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ibutilide (Corvert)
Tradename: Corvert. (ibutilide fumarate) Presumptive Group 1c anti-arrhythmic agent.
Indications:
- cardioversion of acute atrial fibrillation/flutter of recent onset
Dosage:
1) 0.01 mg/kg up to 1 mg IV over 10 minutes
2) may repeat if no response in 10 minutes Injection (fumarate): 0.1 mg/mL (10 mL).
Pharmacokinetics:
1) onset of action:
a) within 90 minutes after start of infusion
b) 1/2 of conversions occur during infusion
2) extensively metabolized in the liver
3) elimination 1/2life 2-12 hours
4) parent drug & metabolite eliminated in urine
Monitor:
1) continuous EKG for at least 4 hours following infusion until QTc has returned to baseline
2) electrolytes (including Mg+2 & K+) should be corrected prior to administration
Adverse effects:
1) less common (1-10%)
1) QT prolongation (Torsades de pointes in 2-8%)
2) non-sustained monomorphic & polymorphic ventricular tachycardia
3) non-sustained monomorphic ventricular extrasystoles
4) supraventricular tachycardia
5) hypotension
6) bundle-branch block
7) AV block
8) bradycardia
9) hypertension
10) palpitations
11) headache
12) nausea
2) uncommon (< 1%)
- supraventricular extrasystoles, nodal arrhythmia, congestive heart failure, syncope, idioventricular rhythm, sustained monomorphic ventricular tachycardia, renal failure
Drug interactions:
1) prolonged refractoriness with:
a) class Ia anti-arrhythmic agents
b) other class III anti-arrhythmic agents
2) risk of excessive QT interval prolongation with:
a) phenothiazines
b) tricyclic antidepressants (TCA)
c) cisapride
d) non-sedating antihistamines: astemizole & terfenadine
3) masking of signs of digoxin toxicity
Interactions
drug interactions
drug adverse effects of antiarrhythmic agent, Group IC
General
antiarrhythmic agent, Group IC
Properties
MISC-INFO: elimination route LIVER
KIDNEY
1/2life 2-12 HOURS
pregnancy-category C
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Mountantonakis SE, Moutzouris DA, Tiu RV, Papaioannou GN,
McPherson CA.
Ibutilide to expedite ED therapy for recent-onset atrial
fibrillation flutter.
Am J Emerg Med. 2006 Jul;24(4):407-12.
PMID: 16787796