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cardio:arrhythmias:dronedarone

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cardio:arrhythmias:dronedarone [2026/02/15 03:12] – created andrew2393cnscardio:arrhythmias:dronedarone [2026/02/15 03:15] (current) – andrew2393cns
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 ^ Dronedarone | {{ :cardio:arrhythmias:dronedarone_structure.svg?200 |}} | ^ Dronedarone | {{ :cardio:arrhythmias:dronedarone_structure.svg?200 |}} |
 | Brand Name | Multaq® | | Brand Name | Multaq® |
-| Drug Class | [[cardio:antiarrhythmics:start|Class III Antiarrhythmic]] | +| Drug Class | [[cardio:arrhythmias:start|Class III Antiarrhythmic]] | 
-| Vaughan-Williams Class | Class III (Multichannel blocker) |+| Vaughan-Williams Class | Class III (Multichannel Blocker) |
 | Primary Indication | Atrial Fibrillation / Atrial Flutter | | Primary Indication | Atrial Fibrillation / Atrial Flutter |
 | QT Prolongation | Yes | | QT Prolongation | Yes |
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 ===== Overview ===== ===== Overview =====
  
-Dronedarone is a multichannel antiarrhythmic agent structurally related to amiodarone but lacking iodine moieties.+Dronedarone is a multichannel antiarrhythmic agent structurally related to [[cardio:arrhythmias:amiodarone|Amiodarone]] but without iodine moieties.
  
 It is used for rhythm control in paroxysmal or persistent atrial fibrillation (AF) and atrial flutter (AFL). It is used for rhythm control in paroxysmal or persistent atrial fibrillation (AF) and atrial flutter (AFL).
  
-Compared to amiodarone, dronedarone has fewer thyroid and pulmonary toxicities but is less effective and carries a black box warning in patients with heart failure.+Compared to amiodarone, dronedarone has fewer thyroid and pulmonary toxicities but is less effective and carries a boxed warning in patients with heart failure.
  
 <WRAP clear></WRAP> <WRAP clear></WRAP>
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 Dronedarone blocks multiple cardiac ion channels: Dronedarone blocks multiple cardiac ion channels:
  
-  * Potassium channels (prolongs repolarization → ↑ QT interval) +  * Potassium channels → ↑ action potential duration → ↑ QT interval   
-  * Sodium channels +  * Sodium channels   
-  * Calcium channels +  * Calcium channels   
-  * Noncompetitive beta-adrenergic receptor antagonism+  * Noncompetitive β-adrenergic receptor antagonism  
  
-Net effect: +Net effects: 
-  * Prolonged action potential duration +  * Prolonged repolarization   
-  * Slowed AV nodal conduction +  * Slowed AV nodal conduction   
-  * Reduced risk of AF recurrence+  * Reduced AF recurrence  
  
-Multichannel blockade resembles amiodarone but with shorter half-life.+Mechanistically similar to amiodarone but with shorter half-life and less tissue accumulation.
  
 ---- ----
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 Goal: Goal:
-  * Reduce hospitalization due to AF  +  * Reduce hospitalization in AF  
  
 Not indicated for: Not indicated for:
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 ===== Black Box Warning ===== ===== Black Box Warning =====
  
-Dronedarone increases the risk of death in:+Dronedarone increases risk of death in:
  
-  * Patients with symptomatic heart failure (NYHA Class III or IV)  +  * Symptomatic heart failure (NYHA Class III or IV)  
   * Recently decompensated heart failure     * Recently decompensated heart failure  
   * Permanent atrial fibrillation     * Permanent atrial fibrillation  
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 Absorption: Absorption:
-  * Oral; improved with food  +  * Oral; increased with food  
  
 Metabolism: Metabolism:
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 Elimination: Elimination:
-  * Fecal (primary)  +  * Primarily fecal  
  
-Shorter half-life than amiodarone.+Shorter half-life and less tissue accumulation than amiodarone.
  
 </WRAP> </WRAP>
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   * Heart failure exacerbation     * Heart failure exacerbation  
  
-Less pulmonary and thyroid toxicity compared to amiodarone.+Lower risk of: 
 +  * Thyroid toxicity (no iodine)   
 +  * Pulmonary fibrosis   
 + 
 +Compared to [[cardio:arrhythmias:amiodarone|Amiodarone]].
  
 </WRAP> </WRAP>
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 QT-prolonging agents: QT-prolonging agents:
   * Fluoroquinolones     * Fluoroquinolones  
-  * Other antiarrhythmics   +  * Other Class III antiarrhythmics  
- +
-Warfarin: +
-  * May increase INR  +
  
 Digoxin: Digoxin:
   * Increases digoxin levels     * Increases digoxin levels  
 +
 +Warfarin:
 +  * May increase INR  
  
 </WRAP> </WRAP>
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   * Electrolytes     * Electrolytes  
  
-Avoid use if patient converts to permanent AF.+Discontinue if patient develops permanent AF.
  
 </WRAP> </WRAP>
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 ===== Clinical Pearls ===== ===== Clinical Pearls =====
  
-  * Structurally related to amiodarone but lacks iodine.   +  * Structurally similar to amiodarone but lacks iodine.   
-  * Fewer thyroid and pulmonary toxicities than amiodarone.  +  * Less effective than amiodarone.   
 +  * Fewer thyroid and pulmonary toxicities.  
   * Contraindicated in symptomatic heart failure.     * Contraindicated in symptomatic heart failure.  
-  * Not effective for permanent AF.   +  * Not used for ventricular arrhythmias.  
-  * Shorter half-life than amiodarone.  +
  
 </WRAP> </WRAP>
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 ===== Comparison Within Class ===== ===== Comparison Within Class =====
  
-Compared to [[cardio:antiarrhythmics:amiodarone|Amiodarone]]:+Compared to [[cardio:arrhythmias:amiodarone|Amiodarone]]:
   * Less effective     * Less effective  
-  * Less organ toxicity   +  * Fewer organ toxicities  
-  * No iodine  +
   * Shorter half-life     * Shorter half-life  
  
-Compared to [[cardio:antiarrhythmics:sotalol|Sotalol]]: +Compared to [[cardio:beta_blockers:sotalol|Sotalol]]: 
-  * Multichannel blocker vs pure Class III + beta-blocker   +  * Multichannel blockade vs β-blocker + K channel block   
-  * No renal dosing required  +  * No renal dosing requirement  
  
-Compared to [[cardio:antiarrhythmics:dofetilide|Dofetilide]]: +Compared to [[cardio:arrhythmias:dofetilide|Dofetilide]]:
-  * Less torsades risk  +
   * No inpatient loading required     * No inpatient loading required  
 +  * Lower torsades risk  
  
 ---- ----
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 ===== Related ===== ===== Related =====
  
-  * [[cardio:antiarrhythmics:start|Antiarrhythmics]] 
-  * [[cardio:antiarrhythmics:amiodarone|Amiodarone]] 
-  * [[cardio:antiarrhythmics:sotalol|Sotalol]] 
   * [[cardio:arrhythmias:start|Arrhythmias]]   * [[cardio:arrhythmias:start|Arrhythmias]]
 +  * [[cardio:arrhythmias:amiodarone|Amiodarone]]
 +  * [[cardio:beta_blockers:sotalol|Sotalol]]
 +  * [[cardio:arrhythmias:dofetilide|Dofetilide]]
cardio/arrhythmias/dronedarone.1771125171.txt.gz · Last modified: by andrew2393cns