Dosing & Uses
Dosage Forms & Strengths
capsule
- 100mg
- 150mg
capsule, controlled-release
- 100mg
- 150mg
Ventricular Arrhythmias
>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 Arrhythmias
>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
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
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (52)
- amitriptyline
amitriptyline and disopyramide both increase QTc interval. Contraindicated.
- amoxapine
amoxapine and disopyramide both increase QTc interval. Contraindicated.
- artemether/lumefantrine
disopyramide and artemether/lumefantrine both increase QTc interval. Contraindicated.
- chlorpromazine
chlorpromazine and disopyramide both increase QTc interval. Contraindicated.
- clomipramine
clomipramine and disopyramide both increase QTc interval. Contraindicated.
- desipramine
desipramine and disopyramide both increase QTc interval. Contraindicated.
- dofetilide
disopyramide and dofetilide both increase QTc interval. Contraindicated.
disopyramide, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects. - doxepin
doxepin and disopyramide both increase QTc interval. Contraindicated.
- dronedarone
disopyramide and dronedarone both increase QTc interval. Contraindicated.
- droperidol
disopyramide and droperidol both increase QTc interval. Contraindicated.
- epinephrine
epinephrine and disopyramide both increase QTc interval. Contraindicated.
- epinephrine racemic
epinephrine racemic and disopyramide both increase QTc interval. Contraindicated.
- erythromycin base
disopyramide and erythromycin base both increase QTc interval. Contraindicated.
- erythromycin ethylsuccinate
disopyramide and erythromycin ethylsuccinate both increase QTc interval. Contraindicated.
- erythromycin lactobionate
disopyramide and erythromycin lactobionate both increase QTc interval. Contraindicated.
- erythromycin stearate
disopyramide and erythromycin stearate both increase QTc interval. Contraindicated.
- fingolimod
fingolimod increases effects of disopyramide by pharmacodynamic synergism. Contraindicated. Due to increased risk of bradycardia, AV block, and torsade de pointes, concomitant use is contraindicated.
fingolimod and disopyramide both increase QTc interval. Contraindicated. - fluconazole
disopyramide and fluconazole both increase QTc interval. Contraindicated.
- fluphenazine
fluphenazine and disopyramide both increase QTc interval. Contraindicated.
- goserelin
goserelin increases toxicity of disopyramide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- haloperidol
disopyramide and haloperidol both increase QTc interval. Contraindicated.
- ibutilide
disopyramide and ibutilide both increase QTc interval. Contraindicated.
- imipramine
imipramine and disopyramide both increase QTc interval. Contraindicated.
- indapamide
disopyramide and indapamide both increase QTc interval. Contraindicated.
- itraconazole
itraconazole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
disopyramide and itraconazole both increase QTc interval. Contraindicated. - ketoconazole
ketoconazole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
disopyramide and ketoconazole both increase QTc interval. Contraindicated. - lefamulin
lefamulin will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.
- leuprolide
leuprolide increases toxicity of disopyramide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- levoketoconazole
levoketoconazole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
disopyramide and levoketoconazole both increase QTc interval. Contraindicated. - lofepramine
lofepramine and disopyramide both increase QTc interval. Contraindicated.
- lumefantrine
disopyramide and lumefantrine both increase QTc interval. Contraindicated.
- maprotiline
maprotiline and disopyramide both increase QTc interval. Contraindicated.
- moxifloxacin
disopyramide and moxifloxacin both increase QTc interval. Contraindicated.
- nilotinib
disopyramide and nilotinib both increase QTc interval. Contraindicated.
- nortriptyline
nortriptyline and disopyramide both increase QTc interval. Contraindicated.
- octreotide
disopyramide and octreotide both increase QTc interval. Contraindicated.
- octreotide (Antidote)
disopyramide and octreotide (Antidote) both increase QTc interval. Contraindicated.
- pentamidine
disopyramide and pentamidine both increase QTc interval. Contraindicated.
- perphenazine
perphenazine and disopyramide both increase QTc interval. Contraindicated.
- pimozide
disopyramide and pimozide both increase QTc interval. Contraindicated.
- procainamide
disopyramide and procainamide both increase QTc interval. Contraindicated.
- prochlorperazine
prochlorperazine and disopyramide both increase QTc interval. Contraindicated.
- promazine
promazine and disopyramide both increase QTc interval. Contraindicated.
- promethazine
promethazine and disopyramide both increase QTc interval. Contraindicated.
- protriptyline
protriptyline and disopyramide both increase QTc interval. Contraindicated.
- quinidine
quinidine and disopyramide both increase QTc interval. Contraindicated.
- sotalol
disopyramide and sotalol both increase QTc interval. Contraindicated.
- thioridazine
thioridazine and disopyramide both increase QTc interval. Contraindicated.
- trazodone
trazodone and disopyramide both increase QTc interval. Contraindicated.
- trifluoperazine
trifluoperazine and disopyramide both increase QTc interval. Contraindicated.
- trimipramine
trimipramine and disopyramide both increase QTc interval. Contraindicated.
- ziprasidone
disopyramide and ziprasidone both increase QTc interval. Contraindicated.
Serious - Use Alternative (111)
- adagrasib
adagrasib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of adagrasib, a CYP3A4 inhibitor, with sensitive CYP3A substrates unless otherwise recommended in the prescribing information for these substrates.
adagrasib, disopyramide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients. - alfuzosin
alfuzosin and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- amiodarone
amiodarone and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- anagrelide
anagrelide and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- apalutamide
apalutamide will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.
- apomorphine
apomorphine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- aripiprazole
aripiprazole and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- arsenic trioxide
arsenic trioxide and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
asenapine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- atomoxetine
atomoxetine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- bremelanotide
bremelanotide will decrease the level or effect of disopyramide by Other (see comment). Avoid or Use Alternate Drug. Bremelanotide may slow gastric emptying and potentially reduces the rate and extent of absorption of concomitantly administered oral medications. Avoid use when taking any oral drug that is dependent on threshold concentrations for efficacy. Interactions listed are representative examples and do not include all possible clinical examples.
- brigatinib
brigatinib will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Brigatinib induces CYP3A4 in vitro. Coadministration with CYP3A4 substrates, particularly those with a narrow therapeutic index, can result in decreased concentrations and loss of efficacy. If unable to avoid coadministration, monitor CYP3A4 substrate levels and adjust dose as needed.
- buprenorphine
buprenorphine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
ceritinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. - chloroquine
chloroquine increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
clozapine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- crizotinib
crizotinib increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of crizotinib with CYP3A substrates with narrow therapeutic indices should be avoided. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
crizotinib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. - dasatinib
dasatinib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
degarelix and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- dofetilide
dofetilide increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug.
- dolasetron
disopyramide and dolasetron both increase QTc interval. Avoid or Use Alternate Drug.
- donepezil
donepezil and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- efavirenz
efavirenz and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- eliglustat
eliglustat and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.
- entrectinib
disopyramide and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
eribulin and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.
- escitalopram
escitalopram increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
fexinidazole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates. - flecainide
disopyramide and flecainide both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
disopyramide and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug.
- fluvoxamine
fluvoxamine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- formoterol
disopyramide and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
- foscarnet
disopyramide and foscarnet both increase QTc interval. Avoid or Use Alternate Drug.
- gadobenate
gadobenate and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- gemifloxacin
gemifloxacin and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- gilteritinib
gilteritinib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- glasdegib
disopyramide and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- granisetron
granisetron and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- histrelin
histrelin increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxyzine
hydroxyzine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- idelalisib
idelalisib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates
- iloperidone
disopyramide and iloperidone both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.
- isoflurane
isoflurane and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
- lapatinib
disopyramide and lapatinib both increase QTc interval. Avoid or Use Alternate Drug.
- levofloxacin
disopyramide and levofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- lithium
lithium and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- lopinavir
lopinavir will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- lumacaftor/ivacaftor
lumacaftor/ivacaftor will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Lumacaftor is a strong inducer of CYP3A. Avoid coadministration with sensitive CYP3A substrates or CYP3A substrates with a narrow therapeutic index.
- macimorelin
macimorelin and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.
- mavacamten
disopyramide, mavacamten. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Expect additive negative inotropic effects of mavacamten and other drugs that reduce cardiac contractility.
- mefloquine
mefloquine increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
- methadone
disopyramide and methadone both increase QTc interval. Avoid or Use Alternate Drug.
- mifepristone
mifepristone will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
- mirtazapine
mirtazapine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, increase CYP3A4 substrate dosage in accordance with its prescribing information.
mobocertinib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently. - nefazodone
nefazodone will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- nilotinib
nilotinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Additive QT prolongation may occur during coadministration of nilotinib and disopyramide Coadministration of nilotinib and a drug that prolongs the QT interval is not advised
- ofloxacin
disopyramide and ofloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- olanzapine
olanzapine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- olutasidenib
olutasidenib will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of olutasidenib (a CYP3A4 inducer) with sensitive CYP3A substrates unless otherwise instructed in substrates prescribing information. If unavoidable, monitor for loss of therapeutic effect of sensitive CYP3A4 substrates.
- ondansetron
disopyramide and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.
- oxaliplatin
oxaliplatin and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- pacritinib
pacritinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
- paliperidone
disopyramide and paliperidone both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
disopyramide and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.
- paroxetine
disopyramide and paroxetine both increase QTc interval. Avoid or Use Alternate Drug.
- pexidartinib
pexidartinib will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of pexidartinib (a CYP3A4 inducer) with sensitive CYP3A substrates may lead to serious therapeutic failures. If concomitant use is unavoidable, increase the CYP3A substrate dosage in accordance with approved product labeling.
- pimavanserin
disopyramide and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.
- pitolisant
disopyramide and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- posaconazole
disopyramide and posaconazole both increase QTc interval. Avoid or Use Alternate Drug.
- primaquine
primaquine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- ranolazine
disopyramide and ranolazine both increase QTc interval. Avoid or Use Alternate Drug.
- ribociclib
ribociclib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
ribociclib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. - risperidone
disopyramide and risperidone both increase QTc interval. Avoid or Use Alternate Drug.
- romidepsin
disopyramide and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- saquinavir
saquinavir increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Increased risk of QT prolongation and cardiac arrhythmias.
- sertraline
sertraline and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- sevoflurane
sevoflurane and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- siponimod
siponimod, disopyramide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Because of the potential additive effects on heart rate, siponimod should generally not be initiated in patients taking QT prolonging drugs with known arrhythmogenic properties, heart rate lowering calcium channel blockers, or other drugs that may decrease heart rate. If treatment considered, obtain cardiology consult regarding switching to non-heart-rate lowering drugs or appropriate monitoring for treatment initiation.
- sotorasib
sotorasib will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the CYP3A4 substrate for dosage modifications
- sulfamethoxazole
sulfamethoxazole and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- sunitinib
sunitinib and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- tacrolimus
tacrolimus and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- telavancin
disopyramide and telavancin both increase QTc interval. Avoid or Use Alternate Drug.
- tetrabenazine
tetrabenazine and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- tipranavir
tipranavir increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Increased risk of QT prolongation and cardiac arrhythmias.
- toremifene
disopyramide and toremifene both increase QTc interval. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.
- trimethoprim
disopyramide and trimethoprim both increase QTc interval. Avoid or Use Alternate Drug.
- triptorelin
triptorelin increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug. Increases risk of torsades de pointes.
- tropisetron
disopyramide and tropisetron both increase QTc interval. Avoid or Use Alternate Drug.
- tucatinib
tucatinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.
- umeclidinium bromide/vilanterol inhaled
disopyramide increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- vandetanib
disopyramide, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.
- venlafaxine
disopyramide and venlafaxine both increase QTc interval. Avoid or Use Alternate Drug.
- vilanterol/fluticasone furoate inhaled
disopyramide increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.
- voriconazole
disopyramide and voriconazole both increase QTc interval. Avoid or Use Alternate Drug.
- vorinostat
vorinostat and disopyramide both increase QTc interval. Avoid or Use Alternate Drug.
- voxelotor
voxelotor will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.
Monitor Closely (148)
- albuterol
albuterol and disopyramide both increase QTc interval. Use Caution/Monitor.
- amiloride
amiloride increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.
- arformoterol
arformoterol and disopyramide both increase QTc interval. Use Caution/Monitor.
- artemether/lumefantrine
artemether/lumefantrine will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Additive QTc prolongation effects. Concomitant use of artemether; lumefantrine with other drugs that prolong the QT interval such as Class IA antiarrhythmics should be avoided.
- atenolol
atenolol increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive negative inotropic effects.
- azithromycin
azithromycin and disopyramide both increase QTc interval. Modify Therapy/Monitor Closely.
- bedaquiline
disopyramide and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- belzutifan
belzutifan will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.
- berotralstat
berotralstat will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor or titrate substrate dose when berotralstat is coadministered with narrow therapeutic index drugs that are CYP3A substrates.
- blinatumomab
blinatumomab increases levels of disopyramide by decreasing metabolism. Modify Therapy/Monitor Closely. Treatment initiation causes transient release of cytokines that may suppress CYP450 enzymes; highest drug-drug interaction risk is during the first 9 days of the first cycle and the first 2 days of the 2nd cycle in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index.
- bosutinib
bosutinib and disopyramide both increase QTc interval. Use Caution/Monitor.
- brodalumab
brodalumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, brodalumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of brodalumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.
- capecitabine
capecitabine and disopyramide both increase QTc interval. Use Caution/Monitor.
- carbamazepine
carbamazepine will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cenobamate
cenobamate will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.
- chlorpropamide
disopyramide increases effects of chlorpropamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- cimetidine
cimetidine will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ciprofloxacin
ciprofloxacin and disopyramide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.
- citalopram
disopyramide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- clarithromycin
clarithromycin will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clinical monitoring is recommended upon coadministration with antiarrhythmics.
- crofelemer
crofelemer increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Crofelemer has the potential to inhibit CYP3A4 at concentrations expected in the gut; unlikely to inhibit systemically because minimally absorbed.
- dabrafenib
dabrafenib will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- darunavir
darunavir will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clinical monitoring is recommended upon coadministration with antiarrhythmics.
- deferasirox
deferasirox will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- deutetrabenazine
disopyramide and deutetrabenazine both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).
- dichlorphenamide
dichlorphenamide and disopyramide both decrease serum potassium. Use Caution/Monitor.
- diltiazem
diltiazem will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- drospirenone
drospirenone increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.
- dulaglutide
dulaglutide, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Dulaglutide slows gastric emptying and may impact absorption of concomitantly administered oral medications; be particularly cautious when coadministered with drugs that have a narrow therapeutic index.
- dupilumab
dupilumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, dupilumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of dupilumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.
- duvelisib
duvelisib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.
- elagolix
elagolix will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.
- elranatamab
elranatamab will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Elranatamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of elranatamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.
- eluxadoline
eluxadoline increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution when CYP3A substrates that have a narrow therapeutic index are coadministered with eluxadoline.
- elvitegravir/cobicistat/emtricitabine/tenofovir DF
elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.
- encorafenib
encorafenib, disopyramide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
- enzalutamide
enzalutamide will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- epcoritamab
epcoritamab, disopyramide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Epcoritamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .
- erythromycin base
erythromycin base will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ethotoin
ethotoin increases toxicity of disopyramide by increasing metabolism. Use Caution/Monitor. Hydantoins decreases the level, but increases the toxicity, of disopyramide.
- ezogabine
ezogabine, disopyramide. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
- fedratinib
fedratinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.
- ferric maltol
ferric maltol, disopyramide. Either increases levels of the other by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration of ferric maltol with certain oral medications may decrease the bioavailability of either ferric maltol and some oral drugs. For oral drugs where reductions in bioavailability may cause clinically significant effects on its safety or efficacy, separate administration of ferric maltol from these drugs. Duration of separation may depend on the absorption of the medication concomitantly administered (eg, time to peak concentration, whether the drug is an immediate or extended release product).
- floxuridine
floxuridine and disopyramide both increase QTc interval. Use Caution/Monitor.
- fosphenytoin
fosphenytoin increases toxicity of disopyramide by increasing metabolism. Use Caution/Monitor. Hydantoins decreases the level, but increases the toxicity, of disopyramide.
- fostemsavir
disopyramide and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemtuzumab
disopyramide and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- glimepiride
disopyramide increases effects of glimepiride by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glipizide
disopyramide increases effects of glipizide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glofitamab
glofitamab, disopyramide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glofitamab causes release of cytokines that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. For certain CYP substrates, minimal changes in their concentration may lead to serious adverse reactions. If needed, modify therapy as recommended in the substrate's prescribing information. .
- glyburide
disopyramide increases effects of glyburide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- glycerol phenylbutyrate
glycerol phenylbutyrate will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Glycerol phenylbutyrate is a weak inducer of CYP3A4. Monitor for decreased efficacy of CYP3A4 substrates that have a narrow therapeutic index.
- guselkumab
guselkumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of guselkumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.
- hawthorn
hawthorn increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor.
- iloperidone
iloperidone increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.
- indacaterol, inhaled
indacaterol, inhaled, disopyramide. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- insulin aspart
disopyramide increases effects of insulin aspart by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin aspart protamine/insulin aspart
disopyramide increases effects of insulin aspart protamine/insulin aspart by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin degludec
disopyramide, insulin degludec. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
disopyramide increases effects of insulin degludec by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring. - insulin degludec/insulin aspart
disopyramide, insulin degludec/insulin aspart. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
- insulin detemir
disopyramide increases effects of insulin detemir by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin glargine
disopyramide increases effects of insulin glargine by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin glulisine
disopyramide increases effects of insulin glulisine by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin inhaled
disopyramide, insulin inhaled. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Both drugs decrease blood glucose.
disopyramide increases effects of insulin inhaled by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring. - insulin isophane human/insulin regular human
disopyramide increases effects of insulin isophane human/insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin lispro
disopyramide increases effects of insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin lispro protamine/insulin lispro
disopyramide increases effects of insulin lispro protamine/insulin lispro by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin NPH
disopyramide increases effects of insulin NPH by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- insulin regular human
disopyramide increases effects of insulin regular human by unspecified interaction mechanism. Use Caution/Monitor. Concomitant use of insulin and disopyramide may require insulin dosage adjustment and increased glucose monitoring.
- isavuconazonium sulfate
isavuconazonium sulfate will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- isoniazid
isoniazid will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- istradefylline
istradefylline will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
- ixekizumab
ixekizumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, ixekizumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of ixekizumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.
- larotrectinib
larotrectinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lenacapavir
lenacapavir will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.
- lenvatinib
disopyramide and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.
- letermovir
letermovir increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lidocaine
disopyramide, lidocaine. Mechanism: pharmacodynamic synergism. Use Caution/Monitor. Risk of arrhythmia, heart failure in predisposed pts.
- lofexidine
disopyramide and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.
- lonapegsomatropin
lonapegsomatropin decreases effects of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.
- lorlatinib
lorlatinib will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lumefantrine
lumefantrine will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Additive QTc prolongation effects. Concomitant use of artemether; lumefantrine with other drugs that prolong the QT interval such as Class IA antiarrhythmics should be avoided.
- mifepristone
mifepristone, disopyramide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- mitotane
mitotane decreases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.
- olodaterol inhaled
disopyramide and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias
- omaveloxolone
omaveloxolone will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Omaveloxolone may reduce systemic exposure of sensitive CYP3A4 substrates. Check prescribing information of substrate if dosage modification is needed.
- ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Caution is warranted and therapeutic concentration monitoring (if available) is recommended for antiarrhythmics when coadministered with Viekira Pak
- oritavancin
oritavancin will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Oritavancin is a weak CYP3A4 inducer; caution if coadministered with CYP3A4 substrates that have a narrow therapeutic index
- osilodrostat
osilodrostat and disopyramide both increase QTc interval. Use Caution/Monitor.
- osimertinib
osimertinib and disopyramide both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- oxaliplatin
oxaliplatin will increase the level or effect of disopyramide by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- ozanimod
ozanimod and disopyramide both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.
- palbociclib
palbociclib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. The dose of sensitive CYP3A substrates with a narrow therapeutic index may need to be reduced if coadministered with palbociclib
- pasireotide
disopyramide and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pazopanib
disopyramide and pazopanib both increase QTc interval. Modify Therapy/Monitor Closely.
- phenytoin
phenytoin will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Phenytoin decreases the levels of disopyramide but can also increase the toxicity.
phenytoin increases toxicity of disopyramide by increasing metabolism. Use Caution/Monitor. Hydantoins decreases the level, but increases the toxicity, of disopyramide. - pirtobrutinib
pirtobrutinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pirtobrutinib (a CYP3A4 inhibitor) may increase plasma concentrations of sensitive CYP3A4 substrate which may increase the risk of adverse reactions related to these substrates.
- pitolisant
pitolisant will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Pitolisant is a borderline/weak inducer of CYP3A4. Monitor sensitive CYP3A4 substrates for reduced effectiveness if coadministered.
- ponesimod
ponesimod, disopyramide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class Ia (eg, quinidine, procainamide) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.
- potassium acid phosphate
potassium acid phosphate increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.
- potassium chloride
potassium chloride increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.
- potassium citrate
potassium citrate increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.
- practolol
practolol increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive negative inotropic effects.
- quetiapine
quetiapine, disopyramide. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.
- quinine
disopyramide and quinine both increase QTc interval. Use Caution/Monitor.
- quizartinib
quizartinib, disopyramide. Either increases effects of the other by QTc interval. Modify Therapy/Monitor Closely. Monitor patients more frequently with ECG if coadministered with QT prolonging drugs.
- rifabutin
rifabutin will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rilpivirine
rilpivirine increases toxicity of disopyramide by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.
- ritlecitinib
ritlecitinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Ritlecitinib inhibits CYP3A4 substrates; coadministration increases AUC and peak plasma concentration sensitive substrates, which may increase risk of adverse reactions. Additional monitoring and dosage adjustment may be needed in accordance with product labeling of CYP3A substrates.
- ropeginterferon alfa 2b
ropeginterferon alfa 2b will increase the level or effect of disopyramide by Other (see comment). Use Caution/Monitor. Certain proinflammatory cytokines, including interferons, can suppress CYP450 enzymes resulting in increased exposures of some CYP substrates. Therefore, monitor patients who are receiving concomitant drugs that are CYP450 substrates with a narrow therapeutic index from toxicities to such drugs.
- rucaparib
rucaparib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.
- sarilumab
sarilumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of cytokines such as IL-6. Elevated IL-6 concentration may down-regulate CYP activity, such as in patients with RA, and, hence, increase drug levels compared with subjects without RA. Blockade of IL-6 signaling by IL-6 antagonists (eg, sarilumab) might reverse the inhibitory effect of IL-6 and restore CYP activity, leading to decreased drug concentrations. Caution when initiating or discontinuing sarilumab if coadministered with CYP450 substrates, especially those with a narrow therapeutic index.
- schisandra
schisandra will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- secukinumab
secukinumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, secukinumab could normalize the formation of CYP450 enzymes. Upon initiation or discontinuation of secukinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.
- selpercatinib
selpercatinib increases toxicity of disopyramide by QTc interval. Use Caution/Monitor.
- sevelamer
sevelamer decreases levels of disopyramide by increasing elimination. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of disopyramide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of disopyramide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
- sofosbuvir/velpatasvir
sofosbuvir/velpatasvir increases levels of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Velpatasvir inhibits CYP3A4. Caution if coadministered with drugs with narrow therapeutics indexes.
- solifenacin
solifenacin and disopyramide both increase QTc interval. Use Caution/Monitor.
- somapacitan
somapacitan decreases effects of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.
- somatrogon
somatrogon decreases effects of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.
- somatropin
somatropin decreases effects of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Limited published data indicate that growth hormone treatment increases cytochrome P450 (CYP450)-mediated antipyrine clearance. Caution with sensitive CYP substrates.
- sorafenib
sorafenib and disopyramide both increase QTc interval. Use Caution/Monitor.
- spironolactone
spironolactone increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.
- St John's Wort
St John's Wort will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- stiripentol
stiripentol, disopyramide. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
- talquetamab
talquetamab will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Talquetamab causes cytokine release syndrome (CRS) that may suppress activity of CYP enzymes, resulting in increased exposure of CYP substrates. This is more likely to occur from initiation of talquetamab step-up dosing up to 14 days after the first treatment dose and during and after CRS.
- tazemetostat
tazemetostat will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- teclistamab
teclistamab will increase the level or effect of disopyramide by altering metabolism. Use Caution/Monitor. Teclistamab causes release of cytokines that may suppress activity of CYP450 enzymes, resulting in increased exposure of CYP substrates. Monitor for increased concentrations or toxicities of sensitive CYP substrates. Adjust dose of CYP substrate drug as needed.
- tecovirimat
tecovirimat will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.
- teduglutide
teduglutide increases levels of disopyramide by Other (see comment). Use Caution/Monitor. Comment: Teduglutide may increase absorption of concomitant PO medications; caution with with drugs requiring titration or those with a narrow therapeutic index; dose adjustment may be necessary.
- telotristat ethyl
telotristat ethyl will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Telotristat ethyl induces CYP3A4 and may reduce systemic exposure of sensitive CYP3A4 substrates. Monitor for suboptimal efficacy and consider increasing the dose of the CYP3A4 substrate.
- tolazamide
disopyramide increases effects of tolazamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- tolbutamide
disopyramide increases effects of tolbutamide by unspecified interaction mechanism. Use Caution/Monitor. Risk of hypoglycemia.
- triamterene
triamterene increases effects of disopyramide by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiovascular depression.
- triclabendazole
triclabendazole and disopyramide both increase QTc interval. Use Caution/Monitor.
- trofinetide
trofinetide will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor CYP3A4 substrates for which a small increase in plasma concentration may lead to serious toxicities if coadministered with trofinetide (a weak CYP3A4 inhibitor).
- turmeric
turmeric will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- ustekinumab
ustekinumab, disopyramide. Other (see comment). Use Caution/Monitor. Comment: Formation of CYP450 enzymes can be altered by increased levels of certain cytokines during chronic inflammation; thus, normalizing the formation of CYP450 enzymes. Upon initiation or discontinuation of ustekinumab in patients who are receiving concomitant CYP450 substrates, particularly those with a narrow therapeutic index, consider monitoring for therapeutic effect.
- valbenazine
valbenazine and disopyramide both increase QTc interval. Use Caution/Monitor.
- verapamil
verapamil will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Avoid disopyramide administration within 48 hours before or 24 hours after verapamil administration.
- voclosporin
voclosporin, disopyramide. Either increases effects of the other by QTc interval. Use Caution/Monitor.
Minor (54)
- acetazolamide
acetazolamide will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- amobarbital
amobarbital will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- anastrozole
anastrozole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- aprepitant
aprepitant will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- armodafinil
armodafinil will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- atazanavir
atazanavir will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- bosentan
bosentan will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- budesonide
budesonide will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- butabarbital
butabarbital will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- butalbital
butalbital will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- conivaptan
conivaptan will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cortisone
cortisone will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclophosphamide
cyclophosphamide will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclosporine
cyclosporine will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- darifenacin
darifenacin will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dasatinib
dasatinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dexamethasone
dexamethasone will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- DHEA, herbal
DHEA, herbal will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dronedarone
dronedarone will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- efavirenz
efavirenz will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- etravirine
etravirine will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fluconazole
fluconazole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fludrocortisone
fludrocortisone will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fosamprenavir
fosamprenavir will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fosaprepitant
fosaprepitant will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fosphenytoin
fosphenytoin will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- grapefruit
grapefruit will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- griseofulvin
griseofulvin will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- hydrocortisone
hydrocortisone will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- indinavir
indinavir will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- lapatinib
lapatinib will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- lily of the valley
disopyramide, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.
- marijuana
marijuana will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- methylprednisolone
methylprednisolone will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- metronidazole
metronidazole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- miconazole vaginal
miconazole vaginal will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nelfinavir
nelfinavir will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nevirapine
nevirapine will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nifedipine
nifedipine will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- oxcarbazepine
oxcarbazepine will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- pentobarbital
pentobarbital will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- phenobarbital
phenobarbital will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- posaconazole
posaconazole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- prednisone
prednisone will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- primidone
primidone will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- quinupristin/dalfopristin
quinupristin/dalfopristin will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- rifapentine
rifapentine will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ritonavir
ritonavir will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- rufinamide
rufinamide will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- secobarbital
secobarbital will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- topiramate
topiramate will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- voriconazole
voriconazole will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zafirlukast
zafirlukast will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
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
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 AV block (if no pacemaker is present), congenital QT syndrome, sick sinus syndrome
Cautions
Patients with atrial flutter or fibrillation should be digitalized prior to therapy administration to ensure that drug-induced enhancement of AV conduction does not result in an increase of ventricular rate beyond physiologically acceptable limit
Care should be taken when prescribing therapy for patients with sick sinus syndrome (bradycardia-tachycardia syndrome), Wolff-Parkinson-White syndrome(WPW), or bundle branch block; the effect of disopyramide phosphate in these conditions is uncertain at present
Patients with myocarditis or other cardiomyopathy may develop significant hypotension in response to usual dosage of disopyramide phosphate, probably due tocardiodepressant mechanisms; therefore, a loading dose of should not be given to such patients, and initial dosage and subsequent dosage adjustments should be made under close supervision
Dosage should be reduced in patients with impaired renal function; the electrocardiogram should be carefully monitored for prolongation of PR interval, evidence of QRS widening, or other signs of overdosage; this drug is not recommended for patients with severe renal insufficiency (creatinine clearance 40 ml/min or less)
Hepatic impairment causes an increase in plasma half-life of this drug; dosage should be reduced for patients with such impairment; the electrocardiogram should be carefully monitored for signs of overdosage; patients with cardiac dysfunction have a higher potential for hepatic impairment; this should be considered when administering therapy
Antiarrhythmic drugs may be ineffective in patients with hypokalemia, and their toxic effects may be enhanced in patients with hyperkalemia; therefore, potassium abnormalities should be corrected before starting therapy
Negative inotropic properties
- Therapy may cause or worsen congestive heart failure or produce severe hypotension as consequence of its negative inotropic properties
- Hypotension has been observed primarily in patients with primary cardiomyopathy or inadequately compensated congestive heart failure; this drug should not be used in patients with uncompensated or marginally compensated congestive heart failure or hypotension unless congestive heart failure or hypotension is secondary to cardiac arrhythmia
- Patients with a history of heart failure may be treated, but careful attention must be given to maintenance of cardiac function, including optimal digitalization
- If hypotension occurs or congestive heart failure worsens, therapy should be discontinued and, if necessary, restarted at lower dosage only after adequate cardiac compensation established
- Although it is unusual, significant widening (greater than 25%) of the QRS complex may occur during administration; in such cases therapy should be discontinued
- As with other Type 1 antiarrhythmic drugs, prolongation of the Q-T interval (corrected) and worsening of arrhythmia, including ventricular tachycardia and ventricular fibrillation, may occur
- Patients who have evidenced prolongation of Q-T interval in response to quinidine may be at particular risk; as with other Type 1A antiarrhythmics, disopyramide phosphate has been associated with torsade de pointes
- If Q-T prolongation of greater than 25% is observed and if ectopy continues, the patient should be monitored closely, and consideration given to discontinuing therapy
- In rare instances, significant lowering of blood-glucose values reported during administration; the physician should be alert to this possibility, especially in patients with congestive heart failure, chronic malnutrition, hepatic, renal, or other diseases, or drugs (eg, beta-adrenoceptor blockers, alcohol) which could compromise preservation of normal glucoregulatory mechanisms in absence of food; in these patients the blood-glucose levels should be carefully followed
- If first-degree heart block develops in a patient receiving therapy, the dosage should be reduced; if the block persists despite reduction of dosage, continuation of drug must depend upon weighing benefit being obtained against risk of higher degrees of heart block; development of second- or third-degree AV block or unifascicular, bifascicular, or trifascicular block requires discontinuation of therapy, unless ventricular rate is adequately controlled by temporary or implanted ventricular pacemaker
Anticholinergic activity
- Because of its anticholinergic activity, disopyramide phosphate should not be used in patients with glaucoma, myasthenia gravis, or urinary retention unless adequate overriding measures are taken; these consist of topical application of potent miotics (eg, pilocarpine) for patients with glaucoma, and catheter drainage or operative relief for patients with urinary retention
- Urinary retention may occur in patients of either sex as consequence of therapy administration, but males with benign prostatic hypertrophy are at particular risk
- In patients with family history of glaucoma, intraocular pressure should be measured before initiating therapy; disopyramide phosphate should be used with special care in patients with myasthenia gravis since its anticholinergic properties could precipitate a myasthenic crisis in such patients
Drug interaction overview
- If phenytoin or other hepatic enzyme inducers are taken concurrently, lower plasma levels of disopyramide may occur; monitoring of disopyramide plasma levels is recommended in such concurrent use to avoid ineffective therapy
- The concomitant use with other Type 1A antiarrhythmic agents (such as quinidine or procainamide), Type 1C antiarrhythmics (such as encainide, flecainide or propafenone), and/or propranolol should be reserved for patients with life-threatening arrhythmias who are demonstrably unresponsive to single-agent antiarrhythmic therapy; such use may produce serious negative inotropic effects, or may excessively prolong conduction; this should be considered particularly in patients with any degree of cardiac decompensation or those with prior history thereof; patients receiving more than one antiarrhythmic drug must be carefully monitored
- Cases of life-threatening interactions reported for disopyramide when given with clarithromycin and erythromycin indicating that coadministration of disopyramide with inhibitors of cytochrome 3A4 could result in potentially fatal interaction
Pregnancy & Lactation
Pregnancy
There are no adequate and well-controlled studies on pregnant women
This drug has been reported to stimulate contractions of pregnant uterus; the drug has been found in human fetal blood
It is not known whether use of this drug during labor or delivery has immediate or delayed adverse effects on fetus, or whether it prolongs duration of labor or increases need for forceps delivery or other obstetric intervention
Animal data
- Therapy was associated with decreased numbers of implantation sites and decreased growth and survival of pups when administered to pregnant rats at 250 mg/kg/day (20 or more times the usual daily human dose of 12 mg/kg, assuming a patient weight of at least 50 kg), a level at which weight gain and food consumption of dams were also reduced
- Increased resorption rates were reported in rabbits at 60 mg/kg/day (5 or more times the usual daily human dose); effects on implantation, pup growth, and survival were not evaluated in rabbits
- Therapy should be used during pregnancy only if potential benefit justifies potential risk to fetus
Lactation
Studies in rats have shown that concentration of disopyramide and its metabolites is between one and three times greater in milk than in plasma
Following oral administration, disopyramide has been detected in human milk at a concentration not exceeding that in plasma
Because of potential for serious adverse reactions in nursing infants from therapy, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account importance of to the mother
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.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
Metabolized by CYP3A4 in liver (45%) and intestinal wall (16%)
Metabolites: N-monodealkylated metabolite (active met with 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
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Norpace CR oral - | 100 mg capsule |  | |
| Norpace CR oral - | 150 mg capsule |  | |
| disopyramide phosphate oral - | 150 mg capsule |  | |
| disopyramide phosphate oral - | 150 mg capsule |  | |
| disopyramide phosphate oral - | 100 mg capsule |  | |
| disopyramide phosphate oral - | 100 mg capsule |  | |
| disopyramide phosphate oral - | 150 mg capsule |  | |
| disopyramide phosphate oral - | 100 mg capsule |  | |
| Norpace oral - | 150 mg capsule | | |
| Norpace oral - | 100 mg capsule | |
Copyright © 2010 First DataBank, Inc.
Patient Handout
disopyramide phosphate oral
DISOPYRAMIDE - ORAL
(dye-soe-PIR-a-mide)
COMMON BRAND NAME(S): Norpace
WARNING: Though this medication often gives great benefits to people with irregular heartbeat, it may rarely cause a serious new irregular heartbeat. When starting treatment with this drug, your doctor may recommend that you stay in the hospital for proper monitoring and emergency medical treatment if needed. Talk with your doctor about the benefits and risks of taking this medication.
USES: This medication is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as sustained ventricular tachycardia). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat. Disopyramide is known as an anti-arrhythmic drug. It works by blocking certain electrical signals in the heart that can cause an irregular heartbeat. Treating an irregular heartbeat can decrease the risk for blood clots, and this effect can reduce your risk of heart attack or stroke.
HOW TO USE: Take this medication by mouth with or without food exactly as prescribed by your doctor. If you are taking the immediate-release form, take it as directed by your doctor, usually 4 times daily.If you are taking the extended-release form, take it as directed by your doctor, usually twice a day. Swallow extended-release capsules whole. Do not crush or chew extended-release capsules or tablets. Doing so can release all of the drug at once, increasing the risk of side effects. Swallow the whole tablet without crushing or chewing.The dosage is based on your age, medical condition, and response to treatment.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Tell your doctor if your condition does not improve or if it worsens.
SIDE EFFECTS: See also Warning section.Dry mouth, constipation, nausea, abdominal pain/gas/bloating, blurred vision, dizziness, dry nose/eyes/throat, and urination problems (such as difficulty urinating or unusual frequent urge to urinate) may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: symptoms of low blood sugar (such as shakiness with unusual hunger/headache/sweating), signs of liver problems (such as nausea/vomiting that doesn't stop, stomach/abdominal pain, yellowing eyes/skin, dark urine), muscle weakness, worsening symptoms of heart failure (such as shortness of breath, swelling ankles/feet, unusual tiredness, unusual/sudden weight gain).Get medical help right away if you have any very serious side effects, including: fainting, faster/more irregular heartbeat, severe dizziness.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
PRECAUTIONS: Before taking disopyramide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: diabetes, glaucoma, kidney disease, liver problems, myasthenia gravis, urinary problems (such as due to enlarged prostate, urinary retention).This drug may rarely make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Disopyramide may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using disopyramide, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/"water pills") or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using disopyramide safely.This drug may cause low blood sugar (hypoglycemia), especially if you have diabetes, heart failure, decreased kidney/liver function, or nutrition problems. Tell your doctor right away if you have symptoms of low blood sugar including sudden sweating, shaking, fast heartbeat, hunger, blurred vision, dizziness, or tingling hands/feet. If you have diabetes, your diabetes medication, exercise program, or diet may need to be adjusted.Older adults may be more sensitive to the side effects of this drug, especially urination problems and QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. Rarely, disopyramide may cause early labor during pregnancy. Discuss the risks and benefits with your doctor.This medication passes into breast milk, and the effect on a nursing infant is unknown. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: fingolimod, certain calcium channel blockers (diltiazem and verapamil).Many drugs besides disopyramide may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, flecainide, ketoconazole, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as clarithromycin, erythromycin), and certain quinolone antibiotics (such as sparfloxacin), among others. (See also Precautions section.)Other medications can affect the removal of disopyramide from your body, which may affect how disopyramide works. Examples include phenytoin, saquinavir, among others.
OVERDOSE: If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: fainting, new irregular heartbeat, slowed breathing.
NOTES: Do not share this medication with others.Lab and/or medical tests (such as EKG) should be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.
MISSED DOSE: If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.
STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.
MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).
Information last revised April 2023. Copyright(c) 2023 First Databank, Inc.
IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.
Formulary
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