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Medications for Arrhythmias (Heart Rhythm Disturbances)

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Treatment of arrhythmias depends on the type and seriousness of the particular rhythm disturbance. Medications are most often used to treat tachyarrhythmias (fast heart rates). These include:

Prescription Medications

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 Medications

In one way or another, all of these drugs act to slow the electrical activity in the heart. Many of them have additional uses, such as treating high blood pressure. All of them can produce serious side effects and must be used with great care and strict adherence to instructions.

Class I

Class IA

Common names include:

  • Quinidine
  • Procainamide
  • Disopyramide
Class IB

Common names include:

  • Phenytoin
  • Tocainide
  • Mexiletine
Class IC

Common names include:

  • Flecainide
  • Propafenone
  • Moricizine

Class I drugs are the most prone to side effects outside the circulatory system.

Possible side effects include:

  • 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 include:

  • Propranolol
  • Metoprolol

There are many beta blockers, but generally these two are the ones used to treat arrhythmias. All beta blockers are used primarily for blood pressure control or to treat angina. Side effects are less wide ranging than Class I drugs.

Possible side effects include:

Class III    TOP

Common names include:

  • Bretylium
  • Amiodarone
  • Sotalol
  • Ibutilide
  • Dofetilide

These agents are generally reserved for life-threatening ventricular arrhythmias and those that have been resistant to other treatments.

Possible side effects include:

  • Lightheadedness
  • Nausea
  • Unwanted heart rhythm changes
  • Liver problems (sotalol, amiodarone)
  • Lung damage (sotalol, amiodarone)
  • Eye damage (amiodarone)
  • Nerve damage (sotalol)
  • Muscle damage (sotalol)
  • Thyroid changes (sotalol, amiodarone)

Class IV: Calcium Channel Blockers    TOP

  • Diltiazem
  • Verapamil

Most of the drugs in this category are used to lower blood pressure or treat angina.

Common side effects include:

  • Lightheadedness
  • Nausea
  • Water retention

There is also a long list of more serious but rare side effects, depending upon the particular drug, which include:

  • Liver damage
  • Kidney damage
  • Bone marrow damage
  • Worsening heart failure
  • Undesirable heart rhythm changes

Miscellaneous    TOP

Digitalis Glycosides

These drugs are very effective at treating heart failure, but have much more restricted use in heart rhythm disturbances. They are primarily used to control the rate of ventricular response to tachyarrhythmias. Digitalis glycosides have a very narrow therapeutic window between taking too little and taking too much.

Common side effects include:

  • Nausea
  • Vomiting
  • Unwanted heart rhythm changes

Adenosine

Adenosine is given intravenously to stop certain tachyarrhythmias.

Common side effects include:

  • Chest pressure
  • Shortness of breath
  • Nausea
  • Flushing
  • Headache
  • Lightheadedness

Special Considerations    TOP

If you are taking medications, follow these general guidelines:

  • Take the medication as directed. Do not 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 medication.
  • Do not share your prescription medication.
  • Medications can be dangerous when mixed. Talk to your doctor or pharmacist if you are taking more than one medication, including over-the-counter products and supplements.
  • Plan ahead for refills as needed.

References:

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:
...(Click grey area to select URL)
Updated July 2015. Accessed June 1, 2017.
Goldschlager N, Epstein AE, Naccarelli G, Olshansky B, Singh B. Practical guidelines for clinicians who treat patients with amiodarone. Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology. Arch Intern Med. 2000;160(12):1741-1748.
Gutierrez C, Blanchard D. Atrial fibrillation: Diagnosis and treatment. Am Fam Physician. 2011;83(1):61-68.
How are arrhythmias treated? National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/arr/treatment. Updated July 1, 2011. Accessed June 1, 2017.
Medications for arrhythmia. American Heart Association website. Available at:
...(Click grey area to select URL)
Updated December 21, 2016. Accessed June 1, 2017.
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 June 2017 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 12/20/2014

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