Pharm

Ibutilide

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Ibutilide, Corvert

  • See Also
  1. Antiarrhythmic
  • Indications
  1. Atrial Fibrillation Chemical Cardioversion
    1. Consider in combination with Electrical Synchronized Cardioversion of Atrial Fibrillation
  • Contraindications
  1. QTc Prolongation (or QT >500 msec)
  2. Severe Left Ventricular Dysfunction
  3. Combination with Class 1a or Class III Antiarrhythmics
  • Mechanism
  1. Class III Antiarrhythmic
  • Precautions
  1. Cardiac monitoring on starting Ibutilide
    1. Monitor for a minimum of 4 hours after drug administration
    2. Continue monitoring until QTc Interval normalizes
  2. Correct Electrolyte abnormalities before starting Ibutilide (and continue to monitor Electrolyte levels)
    1. Serum Potassium
    2. Serum Magnesium
  • Dosing
  1. Initial
    1. Weight <60 kg: 0.01 mg/kg IV over 10 min
    2. Weight >60 kg: 1 mg IV over 10 min
  2. Subsequent
    1. May repeat once after 10 min if not converted to sinus rhythm with first dose
    2. Stop infusion on conversion to sinus rhythm
  • Adverse Effects
  1. Significantly proarrhythmic
    1. Ventricular Tachycardia or fibrillation risk: 1-2%
    2. Requires EKG monitoring for 4 hours after dose
  2. Prolonged QTc
    1. Risk of Torsades de Pointes
    2. Observe in monitored setting
  • Efficacy
  1. Atrial Fibrillation Cardioversion
    1. Time to Cardioversion: 1 hour
    2. Conversion Rate: 33-45% (60% in Atrial Flutter)
  • Safety
  1. Unknown safety in Lactation
  2. Pregnancy Category C
  • Resources
  1. Ibutilide Injection Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=2428969a-7431-4e94-9503-ad5c680e2ea4
  2. Ibutilide (Stat Pearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK526021/
  • References
  1. Viktorsdottir (2006) Emerg Med J 23(2):133-4 +PMID: 16439743 [PubMed]