Drug reference

Dronedarone

Antiarrhythmic

Also known as Dronedarone hydrochloride, Multaq

AntiarrhythmicATC C01BD07

CDSCO approvedSchedule HATC C01BD07

EXCRETION

—

not curated

INTERACTIONS

11 major

incl. contraindicated

PREGNANCY

—

not curated

Top interactionssee all 11 →

Macrolide AntibioticsContraindicatedTextbookG&G 14e · p688
RitonavirContraindicatedDatabaseDDInter
AbarelixSevereDatabaseDDInter
AbirateroneSevereDatabaseDDInter

Mechanism

Dronedarone is a multi-channel blocking anti-arrhythmic drug.

Indications

Maintenance of sinus rhythm after cardioversion in clinically stable patients with paroxysmal or persistent atrial fibrillation, when alternative treatments are unsuitable (initiated under specialist supervision). Specifically, it is an option for maintenance of sinus rhythm after successful cardioversion in paroxysmal or persistent atrial fibrillation not controlled by first-line therapy (usually including beta-blockers), and after alternative options have been considered in patients who have at least 1 of the following cardiovascular risk factors: hypertension requiring drugs of at least 2 different classes, diabetes mellitus, previous transient ischaemic attack, stroke or systemic embolism, left atrial diameter of 50 mm or greater, or age 70 years or older, AND who do not have left ventricular systolic dysfunction nor a history of, or current, heart failure.Treatment of atrial fibrillationTreatment of atrial flutter (maintaining sinus rhythm)Reducing ventricular response rate during episodes of atrial fibrillationMaintenance of sinus rhythm in hemodynamically stable patients with paroxysmal atrial fibrillation (AF)Maintenance of sinus rhythm in hemodynamically stable patients with non-permanent AFControl of ventricular rate during AFControl of ventricular rate during atrial flutter (AFl)

Dosing

Adult: 400 mg twice daily

Pharmacokinetics

Half-life

13–19 h

Bioavailability

Reduced due to first-pass metabolism

Protein binding

>98%

Metabolism

By CYP3A

Contraindications

Atrial conduction defects
Bradycardia
Complete bundle branch block
Distal block
Existing or previous heart failure
Left ventricular systolic dysfunction
Haemodynamically unstable patients
Liver toxicity associated with previous amiodarone use
Lung toxicity associated with previous amiodarone use
Permanent atrial fibrillation
Prolonged QT interval
Second- or third-degree AV block
Sick sinus syndrome (unless pacemaker fitted)
Sinus node dysfunction
Left ventricular systolic dysfunction
History of, or current, heart failure
Potent CYP3A4 inhibitors (e.g., ketoconazole, macrolide antibiotics)
Severe heart failure

Side effects

Common

AstheniaBradycardiaCongestive heart failureDiarrhoeaGastrointestinal discomfortNauseaQT interval prolongationSkin reactionsVomitingDiarrheaAbdominal painGastrointestinal disturbancesWeaknessCoughDermatological reactions

Serious