ibutilide

REMS

Rapid conversion of recent-onset atrial flutter or fibrillation to normal sinus rhythm, including management of atrial flutter or fibrillation occurring within 1 wk of coronary artery bypass or cardiac valve surgery.

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity.

Use Cautiously in:

HF or left ventricular dysfunction (↑ risk of more serious arrhythmias during infusion);
OB: Pregnancy, lactation, or children <18 yr (safety not established).

Adv. Reactions/Side Effects ⬆ ⬇

CV: arrhythmias

GI: nausea

Neuro: headache

Interactions ⬆ ⬇

Drug-drug:

Amiodarone, disopyramide, procainamide, quinidine, and sotalol should not be given concurrently or within 4 hr because of additive effects on refractoriness.
Proarrhythmic effects may be ↑ by phenothiazines, tricyclic and tetracyclic antidepressants, some antihistamines, and histamine H2-receptor blocking agents; concurrent use should be avoided.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 0.1 mg/mL

Route/Dosage ⬆ ⬇

Atrial Fibrillation/Flutter

IV (Adults ≥60 kg): 1 mg infusion; may be repeated 10 min after end of first infusion.
IV (Adults <60 kg): 0.01 mg/kg infusion; may be repeated 10 min after end of first infusion.

Atrial Fibrillation/Flutter After Cardiac Surgery

IV (Adults ≥60 kg): 0.5 mg infusion, may be repeated once.
IV (Adults <60 kg): 0.005 mg/kg infusion, may be repeated once.

US Brand Names ⬆ ⬇

Action ⬆ ⬇

Activates slow inward current of sodium in cardiac tissue, resulting in delayed repolarization, prolonged action potential duration, and increased refractoriness.
Mildly slows sinus rate and AV conduction.

Therapeutic effects:

Conversion to normal sinus rhythm.

Classifications ⬆ ⬇

Therapeutic Classification: antiarrhythmics (class III)

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Unknown.

Metabolism/Excretion: Highly metabolized by the liver, one metabolite is active; metabolites excreted by kidneys.

Half-Life: 6 hr (2–12 hr).

Time/Action Profile ⬆ ⬇

(antiarrhythmic effect)

ROUTE	ONSET	PEAK	DURATION
IV	within 30–90 min	unknown	up to 24 hr

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Indications ⬇