II. Indications

  1. Ventricular Arrhythmia
    1. Other Antiarrhythmics are preferred

III. Contraindications

  1. Structural heart disease (prior Myocardial Infarction, Systolic Dysfunction)

IV. Mechanism

  1. Class Ib Antiarrhythmic Drug
  2. Decreases automaticity at AV Node and ectopic focil
  3. Increases refractory period in His Bundle, Purkinje Fibers, ventricle and accessory pathways

V. Precautions

  1. Other Antiarrhythmics are preferred (consult cardiology)
  2. Consider dose adjustment in severe liver disease
  3. Proarrhythmic
    1. Higher mortality in non-life threatening ventricular Arrhythmia and structural heart disease

VI. Dosing

  1. Start: 200 mg every 8 hours with food
  2. Titrate dose to effect
    1. May convert to twice daily dosing when effective dose identified
  3. Maximum
    1. Three times daily: 1200 mg/day (400 mg/dose)
    2. Twice daily: 900 mg/day (450 mg/dose)
  4. Renal Dosing for eGFR <10 ml/min
    1. Decrease to 50 to 75% of typical dose

VII. Safety

  1. Avoid in Lactation
  2. Pregnancy Category C

VIII. Adverse Effects

  1. Proarrhythmic
  2. Hepatotoxicity
  3. Neurotoxicity
  4. Seizures

IX. Drug Interactions

  1. Mexiletine may increase levels of other medications
    1. Theophylline
  2. Other medications may effect drug levels of Mexiletine
    1. Cimetidine
    2. Fluvoxamine
    3. Phenobarbital
    4. Phenytoin

XI. References

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Related Studies

Cost: Medications

mexiletine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
MEXILETINE 150 MG CAPSULE Generic $0.43 each
MEXILETINE 200 MG CAPSULE Generic $0.70 each
MEXILETINE 250 MG CAPSULE Generic $0.92 each

Ontology: Mexiletine (C0025887)

Definition (NCI) A local anesthetic and antiarrhythmic (Class IB) agent structurally related to lidocaine. Mexiletine exerts its antiarrhythmic effect by inhibiting the inward sodium current in cardiac cells, thereby reducing the rate of rise of the cardiac action potential (phase 0) and decreases automaticity in the Purkinje fibers. This slows nerve impulses in the heart and stabilizes the heartbeat. Mexiletine's anesthetic activity is due to its ability to block sodium influx in peripheral nerves, thereby reducing the rate and intensity of pain impulses reaching the central nervous system.
Definition (CSP) antiarrhythmia agent pharmacologically similar to lidocaine.
Definition (MSH) Antiarrhythmic agent pharmacologically similar to LIDOCAINE. It may have some anticonvulsant properties.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D008801
SnomedCT 372909002, 96298001
LNC LP16205-4, MTHU004263
English Mexiletine, 2-Propanamine, 1-(2,6-dimethylphenoxy)-, mexiletine, mexiletine (medication), Mexiletine [Chemical/Ingredient], Mexiletinum, 1-Methyl-2-(2,6-xylyloxy)ethylamine, MEXILETINE, Mexiletine (product), Mexiletine (substance)
Swedish Mexiletin
Czech mexiletin
Finnish Meksiletiini
Russian MEKSILETIN, KO 1173, МЕКСИЛЕТИН
Japanese メトレキシン, メキシチール, メキシレチン塩酸塩, 塩酸メキシレチン, メキシレチン, メレート
Polish Meksyletyna
Spanish mexiletina (producto), mexiletina (sustancia), mexiletina, Mexiletine
French Méxilétine
German Mexiletin
Italian Mexiletina
Portuguese Mexiletina