Etripamil

Aka: Etripamil, Cardamyst

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II. Indications

  1. Paroxysmal Supraventricular Tachycardia cessation for home use

III. Contraindications

  1. Congestive Heart Failure NYHA Class 2-4
  2. Heart Blocks and other conduction abnormalities

IV. Mechanism

  1. Rapid onset nondihydropyridine Calcium Channel Blocker
  2. Similar to Verapamil
  3. Delivered intranasally

V. Medications

  1. Etripamil (Cardamyst) intranasal Inhaler ($1700 in 2026)
    1. Available as 2-pack of 70 mg/dose (to be split over both nostrils)

VI. Dosing

  1. Attempt Vagal Maneuvers (e.g. valasalva maneuver) prior to administration
  2. One spray (35 mg) in each nostril (70 mg total) at PSVT onset
    1. May be repeated in 10 minutes if persistent PSVT
    2. Maximum dose: 140 mg per 24 hours
  3. Sit upright with head looking straight ahead for administration and for 10 minutes after
  4. Persistent PSVT after 20 min (and 2 doses totaling 140 mg)
    1. Seek emergency medical care

VII. Adverse Effects

  1. Nasal congestion
  2. Nasal discomfort
  3. Rhinorrhea
  4. Epistaxis
  5. Pharyngitis

VIII. Efficacy

  1. PSVT converts to sinus rhythm (NSR) within 30 minutes (NNT 3)
    1. Median conversion to NSR is 17 minutes (contrast with 54 min for Placebo)

IX. Resources

  1. Etripamil (Dailymed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=a92170b9-4f93-4b83-b2cd-cb85c52821cd

X. References

  1. (2026) Presc Ins 33(3): 4
  2. Ip (2025) J Cardiovasc Electrophysiol 36(11):2990-3003 +PMID: 40931676 [PubMed]

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