Amiodarone
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Drug reference
propafenone
Na+ Channel Blocker (Class IC), K+ Channel Blocker, RyR2 Blocker, β Adrenergic Receptor Antagonist · Antiarrhythmic
Na+ Channel Blocker (Class IC), K+ Channel Blocker, RyR2 Blocker, β Adrenergic Receptor AntagonistAntiarrhythmicATC C01BC03
CDSCO approvedATC C01BC03
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- AmiodaroneSevereDatabaseDDInter
- AmisulprideSevereDatabaseDDInter
- AnagrelideSevereDatabaseDDInter
- ArbutamineSevereDatabaseDDInter
Mechanism
Propafenone is a Na+ channel blocker with a relatively slow time constant for recovery from block. It also blocks K+ channels and RyR2 channels. The S-(+)-enantiomer is a β adrenergic receptor antagonist. Its major electrophysiological effect is to slow conduction in fast-response tissues.
Indications
Maintaining sinus rhythm in patients with supraventricular tachycardias (including atrial fibrillation)Catecholaminergic polymorphic ventricular tachycardia (CPVT) (alternative to flecainide)Prophylaxis of ventricular arrhythmiasTreatment of ventricular arrhythmiasReentrant tachycardias involving AV nodeReentrant tachycardias involving accessory pathwayMaintenance of sinus rhythm in atrial fibrillation (AF)WPW narrow QRS tachycardiaWPW wide QRS tachycardia (in combination with verapamil/propranolol)
Dosing
- Adult
- 150–300 mg q8h; 225–425 mg q12h (slow-release)
- Hepatic adjustment
- Dosage in patients with moderate-to-severe liver disease should be reduced to approximately 20% to 30% of the usual dose, with careful monitoring.
Pharmacokinetics
Half-life
2–32 h
Bioavailability
Well absorbed, but extensive first-pass hepatic metabolism (CYP2D6-mediated)
Metabolism
Primarily by CYP2D6 to 5-hydroxy propafenone (active, less potent β blocker) and N-desalkyl propafenone (less potent). CYP2D6 metabolism is saturable, leading to disproportionate increases in plasma concentrations with small dose increases.
Contraindications
- History of myocardial infarction
- Asthma
- Peripheral vascular disease
Side effects
Common
Adverse effects (significantly higher incidence in poor metabolizers)NauseaVomitingBitter tasteConstipationBlurred visionSino-atrial block (occasionally)
Serious
- Acceleration of ventricular response in atrial flutter
- Increased frequency or severity of episodes of reentrant ventricular tachycardia
- Exacerbation of heart failure
- Sinus bradycardia (β adrenergic blockade effect)
- Bronchospasm (β adrenergic blockade effect)
- Precipitation of congestive heart failure (CHF)
- Bronchospasm
- Increased risk of sudden death
- Increased ventricular rate in atrial flutter (AFl) (occasionally)
- Worsening of some reentrant VTs
Drug interactions
Amisulpride
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anagrelide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Arbutamine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Arsenic Trioxide
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Atazanavir
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Bedaquiline
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Bepridil
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Berotralstat
Severe
Database
Drug interaction classified as: absorption
Source: DDInter
Betrixaban
Severe
Database
Drug interaction classified as: others
Source: DDInter
Bretylium
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cabozantinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about propafenone
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Sources: KD Tripathi 7e, Goodman & Gilman 14e·Verified: 2026-05-10 · House clinical team