digitalis toxicity and other antiarrhythmic drugs are ineffective. Avoid concomitant use of digitalis glycosides and bretylium
• Avoid bretylium in patients with fixed cardiac output as severe hypotension may result from a fall in peripheral resistance without a compensatory increase in cardiac output
• Hyperthermia may occur in patients treated with bretylium. If hyperthermia is diagnosed, discontinue bretylium and provide appropriate treatment

Pregnancy Category:C

Breastfeeding: Safety unknown. Little information is published about bretylium during breastfeeding, other agents may be preferred, especially while nursing a newborn or preterm infant. Breastfed infants should be carefully monitored if this drug is used during lactation, possibly including measurement of serum levels to rule out toxicity if there is a concern. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 09 January 2013).

• CV: Hypotension, postural hypotension, bradycardia, arrhythmias, anginal attacks, shortness of breath
• CNS: Dizziness, light-headedness, syncope
• PSYCHIATRY: Confusion, paranoid psychosis, emotional lability, anxiety
• GI: Nausea, vomiting, diarrhea, abdominal pain, hiccups
• GU: Renal dysfunction
• DERM: Erythematous macular rash, flushing, diaphoresis
• EENT: Vertigo, nasal stuffiness, mild conjunctivitis
• MISC: Hyperthermia, lethargy, generalized tenderness

• Class III antiarrhythmic; inhibits norepinephrine release by depressing adrenergic nerve terminal excitability
• No identifiable metabolites
• Renally excreted in unchanged form
• Half-life
• Normal Patients: 7.8 +/- 0.6 hrs
• Patient on hemodialysis: 13 hrs

US Trade Name(s)

• Only generic available

US Availability

bretylium (generic)

• INJ in 5% Dextrose: 100 mg/100 mL
• INJ in 5% Dextrose: 200 mg/100 mL
• INJ in 5% Dextrose: 400 mg/100 mL

Canadian Trade Name(s)

• Only generic available

Canadian Availability

bretylium (generic)

• INJ: 50 mg/mL

UK Trade Name(s)

• N/A

UK Availability

• N/A

Australian Trade Name(s)

• N/A

Australian Availability

• N/A

Cardiovascular

Antiarrhythmic Agents

Group III Antiarrhythmics