Confidence, Consensus & Continuation of Anti- Arrhythmic Drugs in ...
Confidence, Consensus & Continuation of Anti- Arrhythmic Drugs in ...
Confidence, Consensus & Continuation of Anti- Arrhythmic Drugs in ...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
Dronedarone: Monitor<strong>in</strong>g<br />
Liver function is tested:<br />
‣ before <strong>in</strong>itiation <strong>of</strong> treatment and after one week<br />
‣ on a monthly basis for six months<br />
‣ at months 9 and 12 and then<br />
‣ periodically thereafter<br />
If alan<strong>in</strong>e transam<strong>in</strong>ase (ALT) levels are elevated ≥3 (upper limit <strong>of</strong> normal levels), then<br />
the levels should be re-measured with<strong>in</strong> 48-72 hours.<br />
If ALT levels are confirmed to be ≥3 (upper limit <strong>of</strong> normal levels), after reassessment,<br />
dronedarone treatment should be withdrawn.<br />
Other monitor<strong>in</strong>g requirements <strong>in</strong>cludes:<br />
‣ Regular cardiac exam<strong>in</strong>ations <strong>in</strong>clud<strong>in</strong>g an ECG at least every 6 months<br />
‣ INR closely monitored after <strong>in</strong>itiat<strong>in</strong>g dronedarone <strong>in</strong> patients tak<strong>in</strong>g vitam<strong>in</strong> K<br />
antagonists<br />
‣ Plasma digox<strong>in</strong> concentration, cl<strong>in</strong>ical and ECG monitor<strong>in</strong>g if patient on digox<strong>in</strong><br />
‣ Renal monitor<strong>in</strong>g with plasma creat<strong>in</strong><strong>in</strong>e values measured prior to and 7 days after<br />
<strong>in</strong>itiation <strong>of</strong> dronedarone<br />
‣ Pulmonary monitor<strong>in</strong>g as onset <strong>of</strong> dyspnoea or non productive cough may be related<br />
to pulmonary toxicity<br />
‣ Grapefruit juice should not be taken with dronedarone.<br />
‣ Co–adm<strong>in</strong>istration with potent cytochrome P 450 (CYP) 3A4 <strong>in</strong>hibitors is<br />
contra<strong>in</strong>dicated e.g. ketoconazole, itraconazole, posaconazole and clarithromyc<strong>in</strong>.