II. Indications

  1. Life-Threatening Ventricular Arrhythmia (e.g. Ventricular Tachycardia)
    1. Disopyramide is rarely indicated (other options preferred)
  2. Atrial Fibrillation Rhythm Control (maintain sinus rhythm)

III. Contraindications

IV. Precautions

  1. Proarrhythmic
    1. Consider starting while in hospital on telemetry monitoring
  2. Higher mortality in structural heart disease (Systolic Dysfunction, Myocardial Infarction)

V. Mechanism

  1. Similar to other Class 1A anti-arrhythmics (e.g. Quinidine, Procainamide)
  2. Class 1A anti-arrhythmic
    1. Blocks the fast Sodium channel in cardiac cell membranes within atrial and ventricular tissues
    2. Slows the rate and amplitude of phase 0 depolarization
      1. Prolongs the Action Potential (decreases cell excitability and conduction velocity)
  3. Cardiac depressant
    1. Directly decreases the rate of phase 4, diastolic cell depolarization and automaticity
  4. Potassium Channel Blocker
    1. Prolongs QT Interval
    2. Increases refractory period
  5. Potent Anticholinergic activity
    1. May increase AV Node conduction

VI. Adverse Effects

VII. Safety

  1. Considered safe in Lactation
  2. Pregnancy Category C

VIII. Metabolism

  1. Of ingested medication, 50% is hepatic metabolized and 50% is excreted unchanged

IX. Dosing: Adult

  1. Precautions
    1. Start 6 hours after last dose of Class 1A anti-arrhythmics (e.g. Quinidine, Procainamide)
    2. Wait 6 hours before giving first XR formulation after transitioning from immediate Disopyramide
  2. Ventricular Arrhythmia
    1. Disopyramide 400 to 800 mg orally divided every 6 hours (immediate release) or 12 hours (XR)
  3. Atrial Fibrillation Rhythm Control (maintain sinus rhythm)
    1. Disopyramide 400 to 750 mg orally divided every 6 hours (immediate release) or 12 hours (XR)
  4. Renal Impairment
    1. Creatinine Clearance 40 to 60 ml/min: 400 mg/day in divided doses
    2. Creatinine Clearance 30 to 40 ml/min: 100 mg every 8 hours
    3. Creatinine Clearance 15 to 30 ml/min: 100 mg every 12 hours
    4. Creatinine Clearance <15 ml/min: 100 mg every 24 hours
  5. Other maximum dosing (use immediate release products for these conditions)
    1. Indications to limit dose to 400 mg/day in divided doses
      1. Significant liver disease
    2. Indications to limit dose to 100 mg/day divided every 6 to 8 hours
      1. Cardiomyopathy

XI. References

  1. Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 74-5
  2. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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Related Studies

Cost: Medications

disopyramide (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DISOPYRAMIDE 150 MG CAPSULE Generic $1.56 each

Ontology: Disopyramide (C0012702)

Definition (NCI) A class IA anti-arrhythmic agent with cardiac depressant property. Disopyramide blocks the fast sodium channel in normal cardiac cell membranes within atrial and ventricular tissues. This slows the rate and amplitude of phase 0 depolarization and thus prolongs the duration of the action potential, thereby reducing cell excitability and conduction velocity. Further, disopyramide directly decreases the rate of diastolic (phase 4) depolarization in cells with normal or augmented automaticity. Disopyramide also blocks potassium channel and results in prolonged QT interval, thus increases the effective refractory period. This agent also possesses anticholinergic property.
Definition (MSH) A class I anti-arrhythmic agent (one that interferes directly with the depolarization of the cardiac membrane and thus serves as a membrane-stabilizing agent) with a depressant action on the heart similar to that of guanidine. It also possesses some anticholinergic and local anesthetic properties.
Definition (CSP) class I antiarrhythmic agent (one that interferes directly with the depolarization of the cardiac membrane and thus serves as a membrane stabilizing agent) with a depressant action on the heart similar to that of guanidine; it also possesses some anticholinergic and local anesthetic properties.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D004206
SnomedCT 372844004, 76759004
LNC LP16118-9, MTHU003353
English Diisopyramide, Disopyramide, 2-Pyridineacetamide, alpha-(2-(bis(1-methylethyl)amino)ethyl)-alpha-phenyl-, Disopyramide [Chemical/Ingredient], DISOPYRAMIDE, disopyramide, Disopyramide product, Disopyramide (product), Disopyramide (substance)
Swedish Disopyramid
Czech disopyramid
Finnish Disopyramidi
Russian RITMILEN, DIZOPIRAMID, RITMODAN, ДИЗОПИРАМИД, РИТМИЛЕН, РИТМОДАН
Japanese ジソピラミド
Polish Dizopiramid
Spanish disopiramida (producto), disopiramida (sustancia), disopiramida, Disopiramida
French Disopyramide
German Disopyramid
Italian Disopiramide
Portuguese Disopiramida

Ontology: Norpace (C0701129)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D004206
English norpace, Searle Brand of Disopyramide Phosphate, Norpace