Names and pronunciation
(droe-ned′a-rone) Multaq
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Drug reference
(droe-ned′a-rone) Multaq
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Func. class.: Antidysrhythmic (class III)
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Chem. class.: Iodinated benzofuran derivative
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ACTION: Prolongs duration of action potential and effective refractory period, noncompetitive alpha- and beta-adrener- gic inhibition; increases PR and QT inter- vals, decreases sinus rate, decreases peripheral vascular resistance
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USES: To reduce hospitalization for atrial fibrillation
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CONTRAINDICATIONS: Preg- nancy, breastfeeding; second, third-degree AV block; bradycardia, severe sinus node dysfunction, hypersensitivity, heart failure, hepatic disease, QT prolongation, ami- nodarone-induced lung/liver toxicity
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Black Box Warning: NYHA Class IV heart failure or Class II-III with recent decom- pensation requiring hospitalization, per- manent atrial fibrillation (cannot restore sinus rhythm) Precautions: Children, geriatric pati ents, Asian patients, females, electro- lyte imbalances, atrial fibrillation/flutter Black Box Warning: NYHA Class IV heart failure or symptomatic heart failure with recent decomposition re- quiring hospitalization doubles risk of death • ECG to determine product effective- ness; measure PR, QRS, QT intervals; check for PVCs, other dysrhythmias, B/P continuously for hypo/hyperten- sion; report dysrhythmias, slowing heart rate • Serum creatinine, potassium, magne- sium • I&O ratio; electrolytes (potassium, creatinine, magnesium) • Dehydration or hypovolemia • Rebound hypertension after 1-2 hr • Cardiac rate; respiration: rate, rhythm, character; chest pain; start with patient hospitalized and monitored up to 1 wk • Pregnancy/breastfeeding: do not use in pregnancy, breastfeeding
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SIDE EFFECTS CNS: Weakness CV: Bradycardia, heart failure, QT pro- longation, torsades de pointes, atrial flutter GI: Nausea, vomiting, diarrhea, abdominal pain, severe hepatic injury, hepatic failure INTEG: Rash, photosensitivity, anaphy- laxis, angioedema RESP: Interstitial pneumonitis, pulmo- nary fibrosis
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INTERACTIONS Increase: dronedarone levels—CYP3A inhibitors/2D6 inhibitors Decrease: dronedarone levels—3A/2D6 inducers Increase: bradycardia—beta-blockers, calcium channel blockers Increase: levels of cycloSPORINE, dex- tromethorphan, digoxin, disopyramide, flecainide, methotrexate, phenytoin, procainamide, quiNIDine, theophylline Increase: anticoagulant effects—dabiga- tran, warfarin Drug/Herb Increase: anticoagulant effect—yohimbine Decrease: dronedarone effect—St. John’s wort Drug/Food: Increase: dronedarone effect—grapefruit; avoid use Drug/Lab Test Increase: T4, creatinine, LFTs, bilirubin Decrease: potassium, magnesium
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TREATMENT OF OVERDOSE: O2, artificial ventilation, ECG, administer DOPamine for circulatory depression
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DOSAGE AND ROUTES • Adult: PO 400 mg bid; discontinue class I, III antidysrhythmics or strong CYP3A4 inhibitors prior to beginning treatment; max 800 mg/day; severe he- patic disease
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Available forms: Tablets 400 mg
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Administer: PO route • Give bid with morning, evening meals • Give medication guide; should be dis- pensed with each prescription, refill
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Assess:
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Evaluate: • Therapeutic response: maintenance of normal heart rhythm following atrial fi- brillation, flutter
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take this product as directed in AM, PM with meals; to avoid missed doses; not to use with grapefruit juice, to avoid all other products without approval of pro- vider • To immediately report weight gain, edema, difficulty breathing, fatigue, pe- ripheral edema • Pregnancy/breastfeeding: to use ef- fective contraception during treatment; not to breastfeed
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PHARMACOKINETICS Peak 3-6 hr, half-life 13-19 hr, metabo- lized by liver, by CYP3A excreted in feces (84%), via kidneys (6%), protein bind- ing >98%
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• Adult: PO 400 mg bid; discontinue class I, III antidysrhythmics or strong CYP3A4 inhibitors prior to beginning treatment; max 800 mg/day; severe he- patic disease
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