disopyramide (Rx)

  • Print
Brand and Other Names:Norpace, Norpace CR

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

capsule

  • 100mg
  • 150mg

capsule, controlled-release

  • 100mg
  • 150mg
more...

Ventricular Arrythmias

>50 kg

  • Immediate-release: 150 mg PO q6hr
  • Controlled-release: 300 mg q12hr
  • Range: 400-800 mg/day

<50 kg

  • Immediate-release: 100 mg PO q6hr
  • Controlled-release: 200 mg PO q12hr

Rapid Control of Ventricular Arrythmias

>50 kg

  • Immediate-release: 300 mg PO initially, THEN 150-300 mg q6hr
  • If no response within 6 hours, give 200 mg PO q6hr, may increase to 250-300 mg q6hr if no response in 48 hours

<50 kg

  • Immediate-release: 200 mg PO initially, THEN 150-300 mg q6hr
  • CR should not be used initially for rapid control

Renal Impairment

Immediate-release

  • CrCl >40 mL/min: 100 mg PO q6hr
  • CrCl 30-40 mL/min: 100 mg PO q8hr
  • CrCl 15-30 mL/min: 100 mg PO q12hr
  • CrCl <15 mL/min: 100 mg PO qDay

Controlled-release

  • CrCl >40 mL/min: 200 mg q12hr
  • CrCl ≤40 mL/min: CR not recommended

Hepatic Impairment

Immediate-release: 100 mg PO q6hr OR

Controlled-release: 200 mg q12hr

Monitoring

Therapeutic range 2-4 mcg/mL, toxic range >9 mcg/mL

Dosage Forms & Strengths

capsule

  • 100mg
  • 150mg

capsule, extended-release

  • 100mg
  • 150mg
more...

Ventricular Arrhythmias (Off-label)

<1 year old: 10-30 mg/kg/day divided q6hr PO 

1-4 years old: 10-20 mg/kg/day divided q6hr PO

4-12 years old: 10-15 mg/kg/day divided q6hr PO

12-18 years old: 6-15 mg/kg/day divided q6hr PO

Avoid; potent negative inotrope that may induce heart failure in older adults; nonanticholinergic antiarrhythmic drugs preferred (Beers criteria)

Dose selection in the elderly should be cautious, usually starting at the low end of the dosing range

CNS anticholinergic effects such as confusion, agitation and hallucinations can be intolerable and may lead to discontinuation

Next:

Interactions

Interaction Checker

and disopyramide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 
            Previous
            Next:

            Adverse Effects

            >10%

            Xerostomia (32%)

            Urinary hesitancy (23%)

            Constipation (11%)

            1-10%

            Impotence

            Urinary urgency

            Urinary retention

            Dry throat

            Weight gain

            Abdominal distension

            Flatulence

            Anorexia

            Vomiting

            Nausea

            Dermatoses

            Pruritus

            Generalized rash

            Increased triglycerides and cholesterol

            Hypokalemia

            Muscle weakness

            Muscular pain

            Dyspnea

            Blurred vision

            Dry eyes

            Fatigue

            Malaise

            Headache

            Dizziness

            Nervousness

            Syncope

            Hypotension

            Chest pain

            Edema

            <1%

            AV block

            Hypoglycemia (rare)

            Agranulocytosis

            Respiratory distress

            Creatinine increased

            Psychotic reaction

            Paresthesia

            Lupus (rare)

            Peripheral neuropathy

            Insomnia

            Previous
            Next:

            Warnings

            Black Box Warnings

            National Heart, Lung, and Blood Institute's Cardiac Arrhythmia Suppression Trial (CAST): Excessive mortality or nonfatal cardiac arrest (7.7%) shown with encainide or flecainide compared with placebo (3%)

            CAST was a long-term, multicenter, randomized, double-blind study in patients with asymptomatic non-life-threatening ventricular arrhythmias who had a myocardial infarction (MI) >6 days but <2 yr previously

            Average duration of treatment with encainide or flecainide in CAST was 10 months

            Applicability of CAST results to other populations (eg, patients without recent MI) is uncertain

            Reserve use of Class IC antiarrhythmics for life-threatening ventricular arrhythmias: Considering the known proarrhythmic properties of disopyramide & lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, disopyramide use, as well as other antiarrhythmic agents, should be reserved for patients with life-threatening ventricular arrhythmias

            Contraindications

            Hypersensitivity

            Cardiogenic shock, preexisting second or third degree heart block, congenital QT syndrome, sick sinus syndrome

            Cautions

            CHF, ECG abnormalities, electrolyte abnormalities (hypo/hyper K), glaucoma, hypoglycemia, myasthenia gravis, sick sinus syndrome, BPH/urinary retention, need normal potassium prior to use, hypotension, cardiac myopathies, heart failure, prostatic enlargement, Wolff-Parkinson-White syndrome, bundle branch block, hepatic/renal impairment

            Hypotension may occur

            May cause QTc prolongation and subsequent torsade de pointes

            Can both precipitate and exacerbate HF due to marked myocardial depressant effects in HF

            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: crosses into breast milk, discontinue drug or do not nurse

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
            Previous
            Next:

            Pharmacology

            Mechanism of action

            Direct membrane depressant that decreases conduction velocity, prolongs refractoriness, decreases automaticity and reduces repolarization abnormalities

            Absorption

            Bioavailability: 60-83%

            Peak Plasma Time: 1-2.5 hr (immediate-release); 4-7 hr (controlled-release)

            Onset: 30 min-3.5 hr

            Duration: 1.5-8.5 hr

            Distribution

            Protein Bound: 20-60%

            Vd: 0.8-2 L/kg

            Metabolism

            Metabolised by CYP3A4 in liver (45%) and intestinal wall (16%)

            Metabolites: N-monodealkylated metabolite (active met w/ less antiarrhythmic activity, but greater anticholinergic activity)

            Elimination

            Half-Life: 4-10 hr (parent drug); 12.9 hr (metabolite: N-monodealkylated metabolite)

            Total Body Clearance: 1-2 mL/min/kg

            Renal Clearance: 107 mL/min

            Excretion: urine (40-80%); feces (10-15%)

            Dialyzable: Yes, maintenance dose after dialysis is recommended

            Previous
            Next:

            Images

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous