ibutilide (Rx)

Brand and Other Names:Corvert
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

injectable solution

  • 0.1mg/mL
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Atrial Fibrillation/Flutter

<60 kg: 0.01 mg/kg (0.1 mL/kg) IV infusion repeat after 10 minutes PRN 

>60 kg: 1 mg (one vial) IV infusion, repeat after 10 minutes PRN

Renal Impairment

Dose adjustment not necessary

Hepatic Impairment

Dose adjustment not necessary

Safety & efficacy not established

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Interactions

Interaction Checker

and ibutilide

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            1-10%

            Headache (4%)

            Bradycardia (2%)

            HTN (2%)

            Hypotension (2%)

            Palpitations (2%)

            QTc interval prolongation (<2%)

            Nausea (>2%)

            < 1%

            Heart failure

            Erythematous bollous lesions

            Nodal arrythmia

            Renal failure

            Ventricular tachycardia

            Syncope

            Heart block

            Torsades de pointes

            Potentially lethal arrhythmias: sustained polymorphic V-Tach (Torsades de Pointes), AV block

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            Warnings

            Black Box Warnings

            May cause potentially fatal arrhythmias, particularly sustained polymorphic ventricular tachycardia usually in association with QT prolongation (torsades de pointes), but sometimes without documented QT prolongation

            Studies show arrhythmias requiring cardioversion occurred in 1.7% of treated patients during or within a number of hours of using ibutilide fumarate; these arrhythmias can be reversed if treated promptly

            Administer in with continuous ECG monitoring & by personnel trained in identification and treatment of acute ventricular arrhythmias, particularly polymorphic ventricular tachycardia

            Patients with atrial fibrillation >2-3 days' duration must be adequately anticoagulated, generally for at least 2 wk

            Carefully select patients: Patients with chronic atrial fibrillation have a strong tendency to revert after conversion to sinus rhythm and treatment to maintain sinus rhythms carry risks

            Contraindications

            Prolongs QT interval: concurrent QT-prolonging drugs or congenital long QT patients; QTc >440 msec

            Cautions

            Administer in a setting of continuous ECG monitoring and by personnel trained in treating arrhythmias such as polymorphic ventricular tachycardia

            ANTICIPATE ARRHYTHMIAS, have all materials at hand to handle potential lethal arrhythmias for at least 4-6 hr

            A-Fib >2-3 days duration requires anticoagulation prior to therapy

            Hypokalemia, hypomagnesemia other electrolyte distrubances must be corrected prior and throughout therapy

            Caution in bradycardia, CHF, electrolyte abnormalities, history of polymorphic VT after antiarrhythmic therapy, liver disease, proarrhythmic events, recent MI

            Monitor for heart block

            Drugs that prolong the QT interval and other class I or class III antiarrhythmic agents should not be given concurrently with ibutilide (or within 4 hours after infusion), other antiarrhythmics should be withheld prior to conversion with ibutilide (eg, 5 half-lives)

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            Pregnancy & Lactation

            Pregnancy Category: C

            Lactation: enters breast milk; contraindicated

            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.

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            Pharmacology

            Mechanism of Action

            Prolongs action potential duration and increase both atrial and ventricular refractoriness (class III effects)

            Markedly prolongs action potential and repolarization

            Pharmacokinetics

            Half-Life: 2-12 hr

            Onset: 90 min following infusion

            Duration: 24 hr

            Protein Bound: 40%

            Vd: 11 L/kg

            Metabolism: Liver via oxidation

            Metabolites: Hydroxy derivative (active)

            Excretion: Urine (82%); feces (20%)

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            Administration

            IV Compatibilities

            Solution: D5W, NS

            IV Preparation

            Dilute in 50 mL NS or D5W to make 0.017 mg/mL solution

            IV Administration

            IV infusion over 10 min diluted or undiluted

            Storage

            May store diluted soln for 24 hr at room temperature OR 48 hr at 2-8°C (36-46°F)

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            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.
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.