Medications for Arrhythmias (Heart Rhythm Disturbances)

The medicines below are used to treat arrhythmias. Only the most basic problems are listed. Ask your doctor if there are any other steps you need to take. Use each of them as your doctor tells you. If you have any questions or can’t follow directions on the package, call your doctor.

How an arrhythmia is treated depends on the type and how serious it is. Medicines are mainly used to treat how fast your heart is beating. These may be:

Prescription Medicines

Class IA

  • Quinidine
  • Procainamide
  • Disopyramide

Class IB

  • Phenytoin
  • Tocainide
  • Mexiletine

Class IC

  • Flecainide
  • Propafenone
  • Moricizine

Class II: Beta-blockers

  • Propranolol
  • Metoprolol

Class III

  • Bretylium
  • Amiodarone
  • Sotalol
  • Ibutilide
  • Dofetilide

Class IV: Calcium Channel Blockers

  • Diltiazem
  • Verapamil

Miscellaneous

  • Digitalis glycosides
  • Adenosine

Prescription Medicines

These act to slow the electrical action in the heart. But, they may work in different ways. Many of them have other uses such as treating high blood pressure. All may have serious side effects. Use them as advised.

Class I

Class IA

Common names:

  • Quinidine
  • Procainamide
  • Disopyramide
Class IB

Common names:

  • Phenytoin
  • Tocainide
  • Mexiletine
Class IC

Common names:

  • Flecainide
  • Propafenone
  • Moricizine

These are the most prone to cause problems in other parts of the body.

Some problems are:

  • Seizures
  • Confusion
  • Mental changes
  • Unwanted heart rhythm changes
  • Nausea
  • Dry mouth
  • Vomiting
  • Diarrhea
  • Constipation
  • Bone marrow damage
  • Clumsiness
  • Vision and hearing changes
  • Rashes
  • Coma

Class II: Beta-blockers

Common names:

  • Propranolol
  • Metoprolol

There are many types of beta-blockers. But, these are the main ones used to treat arrhythmias. All beta-blockers are used for blood pressure control or to treat angina.

Side effects are less wide ranging than Class I drugs.

Some problems are:

Class III

Common names:

  • Bretylium
  • Amiodarone
  • Sotalol
  • Ibutilide
  • Dofetilide

These agents are mainly reserved for life-threatening ventricular arrhythmias. They can also help if other treatments aren’t working.

Some problems are:

  • Lightheadedness
  • Nausea
  • Unwanted heart rhythm changes
  • Liver problems (sotalol, amiodarone)
  • Damage to the:
    • Lungs (sotalol, amiodarone)
    • Eyes (amiodarone)
    • Nerves (sotalol)
    • Muscles (sotalol)
    • Thyroid (sotalol, amiodarone)

Class IV: Calcium Channel Blockers

  • Diltiazem
  • Verapamil

Many of these types are used to lower blood pressure or treat angina.

Some problems are:

  • Lightheadedness
  • Nausea
  • Water retention

Rare, but serious problems:

  • Damage to your liver, kidney, or bone marrow
  • Worsening heart failure
  • Unwanted heart rhythm changes

Miscellaneous

Digitalis Glycosides

These are very helpful for treating heart failure. But, they have much more restricted use in treating heart rhythm problems. They are mainly used to control the rate of ventricular response to tachyarrhythmias. Digitalis glycosides have a narrow window of taking too little or too much.

Some problems are:

  • Nausea
  • Vomiting
  • Unwanted heart rhythm changes

Adenosine

Adenosine is given intravenously to stop certain tachyarrhythmias.

Some problems are:

  • Chest pressure
  • Breathing problems
  • Nausea
  • Flushing
  • Headache
  • Lightheadedness

Special Considerations

If you are taking medicines:

  • Take the medicine as directed. Don’t change the amount or the schedule.
  • Ask what side effects could occur. Report them to your doctor.
  • Talk to your doctor before you stop taking any prescription medicine.
  • Don’t share your prescription medicine.
  • Medicines can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medicine. This includes over-the-counter products and supplements.
  • Plan for refills as needed.

References:

Antiarrhythmic drug classification and pharmacology. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated February 22, 2017. Accessed January 3, 2019.
Arrhythmia. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/arrhythmia. Accessed January 3, 2019.
Colucci R, Silver M, Shubrook J. Common types of supraventricular tachycardia: diagnosis and management. Am Fam Physician. 2010;82(8):942-952.
Drugs for arrhythmias. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/cardiovascular-disorders/arrhythmias-and-conduction-disorders/drugs-for-arrhythmias. Updated September 2017. Accessed January 3, 2019.
Gutierrez C, Blanchard D. Atrial fibrillation: Diagnosis and treatment. Am Fam Physician. 2011;83(1):61-68.
Medications for arrhythmia. American Heart Association website. Available at: https://www.heart.org/en/health-topics/arrhythmia/prevention--treatment-of-arrhythmia/medications-for-arrhythmia. Accessed January 3, 2019.
Triola BR, Kowey PR. Antiarrhythmic drug therapy. Curr Treat Options Cardiovasc Med. 2006;8(5):362-370.
Viskin S, Fish R, Glick A, et al. The adenosine triphosphate test: a bedside diagnostic tool for identifying the mechanism of supraventricular tachycardia in patients with palpitations. J Am Coll Cardiol. 2001;38(1):173-177.
Last reviewed December 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 1/3/2019

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