netFormulary George Eliot Hospital NHS
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 Formulary Chapter 2: Cardiovascular system - Full Chapter

Chapter complete - updated July 18

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02.03.02  Expand sub section  Drugs for arrhythmias

Anti-arrhythmic drugs can be classified clinically into those that act on supraventricular arrhythmias (e.g. verapamil hydrochloride), those that act on both supraventricular and ventricular arrhythmias (e.g. amiodarone hydrochloride) and those that act on ventricular arrhythmias (e.g. lidocaine hydrochloride).

Anti-arrhythmic drugs can also be classified according to their effects on the electrical behaviour of myocardial cells during activity, although this classification is of less clinical significance:

- Class I: membrane stabilising drugs (e.g. lidocaine, flecainide)
- Class II: beta-blockers
- Class III: amiodarone; sotalol (also Class II)
- Class IV: calcium-channel blockers (included verapamil but not   dihyropyridines)

The negative inotropic effects of anti-arrhythmic drugs tend to be additive. Therefore special care should be taken if two or more are used, especially if myocardial function is impaired. Most drugs that are effective in countering arrhythmias can also provoke them in some circumstances; moreover, hypokalaemia enhances the pro-arrhythmic effect of many drugs.

02.03.02  Expand sub section  Supraventricular arrhythmias
View adult BNF View SPC online View childrens BNF  Track Changes
Red SO
  • Available as injection 6mg/2mL ££/6 ampoules
View adult BNF View SPC online View childrens BNF  Track Changes
Amber SC
  • Available as tablets £££
  • Dronedarone should be initiated by a sepcialist in line with NICE TA197, after the patient is stabilised on treatment, prescribing may be continued in primary care under shared care arrangements
  • Due to its safety profile, dronedarone should only be prescribed after alternative treatment options have been considered
Link  Dronedarone - shared care agreement
Link  APC - drug positioning statement
Link  NICE TA197: Dronedarone for the treatment of non-permanent atrial fibrillation
02.03.02  Expand sub section  Supraventricular and ventricular arrhythmias
02.03.02  Expand sub section  Ventricular arrhythmias
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Traffic Light Status Information

Status Description

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]