Drug | Characteristics | Indication(s) | Dosing | Side Effects | Precautions or Special Considerations |
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Intravenous Drugs Used to Treat Supraventricular Tachyarrhythmias | |||||
Adenosine | Endogenous purine nucleoside; briefly depresses sinus node rate and AV node conduction; vasodilator |
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6 mg IV as a rapid IV push followed by a 20 mL saline flush; repeat if required as 12 mg IV push | Hypotension, bronchospasm, chest discomfort | Contraindicated in patients with asthma; may precipitate atrial fibrillation, which may be very rapid in patients with WPW; thus a defibrillator should be readily available; reduce dose in post–cardiac transplant patients, those taking dipyridamole or carbamazepine and when administered via a central vein |
Diltiazem, Verapamil | Non-dihydropyridine calcium channel blockers; slow AV node conduction and increase AV node refractoriness; vasodilators, negative inotropes |
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Diltiazem: Initial dose 15 to 20 mg (0.25 mg/kg) IV over 2 minutes; additional 20 to 25 mg (0.35 mg/kg) IV in 15 minutes if needed; 5 to 15 mg/h IV maintenance infusion (titrated to AF heart rate if given for rate control) Verapamil: Initial dose 2.5 to 5 mg IV given over 2 minutes; may repeat as 5 to 10 mg every 15 to 30 minutes to total dose of 20 to 30 mg |
Hypotension, bradycardia, precipitation of heart failure | Should only be given to patients with narrow-complex tachycardias (regular or irregular). Avoid in patients with heart failure and pre-excited AF or flutter or rhythms consistent with VT |
Atenolol, Esmolol, Metoprolol, Propranolol | β-Blockers; reduce effects of circulating catecholamines; reduce heart rate, AV node conduction and blood pressure; negative inotropes |
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Atenolol (β1 specific blocker) 5 mg IV over 5 minutes; repeat 5 mg in 10 minutes if arrhythmia persists or recurs Esmolol (β1 specific blocker with 2- to 9-minute half-life) IV loading dose 500 mcg/kg (0.5 mg/kg) over 1 minute, followed by an infusion of 50 mcg/kg per minute (0.05 mg/kg per minute); if response is inadequate, infuse second loading bolus of 0.5 mg/kg over 1 minute and increase maintenance infusion to 100 mcg/kg (0.1 mg/kg) per minute; increment; increase in this manner if required to maximum infusion rate of 300 mcg/kg [0.3 mg/kg] per minute Metoprolol (β1 specific blocker) 5 mg over 1 to 2 minutes repeated as required every 5 minutes to maximum dose of 15 mg Propranolol (nonselective β-blocker) 0.5 to 1 mg over 1 minute, repeated up to a total dose of 0.1 mg/kg if required |
Hypotension, bradycardia, precipitation of heart failure | Avoid in patients with asthma, obstructive airway disease, decompensated heart failure and pre-excited artrial fibrillation or flutter |
Procainamide | Sodium and potassium channel blocker |
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20 to 50 mg/min until arrhythmia suppressed, hypotension ensues, or QRS prolonged by 50%, or total cumulative dose of 17 mg/kg; or 100 mg every 5 minutes until arrhythmia is controlled or other conditions described above are met |
Bradycardia, hypotension, torsades de pointes | Avoid in patients with QT prolongation and CHF |
Amiodarone | Multichannel blocker (sodium, potassium, calcium channel, and noncompetitive α/β-blocker) |
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150 mg given over 10 minutes and repeated if necessary, followed by a 1 mg/min infusion for 6 hours, followed by 0.5 mg/min. Total dose over 24 hours should not exceed 2.2 g. |
Bradycardia, hypotension, phlebitis | |
Digoxin | Cardiac glycoside with positive inotropic effects; slows AV node conduction by enhancing parasympathetic tone; slow onset of action |
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8 to 12 mcg/kg total loading dose, half of which is administered initially over 5 minutes, and remaining portion as 25% fractions at 4- to 8- hour intervals |
Bradycardia | Slow onset of action and relative low potency renders it less useful for treatment of acute arrhythmias |
Intravenous Drugs Used to Treat Ventricular Tachyarrhythmias | |||||
Procainamide | Sodium and potassium channel blocker |
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20 to 50 mg/min until arrhythmia suppressed, hypotension ensues, or QRS prolonged by 50%, or total cumulative dose of 17 mg/kg; or 100 mg every 5 minutes until arrhythmia is controlled or other conditions described above are met |
Bradycardia, hypotension, torsades de pointes | Avoid in patients with QT prolongation and CHF |
Amiodarone | Multichannel blocker (sodium, potassium, calcium channel, α- and noncompetitive β-blocker) |
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150 mg given over 10 minutes and repeated if necessary, followed by a 1 mg/min infusion for 6 hours, followed by 0.5 mg/min. Total dose over 24 hours should not exceed 2.2 g. |
Bradycardia, hypotension, phlebitis | |
Sotalol | Potassium channel blocker and nonselective β-blocker |
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In clinical studies 1.5 mg/kg infused over 5 minutes; however, US package labeling recommends any dose of the drug should be infused slowly over a period of 5 hours |
Bradycardia, hypotension, torsades de pointes | Avoid in patients with QT prolongation and CHF |
Lidocaine | Relatively weak sodium channel blocker |
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Initial dose range from 1 to 1.5 mg/kg IV; repeated if required at 0.5 to 0.75 mg/kg IV every 5 to 10 minutes up to maximum cumulative dose of 3 mg/kg; 1 to 4 mg/min (30 to 50 mcg/kg per minute) maintenance infusion |
Slurred speech, altered consciousness, seizures, bradycardia | |
Magnesium | Cofactor in variety of cell processes including control of sodium and potassium transport |
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1 to 2 g IV over 15 minutes | Hypotension, CNS toxicity, respiratory depression | Follow magnesium levels if frequent or prolonged dosing required, particularly in patients with impaired renal function |