III. Contraindications

  1. NYHA Class IV Heart Failure (or recent hospitalization for decompensated, symptomatic CHF)
  2. Chronic or persistent Atrial Fibrillation (patient should be in sinus rhythm when initiated)
  3. Second or third degree AV Block or Sick Sinus Syndrome (without Pacemaker)
  4. Significant Bradycardia (Heart Rate <50 bpm)
  5. QTc Prolongation > 500 ms
  6. Severe Hepatic Impairment
  7. Concurrent use of agents with significant Drug Interactions (esp. CYP3A4 Inhibitors, other Antiarrhythmics, see below)

IV. Mechanism

  1. Class III Antiarrhythmic

V. Precautions

  1. Significantly increased mortality in patients with CHF or with chronic, persistent Atrial Fibrillation
  2. Proarrhythmic
  3. Correct Hypomagnesemia and Serum Potassium abnormalities prior to infusion

VI. Dosing: Adults with Atrial Fibrillation Rhythm Control

  1. Dronedarone 400 mg orally twice daily with breakfast and dinner

VII. Drug Interactions

  1. Concurrent use of other Antiarrhythmics (Class I or Class III)
  2. Agents affecting AV Node (e.g. Calcium Channel Blockers, Beta Blockers)
  3. CYP3A4 Inhibitors (e.g. Clarithromycin, Ketoconazole, Ritonavir)
  4. CYP3A4 Inducers (Carbamazepine, Phenytoin, Rifampin)
  5. Simvastatin (limit dose to 10 mg)
  6. Increases levels and effects of other drugs
    1. Warfarin (increases INR)
    2. Dabigatran
    3. CYP3A4 Substrates (e.g. Tacrolimus, Sirolimus)

VIII. Adverse Effects

  1. Hepatotoxicity
  2. QTc Prolongation
  3. Increased Serum Creatinine >10%
    1. Occurs early in medication course and resolves when medication is stopped
  4. Gastrointestinal Effects (Diarrhea, Nausea, Vomiting)

IX. Safety

  1. Pregnancy Category X
  2. Avoid in Lactation

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Cost: Medications

multaq (on 1/3/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
MULTAQ 400 MG TABLET $11.56 each