Merck Manual

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Some Drugs Used to Treat Arrhythmias

Some Drugs Used to Treat Arrhythmias

Examples

Some Side Effects

Comments

Beta-blockers

Acebutolol

Atenolol

Betaxolol

Bisoprolol

Carvedilol

Esmolol

Metoprolol

Nadolol

Propranolol

Timolol

An abnormally slow heart rate (bradycardia)

Fatigue

Depression

Possible masking of low blood sugar levels

Impaired circulation in the trunk, arms, and legs

Insomnia

Sexual dysfunction

Shortness of breath

Spasm of the airways (bronchospasm)

With some beta-blockers, an increase in the triglyceride (a fat) level

In people with glaucoma, increased pressure in the eye

These drugs are used to treat ventricular premature beats, ventricular tachycardia, ventricular fibrillation, and paroxysmal supraventricular tachycardia. They are also used to slow the ventricular rate (how fast the heart's lower chambers—the ventricles—beat) in people with atrial fibrillation or atrial flutter.

People who have asthma should ask their doctor before taking these drugs.

Timolol is not available in the United States.

Calcium channel blockers

Diltiazem

Verapamil

Constipation

Diarrhea

Low blood pressure

Swollen feet

Only certain calcium channel blockers, such as diltiazem and verapamil, are useful. They are used to slow the ventricular rate in people who have atrial fibrillation or atrial flutter and to treat paroxysmal supraventricular tachycardia.

Diltiazem and verapamil slow the conduction of electrical impulses through the atrioventricular node.

Certain people with Wolff-Parkinson-White syndrome should not take verapamil or diltiazem.

Digoxin

Digoxin

Nausea

Vomiting

Serious arrhythmias

If the dose is too high, distortion of color vision, making objects appear greenish yellow

Digoxin slows conduction of electrical impulses through the atrioventricular node. Digoxin is used to decrease the ventricular rate in people who have atrial fibrillation or atrial flutter and to treat paroxysmal supraventricular tachycardia.

Potassium channel blockers

Amiodarone

Azimilide

Bretylium

Dofetilide

Dronedarone

Ibutilide

Sotalol

Vernakalant

For all potassium channel blockers: Arrhythmias and low blood pressure

For amiodarone: scarring in the lungs (pulmonary fibrosis) and thyroid, liver, and eye abnormalities.

For sotalol (also a beta-blocker): the same side effects as beta-blockers

These drugs are used to treat ventricular premature beats, ventricular tachycardia, ventricular fibrillation, atrial fibrillation, and atrial flutter.

Because amiodarone can be toxic, it is used for long-term treatment only in some people who have serious or very bothersome arrhythmias.

Bretylium is used only for short-term treatment of life-threatening ventricular tachycardias.

Azimilide, bretylium, and vernakalant are not available in the United States.

Purine nucleoside

Adenosine

Spasm of the airways

Flushing (for a short time)

Adenosine slows conduction of electrical impulses through the atrioventricular node.

Adenosine is used to end episodes of paroxysmal supraventricular tachycardia.

People who have asthma are not given this drug.

Sodium channel blockers

Disopyramide

Flecainide

Lidocaine

Mexiletine

Procainamide

Propafenone

Quinidine

Arrhythmias (which can be fatal, particularly in people who have a heart disorder)

For some drugs:

Digestive upset

Dizziness

Dry mouth

Light-headedness

Retention of urine

Tremor

In people with glaucoma, increased pressure in the eyes

These drugs slow the conduction of electrical impulses through the heart.

These drugs are used to treat ventricular premature beats, ventricular tachycardia, and ventricular fibrillation and to convert atrial fibrillation or atrial flutter to normal rhythm (cardioversion).

Except for lidocaine and mexiletine, these drugs may also be used to prevent episodes of atrial fibrillation or atrial flutter and, less commonly, paroxysmal supraventricular tachycardia.