• Prophylaxis/treatment of serious ventricular arrhythmias, including ventricular tachycardia.

Unlabeled Uses:

• Management of chronic neuropathic pain.

Contraindicated in:

• Hypersensitivity
• Cardiogenic shock
• 2nd- or 3rd-degree heart block (if a pacemaker has not been inserted)
• Lactation: Lactation.

Use Cautiously in:

• Sinus node or intraventricular conduction abnormalities
• Hypotension
• HF
• Severe hepatic impairment (dosage ↓ suggested)
• OB: Pedi: Safety not established.

CNS: dizziness, nervousness, confusion, fatigue, headache, sleep disorder.

EENT: blurred vision, tinnitus.

Resp: dyspnea.

CV: ARRHYTHMIAS, chest pain, edema, palpitations.

GI: HEPATIC NECROSIS, heartburn, nausea, vomiting.

Derm: rash.

Hemat: blood dyscrasias.

Neuro: tremor, coordination difficulties, paresthesia.

Drug-Drug:

• Opioid analgesics, atropine, and antacids may slow absorption.
• Metoclopramide may speed absorption.
• Phenytoin, rifampin, cigarette smoking, orphenobarbital may ↑ metabolism and ↓ effectiveness.
• Cimetidine may ↑ levels.
• May ↑ levels and risk of toxicity from theophylline.
• Additive cardiac effects may occur with other antiarrhythmics.
• Drugs that drastically alter urine pH may alter blood levels (alkalinization ↑ reabsorption and blood levels; acidification ↑ excretion and ↓ levels).

Drug-Food:

• Foods that drastically alter urine pH may alter blood levels. Alkalinization ↑ reabsorption and ↑ levels. Acidification ↑ excretion and may ↓ effectiveness (see Appendix M).

(Generic available)

• Capsules: 100 mg; 150 mg; 200 mg; 250 mg;

• PO (Adults): 400-mg loading dose initially, then 200 mg 8 hr later, then 200–400 mg q 8 hr; dosage alterations of 50–100 mg may be made q 2–3 days. If controlled on 300 mg q 8 hr, can give same daily dose at 12-hr intervals (not to exceed 1200 mg/day). Some patients may require q 6 hr dosing.

Mexitil

• Decreases the duration of the action potential and effective refractory period in cardiac conduction tissue by altering transport of sodium across myocardial cell membranes.
• Has little or no effect on heart rate.

• Control of ventricular arrhythmias.

Therapeutic Classification: antiarrhythmics (class IB)

Absorption: Well absorbed from the GI tract.

Distribution: Enters breast milk in concentrations similar to plasma.

Metabolism/Excretion: Mostly metabolized by the liver; 10% excreted unchanged by the kidneys.

Half-life: 10–12 hr.

(antiarrhythmic effects†)

†Provided a loading dose has been given.

• Advise patient to take medication exactly as directed, at evenly spaced intervals, even if feeling well. Missed doses should be taken within 4 hr or omitted. Do not skip or double up on missed doses.
• Teach patients to monitor pulse. Advise patient to contact health care professional if pulse rate is <50 bpm or becomes irregular.
• May cause dizziness and light-headedness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
• Instruct patient to avoid changes in diet that may drastically acidify or alkalinize the urine (see Appendix M for foods included).
• Advise patient to notify health care professional of disease process and medication regimen prior to treatment or surgery.
• Advise patient to notify health care professional if general tiredness, yellowing of the skin or eyes, fever, sore throat, or persistent side effects occur.
• Patient should carry identification describing disease process and medication regimen at all times.

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