ibutilide

REMS

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

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.

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

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: QT interval prolongation, VENTRICULAR ARRHYTHMIAS, TORSADES DE POINTES

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.

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.

Availability ⬆ ⬇

(Generic available)

Solution for injection: 0.1 mg/mL

Assessment ⬆ ⬇

Monitor ECG continuously throughout and for 4 hr after infusion or until QT interval normalizes. Discontinue if arrhythmia terminates or if sustained ventricular tachycardia, prolonged QT, or QT develops. Ibutilide may have proarrhythmic effects. These arrhythmias may be serious and potentially life-threatening. Clinicians trained to treat ventricular arrhythmias, medications, and equipment (defibrillator/cardioverter) should be available during therapy and monitoring of patient.

Lab Test Considerations:

Correct hypokalemia and hypomagnesemia before starting therapy.

Implementation ⬆ ⬇

Oral antiarrhythmic therapy may be instituted 4 hr after ibutilide infusion.

IV Administration:

Intermittent Infusion: Diluent: May be administered undiluted or diluted in 50 mL of 0.9% NaCl or D5W. Diluted solution is stable for 24 hr at room temperature or 48 hr if refrigerated. Concentration: Undiluted: 0.1 mg/mL; Diluted: 0.017 mg/mL.
Rate: Administer over 10 min.
Y-Site Compatibility:
- argatroban

Patient/Family Teaching ⬆ ⬇

Inform patient of the purpose of ibutilide.

Evaluation/Desired Outcomes ⬆ ⬇

Conversion of recent-onset atrial flutter or fibrillation to sinus rhythm.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

0009- Pharmacia & Upjohn Company LLC
- 0009-3794- Corvert
  - 0009-3794-01- 1 VIAL, SINGLE-DOSE in 1 CARTON (0009-3794-01) / 10 mL in 1 VIAL, SINGLE-DOSE

0009- Pharmacia & Upjohn Company LLC
- 0009-3794- Corvert
  - 0009-3794-22- 1 VIAL, SINGLE-DOSE in 1 CARTON (0009-3794-22) / 10 mL in 1 VIAL, SINGLE-DOSE

14474- Sai Life Sciences Limited
- 14474-040-
  - 14474-040-01- 25 g in 1 PACKAGE (14474-040-01)

14593- Emcure Pharmaceuticals Limited
- 14593-858-
  - 14593-858-01- 5 kg in 1 JAR (14593-858-01)

14593- Emcure Pharmaceuticals Limited
- 14593-858-
  - 14593-858-02- 15 kg in 1 DRUM (14593-858-02)

14593- Emcure Pharmaceuticals Limited
- 14593-858-
  14593-858-03- 50 kg in 1 DRUM (14593-858-03)

23155- Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc.
- 23155-326- Ibutilide Fumarate
  23155-326-31- 1 VIAL, GLASS in 1 CARTON (23155-326-31) / 10 mL in 1 VIAL, GLASS

67457- Mylan Institutional LLC
- 67457-366- Ibutilide Fumarate
  - 67457-366-10- 1 VIAL, GLASS in 1 CARTON (67457-366-10) / 10 mL in 1 VIAL, GLASS

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇