Disopyramide

Aka: Disopyramide, Norpace

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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

  1. QT Prolongation
  2. Torsades de Pointes history
  3. Cardiogenic Shock
  4. Second or Third Degree AV Block

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

  1. Lupus Like Syndrome
  2. Hypersensitivity Reaction

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

X. Resources

  1. Disopyramide (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=11a68e26-d2e4-48f6-ba0f-9bdd5778f25a

XI. References

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

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Cost: Medications

disopyramide (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
DISOPYRAMIDE 150 MG CAPSULE Generic $1.56 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

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