Class Ia | | | | | |
| Quinidine | AF, AFL, AVNRT, AVRT | 6–10 mg/kg over 20–30 min | 200–400 mg q4–6h; q8h with long-acting preparations | Hypotension (especially IV), ventricular proarrhythmia, GI disturbance, thrombocytopenia | ↑ Digitalis level ↑ Warfarin effect ↑ Metoprolol, propranolol, propafenone levels |
Procainamide | AF, AFL, AVNRT, AVRT | Bolus: 15 mg/kg given as 20 mg/min Infusion: 2–4 mg/min | 50 mg/kg/day q3–4h; twice daily dosage with long-acting preparation | GI disturbance, hypotension, SLE, agranulocytosis, FUO hemolytic anemia, myasthenia gravis aggravation, ventricular proarrhythmia | ↑ Procainamide level with cimetidine, quinidine, and amiodarone |
Class 1c | | | | | |
Flecainide | AF, AFL, AT, AVNRT, AVRT | N/A | 50–200 mg q12h | Ventricular proarrhythmia, CHF, GI disturbance, CNS (dizziness, tremor, light-headedness) | ↑ Digitalis level ↑ Flecainide level with amiodarone, cimetidine, Norpace, propranolol ↓ Flecainide level with smoking |
Propafenone | AF, AFL, AVNRT, AVRT | N/A | 150–300 mg q8h or 225–425 mg bid (long-acting form) | GI disturbance, CNS (dizziness), metallic taste, CHF, first-degree AVB, IVCD, positive ANA | Synergism with β-blockers |
Class II (IV) | | | | | |
Esmolol | Ventricular rate control for AF, AFL, ST, AT | Bolus: 500 mcg/kg over 1–2 min Infusion: 50–200 mcg/kg/min | N/A | CHF, AVB, bradycardia, bronchospasm | |
Propranolol | Ventricular rate control for AF, AFL, ST, AT | 1–5 mg at 1 mg/min | 20–320 mg/day q6h, q8h, q12h, or once daily, depending on preparation | CHF, AVB, bradycardia, bronchospasm | |
Class III | | | | | |
Sotalol | AF, AFL, AVNRT, AVRT, AT | N/A | 80–160 mg q12h | Dyspnea, fatigue, dizziness, CHF, bradycardia, ventricular proarrhythmia, bronchospasm | Synergism with Ca2+ antagonists or β-blockers |
Amiodarone | AF, AFL, AVNRT, AVRT, AT | Bolus: 150 mg over 10 min Infusion: 1 mg/min × 6 h, then 0.5 mg/min | 100–400 mg once daily | Pulmonary toxicity, CHF, tremor, bradycardia, ↑ LFTs, corneal deposits, skin discoloration, GI intolerance, hyper-/hypothyroidism | ↑ Digoxin levels ↑ Warfarin effect ↑ Quinidine, procainamide/NAPA, flecainide ↑ Phenytoin level |
Ibutilide | AF, AFL | 1 mg bolus over 10 min; second bolus, if needed, after 10-min wait | N/A | Ventricular proarrhythmia, hypotension, GI disturbance | |
Dofetilide | AF, AFL | N/A | 125–500 mcg twice daily modified by algorithm | Ventricular proarrhythmia, headache, chest pain, nausea, dizziness | Contraindicated with verapamil, cimetidine, ketoconazole, trimethoprim |
Class IV | | | | | |
Diltiazem | AF, AFL, AVNRT, AVRT, AT, MAT ... |