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

Images: Related links to external sites (from Bing)

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