state of being inactive [50:<1 year: 10 to 30 mg/kg/24 hours in 4 divided doses 1 to 4 years: 10 to 20 mg/kg/24 hours in 4 divided doses 4 to 12 years: 10 to 15 mg/kg/24 hours in 4 divided doses 12 to 18 years: 6 to 15 mg/kg/24 hours in 4 divided doses Dosing: Renal Impairment Manufacturer's labeling: Immediate release: CrCl> 40 mL/minute: 100 mg every 6 hours CrCl 30 to 40 mL/minute: 100 mg every 8 hours CrCl 15 to 30 mL/minute: 100 mg every 12 hours CrCl <15 mL/minute: 100 mg every 24 hours Controlled release: CrCl> 40 mL/minute: 200 mg every 12 hours CrCl 40 mL/minute: Not recommended for use Alternative recommendations (Aronoff, 2007): Immediate release: CrCl >50 mL/minute: 100 to 200 mg every 8 hours CrCl 10 to 50 mL/minute: 100 to 200 mg every 12 to 24 hours CrCl <10 mL/minute: 100 to 200 mg every 24 to 48 hours Dialysis: Not dialyzable (0% to 5%) by hemo- or peritoneal methods; supplemental dose is not necessary. Dosing: Hepatic Impairment Manufacturer's labeling: Immediate release: 100 mg every 6 hours Controlled release: 200 mg every 12 hours Administration Do not break or chew controlled release capsules. Administer around-the-clock rather than 4 times/day (ie, 12-6-12-6, not 9-1-5-9) to promote less variation in peak and trough serum levels. Should be taken on an empty stomach. Dietary Considerations Should be taken on an empty stomach. Storage Store at 25 C (77 F); excursions permitted to 15 C to 30 C (59 F to 86 F). Drug Interactions AbobotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of AbobotulinumtoxinA. Monitor therapy Acetylcholinesterase Inhibitors: May diminish the therapeutic effect of Anticholinergic Agents. Anticholinergic Agents may diminish the therapeutic effect of Acetylcholinesterase Inhibitors. Monitor therapy Aclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Amifampridine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Avoid combination Amiodarone: May enhance the QTc-prolonging effect of Antiarrhythmic Agents (Class Ia). Amiodarone may increase the serum concentration of Antiarrhythmic Agents (Class Ia). Management: Avoid whenever possible. While considered contraindicated in some places, amiodarone U.S. prescribing information suggests that use could be considered under some circumstances, with careful monitoring. Reduce quinidine or procainamide dose by one third. Avoid combination Androgens: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Exceptions: Danazol. Monitor therapy Anticholinergic Agents: May enhance the adverse/toxic effect of other Anticholinergic Agents. Monitor therapy Antidiabetic Agents: May enhance the hypoglycemic effect of Hypoglycemia-Associated Agents. Monitor therapy Aprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Beta-Blockers: Disopyramide may enhance the bradycardic effect of Beta-Blockers. Beta-Blockers may enhance the negative inotropic effect of Disopyramide. Exceptions: Levobunolol; Metipranolol. Monitor therapy Bilastine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Monitor therapy Bosentan: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Buprenorphine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Monitor therapy Cannabinoid-Containing Products: Anticholinergic Agents may enhance the tachycardic effect of Cannabinoid-Containing Products. Exceptions: Cannabidiol. Monitor therapy Chloral Betaine: May enhance the adverse/toxic effect of Anticholinergic Agents. Monitor therapy Cimetropium: Anticholinergic Agents may enhance the anticholinergic effect of Cimetropium. Avoid combination Clarithromycin: May enhance the hypoglycemic effect of Disopyramide. Clarithromycin may enhance the QTc-prolonging effect of Disopyramide. Clarithromycin may increase the serum concentration of Disopyramide. Avoid combination Conivaptan: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination CYP3A4 Inducers (Moderate): May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy CYP3A4 Inducers (Strong): May increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification CYP3A4 Inhibitors (Moderate): May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy CYP3A4 Inhibitors (Strong): May decrease the metabolism of CYP3A4 Substrates (High risk with Inhibitors). Consider therapy modification Dabrafenib: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Seek alternatives to the CYP3A4 substrate when possible. If concomitant therapy cannot be avoided, monitor clinical effects of the substrate closely (particularly therapeutic effects). Consider therapy modification Deferasirox: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Eluxadoline: Anticholinergic Agents may enhance the constipating effect of Eluxadoline. Avoid combination Enzalutamide: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Concurrent use of enzalutamide with CYP3A4 substrates that have a narrow therapeutic index should be avoided. Use of enzalutamide and any other CYP3A4 substrate should be performed with caution and close monitoring. Consider therapy modification Etravirine: May decrease the serum concentration of Disopyramide. Monitor therapy Fingolimod: May enhance the arrhythmogenic effect of Antiarrhythmic Agents (Class Ia). Avoid combination Fosaprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Fosphenytoin: Disopyramide may enhance the QTc-prolonging effect of Fosphenytoin. Fosphenytoin may decrease the serum concentration of Disopyramide. Management: Seek alternatives when possible. Monitor patients receiving this combination closely for evidence of QT interval prolongation or changes in cardiac rhythm, as well as for decreased serum concentrations/therapeutic effects of disopyramide. Consider therapy modification Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination Gastrointestinal Agents (Prokinetic): Anticholinergic Agents may diminish the therapeutic effect of Gastrointestinal Agents (Prokinetic). Monitor therapy Glucagon: Anticholinergic Agents may enhance the adverse/toxic effect of Glucagon. Specifically, the risk of gastrointestinal adverse effects may be increased. Monitor therapy Glycopyrrolate (Oral Inhalation): Anticholinergic Agents may enhance the anticholinergic effect of Glycopyrrolate (Oral Inhalation). Avoid combination Herbs (Hypoglycemic Properties): May enhance the hypoglycemic effect of Hypoglycemia-Associated Agents. Monitor therapy Hydroxychloroquine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Avoid combination Hypoglycemia-Associated Agents: May enhance the hypoglycemic effect of other Hypoglycemia-Associated Agents. Monitor therapy Idelalisib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Avoid combination Indapamide: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Consider therapy modification Ipratropium (Oral Inhalation): May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Itopride: Anticholinergic Agents may diminish the therapeutic effect of Itopride. Monitor therapy Itraconazole: May increase the serum concentration of Disopyramide. Avoid combination Ketoconazole (Systemic): May increase the serum concentration of Disopyramide. Avoid combination Levosulpiride: Anticholinergic Agents may diminish the therapeutic effect of Levosulpiride. Avoid combination Lidocaine (Systemic): Disopyramide may enhance the arrhythmogenic effect of Lidocaine (Systemic). Disopyramide may increase the serum concentration of Lidocaine (Systemic). Specifically, the unbound/free fraction of lidocaine. Monitor therapy Lidocaine (Topical): Disopyramide may enhance the arrhythmogenic effect of Lidocaine (Topical). Disopyramide may increase the serum concentration of Lidocaine (Topical). Specifically, the unbound/free fraction of lidocaine. Monitor therapy Lurasidone: May enhance the QTc-prolonging effect of Disopyramide. Management: Consider alternatives to disopyramide in patients with acute lurasidone overdose. If disopyramide treatment cannot be avoided, monitor for excessive QTc interval prolongation. Consider therapy modification Macrolide Antibiotics: May enhance the QTc-prolonging effect of Disopyramide. Macrolide Antibiotics may decrease the metabolism of Disopyramide. Exceptions: Azithromycin (Systemic); Fidaxomicin; Roxithromycin; Spiramycin. Avoid combination MiFEPRIStone: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Avoid combination Mitotane: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Doses of CYP3A4 substrates may need to be adjusted substantially when used in patients being treated with mitotane. Consider therapy modification Mizolastine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Avoid combination Monoamine Oxidase Inhibitors: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy Netupitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Nitroglycerin: Anticholinergic Agents may decrease the absorption of Nitroglycerin. Specifically, anticholinergic agents may decrease the dissolution of sublingual nitroglycerin tablets, possibly impairing or slowing nitroglycerin absorption. Monitor therapy OnabotulinumtoxinA: Anticholinergic Agents may enhance the anticholinergic effect of OnabotulinumtoxinA. Monitor therapy Opioid Analgesics: Anticholinergic Agents may enhance the adverse/toxic effect of Opioid Analgesics. Specifically, the risk for constipation and urinary retention may be increased with this combination. Monitor therapy Oxatomide: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Palbociclib: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy Pegvisomant: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy PHENobarbital: May decrease the serum concentration of Disopyramide. Monitor therapy Phenytoin: May decrease the serum concentration of Disopyramide. Monitor therapy Pitolisant: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Combined use of pitolisant with a CYP3A4 substrate that has a narrow therapeutic index should be avoided. Other CYP3A4 substrates should be monitored more closely when used with pitolisant. Consider therapy modification Potassium Chloride: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Chloride. Management: Patients on drugs with substantial anticholinergic effects should avoid using any solid oral dosage form of potassium chloride. Avoid combination Potassium Citrate: Anticholinergic Agents may enhance the ulcerogenic effect of Potassium Citrate. Avoid combination Pramlintide: May enhance the anticholinergic effect of Anticholinergic Agents. These effects are specific to the GI tract. Consider therapy modification Probucol: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Avoid combination Promazine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Avoid combination Propafenone: May enhance the arrhythmogenic effect of Antiarrhythmic Agents (Class Ia). Management: Concurrent use of propafenone with quinidine, amiodarone, or other class IA or class III antiarrhythmics should be avoided. Treatment with such agents should be withheld for at least 5 half-lives prior to initiation of propafenone. Avoid combination Prothionamide: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy QTc-Prolonging Agents (Highest Risk): May enhance the QTc-prolonging effect of other QTc-Prolonging Agents (Highest Risk). Avoid combination QTc-Prolonging Agents (Indeterminate Risk and Risk Modifying): May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Management: Avoid such combinations when possible. Use should be accompanied by close monitoring for evidence of QT prolongation or other alterations of cardiac rhythm. Consider therapy modification QTc-Prolonging Agents (Moderate Risk): May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Avoid combination Quinolones: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Quinolones may diminish the therapeutic effect of Blood Glucose Lowering Agents. Specifically, if an agent is being used to treat diabetes, loss of blood sugar control may occur with quinolone use. Monitor therapy Ramosetron: Anticholinergic Agents may enhance the constipating effect of Ramosetron. Monitor therapy RifAMPin: May decrease the serum concentration of Disopyramide. Monitor therapy RimabotulinumtoxinB: Anticholinergic Agents may enhance the anticholinergic effect of RimabotulinumtoxinB. Monitor therapy Salicylates: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy Sarilumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Secretin: Anticholinergic Agents may diminish the therapeutic effect of Secretin. Management: Avoid concomitant use of anticholinergic agents and secretin. Discontinue anticholinergic agents at least 5 half-lives prior to administration of secretin. Consider therapy modification Selective Serotonin Reuptake Inhibitors: May enhance the hypoglycemic effect of Blood Glucose Lowering Agents. Monitor therapy Siltuximab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Simeprevir: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Monitor therapy St John's Wort: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Consider therapy modification Stiripentol: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Use of stiripentol with CYP3A4 substrates that are considered to have a narrow therapeutic index should be avoided due to the increased risk for adverse effects and toxicity. Any CYP3A4 substrate used with stiripentol requires closer monitoring. Consider therapy modification Teneligliptin: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Monitor therapy Thiazide and Thiazide-Like Diuretics: Anticholinergic Agents may increase the serum concentration of Thiazide and Thiazide-Like Diuretics. Monitor therapy Tiotropium: Anticholinergic Agents may enhance the anticholinergic effect of Tiotropium. Avoid combination Tocilizumab: May decrease the serum concentration of CYP3A4 Substrates (High risk with Inducers). Monitor therapy Topiramate: Anticholinergic Agents may enhance the adverse/toxic effect of Topiramate. Monitor therapy Umeclidinium: May enhance the anticholinergic effect of Anticholinergic Agents. Avoid combination Verapamil: May enhance the adverse/toxic effect of Disopyramide. Of particular concern is the potential for profound depression of myocardial contractility. Avoid combination Vinflunine: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Avoid combination Xipamide: May enhance the QTc-prolonging effect of QTc-Prolonging Agents (Highest Risk). Monitor therapy Adverse Reactions Frequency not always defined. The most common adverse effects are related to cholinergic blockade. The most serious adverse effects of disopyramide are hypotension and cardiac failure.> 10%: Gastrointestinal: Xerostomia (32%), constipation (11%) Genitourinary: Urinary hesitancy (14% to 23%) 1% to 10%: Cardiovascular: Cardiac conduction disturbance, cardiac failure, chest pain, edema, hypotension, syncope Central nervous system: Dizziness, fatigue, headache, malaise, myasthenia, nervousness Dermatologic: Generalized dermatosis, pruritus, skin rash Endocrine & metabolic: Hypokalemia, increased serum cholesterol, increased serum triglycerides, weight gain Gastrointestinal: Abdominal distention, anorexia, bloating, diarrhea, flatulence, nausea, vomiting Genitourinary: Impotence (1% to 3%), urinary frequency, urinary retention, urinary urgency Neuromuscular & skeletal: Myalgia Ophthalmic: Blurred vision, xerophthalmia Respiratory: Dry throat, dyspnea <1% (Limited to important or life-threatening): Agranulocytosis, atrioventricular block, cardiac arrhythmia (new or worsened; proarrhythmic effect), cholestatic jaundice, dysuria, gynecomastia, hepatotoxicity, hypoglycemia, increased blood urea nitrogen, increased serum creatinine, increased serum transaminases, insomnia, paresthesia, peripheral neuropathy, psychosis, psychotic reaction, respiratory distress, skin bluster (toxic), systemic lupus erythematosus (rare; generally in patients previously receiving procainamide), thrombocytopenia ALERT: U.S. Boxed Warning Mortality: In the National Heart, Lung, and Blood Institute's Cardiac Arrhythmia Suppression Trial (CAST), a long-term, multicenter, randomized, double-blind study in patients with asymptomatic non-life-threatening ventricular arrhythmias who had an MI more than 6 days but less than 2 years previously, an excessive mortality or nonfatal cardiac arrest rate (7.7%) was seen in patients treated with encainide or flecainide compared with that seen in patients assigned to carefully matched placebo-treated groups (3%). The average duration of treatment with encainide or flecainide in this study was 10 months. The applicability of the CAST results to other populations (eg, those without recent MI) is uncertain. Considering the known proarrhythmic properties of disopyramide and the lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, the use of disopyramide as well as other antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias. Warnings/Precautions Concerns related to adverse effects: Hypotension: May occur during the initiation of therapy; monitor closely. Proarrhythmic effects: Watch for proarrhythmic effects; may cause QT c prolongation and subsequent torsade de pointes; avoid use in patients with diagnosed or suspected congenital long QT syndrome. Monitor and adjust dose to prevent QT c prolongation. Increases in QT c> 25% over baseline should result in cessation or reduction in disopyramide dosing. Because of the risk of QT c prolongation and arrhythmias, disopyramide should be initiated within the hospital with cardiac monitoring. In patients with pre-existing cardiovascular disease, the incidence of proarrhythmic effects and mortality may be increased with Class Ia antiarrhythmic agents. Disease-related concerns: Atrial fibrillation/flutter: Appropriate use: In patients with atrial fibrillation or flutter, block the AV node before initiating. BPH/urinary retention: Do not use in patients with BPH and/or urinary retention due to significant anticholinergic effects. Conduction disturbances: Use with caution in patients with bundle branch block or heart block. Electrolyte imbalance: Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy. Glaucoma: Do not use in patients with glaucoma due to significant anticholinergic effects. Heart failure (HF): Use with caution or avoid in patients with any degree of left ventricular dysfunction or history of HF; may precipitate or exacerbate condition. Hepatic impairment: Use with caution in patients with hepatic impairment; reduced dosage recommended. Myasthenia gravis: Do not use in patients with myasthenia gravis due to significant anticholinergic effects. Renal impairment: Use with caution in renal impairment; reduced dosage recommended. The controlled release form is not recommended for CrCl 40 mL/minute. Wolff-Parkinson-White syndrome: Use with caution in patients with Wolff-Parkinson-White syndrome. Concurrent drug therapy issues: Drugs with QT prolongation potential: Avoid concurrent use with other drugs known to prolong QT c interval or decrease myocardial contractibility. Other warnings/precautions: CAST trial: [US Boxed Warning]: In the Cardiac Arrhythmia Suppression Trial (CAST), recent (>6 days but <2 years ago) myocardial infarction patients with asymptomatic, non-life-threatening ventricular arrhythmias did not benefit and may have been harmed by attempts to suppress the arrhythmia with flecainide or encainide. An increased mortality or nonfatal cardiac arrest rate (7.7%) was seen in the active treatment group compared with patients in the placebo group (3%). The applicability of the CAST results to other populations is unknown. Antiarrhythmic agents should be reserved for patients with life-threatening ventricular arrhythmias. Monitoring Parameters ECG, blood pressure, urinary retention, CNS anticholinergic effects (confusion, agitation, hallucinations, etc); disopyramide drug level (if available); signs and symptoms of heart failure Pregnancy Risk Factor C Pregnancy Considerations Adverse events have been observed in animal reproduction studies. Disopyramide levels have been reported in human fetal blood. Disopyramide may stimulate contractions in pregnant women. In a case report, disopyramide use in the third trimester resulted in painful uterine contractions after the first dose and hemorrhage after the second dose (Abbi, 1999). Patient Education Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?) Patient may experience headache, constipation, dry mouth, nasal dryness, dry eyes, loss of strength and energy, bloating, flatulence, nausea, or abdominal pains. Have patient report immediately to prescriber signs of low blood sugar (dizziness, headache, fatigue, feeling weak, shaking, tachycardia, confusion, increased hunger, or sweating), angina, muscle weakness, tachycardia, abnormal heartbeat, severe dizziness, passing out, shortness of breath, excessive weight gain, swelling of arms or legs, vision changes, or difficult urination (HCAHPS). Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients. Next Interactions Print this page Add to My Med List More about disopyramide Side Effects During Pregnancy or Breastfeeding Dosage Information Drug Images Drug Interactions Support Group Pricing & Coupons En Español 5 Reviews Add your own review/rating Drug class: group I antiarrhythmics Consumer resources Disopyramide ... +3 more Professional resources Disopyramide Phosphate (AHFS Monograph) Disopyramide (FDA) Other brands: Norpace Related treatment guides Arrhythmia> ]} Drug Status Rx Availability Prescription only C Pregnancy Category Risk cannot be ruled out N/A CSA Schedule Not a controlled drug Approval History Drug history at FDA Disopyramide Rating 5 User Reviews 8.8 /10 5 User Reviews 8.8 Rate it! Manufacturers Teva Pharmaceuticals USA, Inc. AvKare, Inc. Drug Class Group I antiarrhythmics Related Drugs group I antiarrhythmics lidocaine , flecainide , Dilantin , phenytoin , propafenone Arrhythmia propranolol , amiodarone , verapamil , lidocaine , Inderal , Tikosyn , Pacerone , mexiletine , dofetilide , Calan , Cordarone , quinidine , Mexitil , Calan SR , procainamide , Verelan , Norpace , Nexterone , Isoptin SR , Ethmozine , Norpace CR , Pronestyl , More... Disopyramide Images Disopyramide systemic 150 mg (ETHEX 002 ) View all images} } even though
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