ibutilide fumarate

ibutilide fumarate

(eye byu' ti lyed)

Corvert

Pregnancy Category C

Drug class

Antiarrhythmic (predominately class III)

Therapeutic actions

Prolongs cardiac action potential, increases atrial and ventricular refractoriness; produces mild slowing of sinus rate and AV conduction.

Indications

·        Rapid conversion of atrial fibrillation or flutter of recent onset to sinus rhythm; most effective in arrhythmias of < 90 days' duration

Contraindications and cautions

·        Contraindicated with hypersensitivity to ibutilide; second- or third-degree AV heart block, prolonged QTc intervals.

·        Use cautiously with ventricular arrhythmias, pregnancy, lactation, renal and hepatic impairment.

Available forms

Solution—0.1 mg/mL

Dosages

ADULTS > 60 KG (132 LB)

1 vial (1 mg) infused over 10 min; may be repeated after 10 min if arrhythmia is not terminated.

ADULTS < 60 KG

0.1 mL/kg (0.01 mg/kg) infused over 10 min; may be repeated after 10 min if arrhythmia is not terminated.

PEDIATRIC PATIENTS

Not recommended.

Pharmacokinetics

Route	Onset	Peak
IV	Immediate	10 min

Metabolism: Hepatic; T_1/2: 6 hr

Distribution: Crosses placenta, may enter breast milk

Excretion: Feces, urine

IV facts

Preparation: May be diluted in 50 mL of diluent, 0.9% sodium chloride, or 5% dextrose injection; one 10-mL vial added to 50 mL of diluent yields a concentration of 0.017 mg/mL; may also be infused undiluted; diluted solution is stable for 24 hr at room temperature or for 48 hr refrigerated.

Infusion: Infuse slowly over 10 min.

Compatibilities: Compatible with 5% dextrose injection, 0.9% sodium chloride injection.

Incompatibilities: Do not mix in solution with any other drugs.

Adverse effects

·        CNS: Headache, light-headedness, dizziness, tingling in arms, numbness

·        CV: Ventricular arrhythmias, hypotension, hypertension

·        GI: Nausea

Interactions

Drug-drug

·        Increased risk of serious to life-threatening arrhythmias with disopyramide, quinidine, procainamide, amiodarone, sotalol; do not give together

·        Increased risk of proarrhythmias with phenothiazines, TCAs, antihistamines

·        Use cautiously with digoxin because ibutilide may mask digoxin cardiotoxicity

Nursing considerations

Assessment

·        History: Hypersensitivity to ibutilide; second- or third-degree AV heart block, time of onset of atrial arrhythmia; prolonged QTc intervals; pregnancy, lactation; ventricular arrhythmias

·        Physical: Orientation; BP, P, auscultation, ECG; R, adventitious sounds

Interventions

·        Determine time of onset of arrhythmia and potential benefit before beginning therapy. Conversion is more likely in patients with arrhythmias of short (< 90 days') duration.

·        WARNING: Ensure that patient is adequately anticoagulated, generally for at least 2 wk, if atrial fibrillation lasts > 2–3 days.

·        Monitor ECG continually during and for at least 4 hr after administration. Be alert for possible arrhythmias, including PVCs, sinus tachycardia, sinusbradycardia, varying degrees of block at time of conversion.

·        WARNING: Keep emergency equipment readily available during and for at least 4 hr after administration.

·        Provide appointments for continued follow-up, including ECG monitoring; tendency to revert to atrial arrhythmia after conversion increases with length of time patient was in abnormal rhythm.

Teaching points

·        This drug can only be given by IV infusion. You will need electrocardiogram monitoring during and for 4 hours after administration.

·        Arrange for follow-up medical evaluation, including an electrocardiogram, which is important to monitor the effect of the drug on your heart.

·        You may experience these side effects: Rapid or irregular heartbeat (usually passes shortly), headache.

·        Report chest pain, difficulty breathing, numbness or tingling.

Adverse effects in Italic are most common; those in Bold are life-threatening.