Dosing & Uses
Dosage Forms & Strengths
tablet
- 150mg
- 225mg
- 300mg
capsule, extended-release
- 225mg
- 325mg
- 425mg
Ventricular Arrhythmias/Paroxysmal Supraventricular Tachycardia
IR: 150 mg PO q8hr; may increase to 225 mg q8hr after 3-4 days, and, if required, 300 mg q8hr; not to exceed 300 mg q8hr
Atrial Fibrillation/Flutter
IR: 150 mg PO q8hr; may increase to 225 mg q8hr after 3-4 days, and, if required, 300 mg q8hr; not to exceed 300 mg q8hr
ER: 225 mg PO q12hr initially; may increase dose q5Days to 325 mg PO q12hr OR 425 mg PO q12hr, if necessary
Dosing Considerations
Reduce dose in patients with significant widening of the QRS complex or 2nd or 3rd degree AV block
Dosing Modifications
Renal impairment: Not studied
Hepatic impairment: Administer 20-30% of normal IR dose and monitor closely; consider dose reduction if administering ER dose
Safety and efficacy not established
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (5)
- dofetilide
propafenone, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- fezolinetant
propafenone will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors
- nirmatrelvir
nirmatrelvir will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.
- nirmatrelvir/ritonavir
nirmatrelvir/ritonavir will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Nirmatrelvir/ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated concentrations are associated with serious and/or life-threatening reactions.
- tipranavir
tipranavir increases levels of propafenone by decreasing metabolism. Contraindicated.
Serious - Use Alternative (87)
- adagrasib
adagrasib, propafenone. 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.
- afatinib
propafenone increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.
- alfuzosin
alfuzosin and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- amisulpride
amisulpride and propafenone both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.
- anagrelide
anagrelide and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- apomorphine
apomorphine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- aripiprazole
aripiprazole and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- artemether
artemether and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
artemether/lumefantrine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
- asenapine
asenapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine transdermal
asenapine transdermal and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- atomoxetine
atomoxetine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- bosutinib
propafenone increases levels of bosutinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- buprenorphine
buprenorphine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine buccal
buprenorphine buccal and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine subdermal implant
buprenorphine subdermal implant and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine transdermal
buprenorphine transdermal and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- buprenorphine, long-acting injection
buprenorphine, long-acting injection and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
propafenone will increase the level or effect of chlorpromazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- clozapine
clozapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- dacomitinib
dacomitinib will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid use with CYP2D6 substrates where minimal increases in concentration of the CYP2D6 substrate may lead to serious or life-threatening toxicities.
- dasatinib
dasatinib and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- degarelix
degarelix and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- digoxin
propafenone increases levels of digoxin by decreasing renal clearance. Avoid or Use Alternate Drug.
- diltiazem
diltiazem will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of diltiazem with pimozide may increase the serum concentration of pimozide (eg, ventricular tachycardia, torsade de pointes, cardiac arrest, sudden death).
- dolasetron
dolasetron and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- donepezil
donepezil and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- dronedarone
dronedarone will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Prolongation of the QT interval with possible development of cardiac arrhythmias possible with co-administration. Concurrent use of drugs that prolong the QTc interval is contraindicated with dronedarone.
- edoxaban
propafenone will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended
- efavirenz
efavirenz and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- eliglustat
eliglustat and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- entrectinib
propafenone and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
eribulin and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- fexinidazole
fexinidazole and propafenone both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval.
- fingolimod
fingolimod and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- fluoxetine
fluoxetine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
propafenone will increase the level or effect of fluoxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
propafenone and fluoxetine both increase QTc interval. Avoid or Use Alternate Drug. - gemifloxacin
gemifloxacin and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- gilteritinib
gilteritinib and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- givosiran
givosiran will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP2D6 substrates with givosiran. If unavoidable, decrease the CYP2D6 substrate dosage in accordance with approved product labeling.
- glasdegib
propafenone 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 propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- hydroxyzine
hydroxyzine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and propafenone 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 propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- itraconazole
itraconazole and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib and propafenone 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.
- lefamulin
lefamulin and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- lithium
lithium and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- lumefantrine
lumefantrine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
- macimorelin
macimorelin and propafenone 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.
- mirtazapine
mirtazapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib and propafenone both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.
- nilotinib
nilotinib will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Additive QT prolongation may occur during coadministration of nilotinib and propafenone. Coadministration of nilotinib and a drug that prolongs the QT interval is not advised
- olanzapine
olanzapine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- ondansetron
propafenone 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 propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- panobinostat
propafenone 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
paroxetine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
propafenone will increase the level or effect of paroxetine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Monitor heart rate and EKG in patients receiving concurrent paroxetine and propafenone. Doses may need to be reduced. - pimozide
propafenone, pimozide. Mechanism: pharmacodynamic synergism. Contraindicated. Risk of prolonged QTc interval.
- pitolisant
propafenone and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- pomalidomide
propafenone increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- ponesimod
ponesimod, propafenone. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Consult cardiologist if considering treatment. Coadministration of ponesimod with drugs that decrease HR may have additive effects on decreasing HR and should generally not be initiated in these patients.
- primaquine
primaquine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
quinidine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug.
- ribociclib
ribociclib will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
ribociclib increases toxicity of propafenone by QTc interval. Avoid or Use Alternate Drug. - rimegepant
propafenone will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
- riociguat
propafenone will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed
- risperidone
propafenone will increase the level or effect of risperidone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. The concurrent administration of propafenone and risperidone is not recommended due to the potential for inducing life-threatening arrhythmias. If concurrent use cannot be avoided, cautious dosing and telemetric monitoring is advised.
- ritonavir
ritonavir will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. Concurrent use of propafenone and ritonavir is contraindicated.
ritonavir increases levels of propafenone by decreasing metabolism. Contraindicated. - siponimod
siponimod and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- solifenacin
solifenacin and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- sunitinib
sunitinib and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- tacrolimus
tacrolimus and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- tetrabenazine
tetrabenazine and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
- thioridazine
propafenone will increase the level or effect of thioridazine by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. The concurrent administration of thioridazine and agents that prolong the QT interval, such as Class I antiarrhythmic agents, is contraindicated.
thioridazine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Avoid or Use Alternate Drug. The concurrent administration of thioridazine and agents that prolong the QT interval, such as Class I antiarrhythmic agents, is contraindicated. - toremifene
propafenone 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.
- umeclidinium bromide/vilanterol inhaled
propafenone 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
propafenone, 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.
- vemurafenib
vemurafenib and propafenone both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
- venetoclax
propafenone will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.
- vilanterol/fluticasone furoate inhaled
propafenone 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.
- vorinostat
vorinostat and propafenone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (147)
- abiraterone
abiraterone increases levels of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Avoid coadministration of abiraterone with substrates of CYP2D6. If alternative therapy cannot be used, exercise caution and consider a dose reduction of the CYP2D6 substrate.
- albuterol
albuterol and propafenone both increase QTc interval. Use Caution/Monitor.
- alfuzosin
propafenone and alfuzosin both increase QTc interval. Use Caution/Monitor.
- amiodarone
amiodarone will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Generally avoid combination because of increased risk of QTc interval.
- amobarbital
amobarbital decreases levels of propafenone by increasing metabolism. Use Caution/Monitor.
- antithrombin alfa
propafenone increases effects of antithrombin alfa by decreasing metabolism. Use Caution/Monitor.
- antithrombin III
propafenone increases effects of antithrombin III by decreasing metabolism. Use Caution/Monitor.
- arformoterol
arformoterol and propafenone both increase QTc interval. Use Caution/Monitor.
- argatroban
propafenone increases effects of argatroban by decreasing metabolism. Use Caution/Monitor.
- asenapine
asenapine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- atomoxetine
propafenone will increase the level or effect of atomoxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- azithromycin
azithromycin increases toxicity of propafenone by QTc interval. Use Caution/Monitor.
- bedaquiline
propafenone and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- bemiparin
propafenone increases effects of bemiparin by decreasing metabolism. Use Caution/Monitor.
- benzhydrocodone/acetaminophen
propafenone will increase the level or effect of benzhydrocodone/acetaminophen by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone [benzhydrocodone is prodrug of hydrocodone]) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.
- berotralstat
propafenone increases levels of berotralstat by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduced berotralstat dose to 110 mg/day when coadministered with P-gp inhibitors.
- betrixaban
propafenone increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.
- bivalirudin
propafenone increases effects of bivalirudin by decreasing metabolism. Use Caution/Monitor.
- bupropion
bupropion will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- butabarbital
butabarbital decreases levels of propafenone by increasing metabolism. Use Caution/Monitor.
- butalbital
butalbital decreases levels of propafenone by increasing metabolism. Use Caution/Monitor.
- carbamazepine
carbamazepine will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- carvedilol
propafenone will increase the level or effect of carvedilol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- celecoxib
celecoxib will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- ceritinib
propafenone increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- chloroquine
chloroquine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
chloroquine increases toxicity of propafenone by QTc interval. Use Caution/Monitor. - cimetidine
cimetidine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
cimetidine will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. - citalopram
propafenone 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 propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- clobazam
clobazam will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Lower doses of drugs metabolized by CYP2D6 may be required when used concomitantly.
- clomipramine
propafenone will increase the level or effect of clomipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- cobicistat
cobicistat will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Clinical monitoring is recommended upon coadministration with antiarrhythmics.
- crizotinib
crizotinib and propafenone both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- dabigatran
propafenone will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min
- dalteparin
propafenone increases effects of dalteparin by decreasing metabolism. Use Caution/Monitor.
- darifenacin
darifenacin will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- darunavir
darunavir will increase the level or effect of propafenone 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 propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- desipramine
propafenone will increase the level or effect of desipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- desvenlafaxine
desvenlafaxine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Desvenlafaxine inhibits CYP2D6; with higher desvenlafaxine doses (ie, 400 mg) decrease the CYP2D6 substrate dose by up to 50%; no dosage adjustment needed with desvenlafaxine doses <100 mg
- deutetrabenazine
deutetrabenazine and propafenone 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 propafenone both decrease serum potassium. Use Caution/Monitor.
- diphenhydramine
diphenhydramine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- dofetilide
dofetilide increases toxicity of propafenone by QTc interval. Use Caution/Monitor.
- doxepin
propafenone will increase the level or effect of doxepin by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
doxepin and propafenone both increase QTc interval. Use Caution/Monitor. - dronedarone
dronedarone will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- duloxetine
duloxetine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
propafenone will increase the level or effect of duloxetine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. - duvelisib
propafenone will increase the level or effect of duvelisib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- eliglustat
eliglustat increases levels of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the concomitant drug and titrate to clinical effect.
- enoxaparin
propafenone increases effects of enoxaparin by decreasing metabolism. Use Caution/Monitor.
- erythromycin base
erythromycin base will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin ethylsuccinate
erythromycin ethylsuccinate will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin lactobionate
erythromycin lactobionate will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- erythromycin stearate
erythromycin stearate will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- escitalopram
escitalopram increases toxicity of propafenone by QTc interval. Use Caution/Monitor.
- ezogabine
ezogabine, propafenone. 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 propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP2D6 substrates as necessary.
- flecainide
propafenone will increase the level or effect of flecainide by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- fluphenazine
propafenone will increase the level or effect of fluphenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- fluvoxamine
fluvoxamine will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- fondaparinux
propafenone increases effects of fondaparinux by decreasing metabolism. Use Caution/Monitor.
- fostemsavir
propafenone and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gadobenate
gadobenate and propafenone both increase QTc interval. Use Caution/Monitor.
- gemtuzumab
propafenone and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- glecaprevir/pibrentasvir
propafenone will increase the level or effect of glecaprevir/pibrentasvir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- goserelin
goserelin increases toxicity of propafenone by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- grapefruit
grapefruit increases levels of propafenone by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
- haloperidol
haloperidol will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. If concurrent use cannot be avoided, cautious dosing and telemetric monitoring is advised.
haloperidol and propafenone both increase QTc interval. Use Caution/Monitor. - hawthorn
hawthorn increases effects of propafenone by pharmacodynamic synergism. Use Caution/Monitor.
- heparin
propafenone increases effects of heparin by decreasing metabolism. Use Caution/Monitor.
- histrelin
histrelin increases toxicity of propafenone by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- hydrocodone
propafenone will increase the level or effect of hydrocodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Hydromorphone (<3% of the circulating parent hydrocodone) is mainly formed by CYP2D6 mediated O-demethylation of hydrocodone. Hydromorphone may contribute to the total analgesic effect of hydrocodone.
- hydromorphone
propafenone will increase the level or effect of hydromorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- iloperidone
propafenone will increase the level or effect of iloperidone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- imatinib
imatinib will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- imipramine
propafenone will increase the level or effect of imipramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- indacaterol, inhaled
indacaterol, inhaled, propafenone. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
- isoniazid
isoniazid will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- itraconazole
itraconazole will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Closely monitor for evidence of propafenone toxicity when used together with a strong CYP3A4 inhibitor. Avoid concurrent use of a CYP2D6 inhibitor in patients receiving proprafenone and a CYP3A4 inhibitor.
- ketoconazole
ketoconazole will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lenvatinib
propafenone 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 propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- leuprolide
leuprolide increases toxicity of propafenone by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- levoketoconazole
levoketoconazole will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- lofepramine
propafenone will increase the level or effect of lofepramine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- lorcaserin
lorcaserin will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- maraviroc
maraviroc will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- marijuana
marijuana will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- methamphetamine
propafenone will increase the level or effect of methamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- metoprolol
propafenone will increase the level or effect of metoprolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. If concurrent therapy is required, monitor cardiac function carefully, particularly blood pressure. A dosage adjustment for the beta blocker may be required.
- mexiletine
propafenone will increase the level or effect of mexiletine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- mifepristone
mifepristone, propafenone. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- mirabegron
mirabegron will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- morphine
propafenone will increase the level or effect of morphine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- naldemedine
propafenone increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.
- nebivolol
propafenone will increase the level or effect of nebivolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Reduced doses of nebivolol may be necessary.
- nefazodone
nefazodone will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- nilotinib
nilotinib will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- nintedanib
propafenone increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy .
- nortriptyline
propafenone will increase the level or effect of nortriptyline by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- olodaterol inhaled
propafenone 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
- ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC)
ombitasvir/paritaprevir/ritonavir & dasabuvir (DSC) will increase the level or effect of propafenone 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
- osimertinib
osimertinib and propafenone 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 propafenone by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- oxycodone
propafenone will increase the level or effect of oxycodone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- oxymorphone
propafenone will increase the level or effect of oxymorphone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- ozanimod
ozanimod and propafenone 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.
- parecoxib
parecoxib will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- pasireotide
propafenone and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- peginterferon alfa 2b
peginterferon alfa 2b, propafenone. Other (see comment). Use Caution/Monitor. Comment: When patients are administered peginterferon alpha-2b with CYP2D6 substrates, the therapeutic effect of these drugs may be altered. Peginterferon alpha-2b may increase or decrease levels of CYP2D6 substrate.
- pentobarbital
pentobarbital decreases levels of propafenone by increasing metabolism. Use Caution/Monitor.
- perphenazine
perphenazine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
propafenone will increase the level or effect of perphenazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. - phenindione
propafenone increases effects of phenindione by decreasing metabolism. Use Caution/Monitor.
- phenobarbital
phenobarbital decreases levels of propafenone by increasing metabolism. Use Caution/Monitor.
- primidone
primidone decreases levels of propafenone by increasing metabolism. Use Caution/Monitor.
- prochlorperazine
propafenone will increase the level or effect of prochlorperazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- promazine
propafenone will increase the level or effect of promazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- promethazine
propafenone will increase the level or effect of promethazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- propranolol
propafenone will increase the level or effect of propranolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. If concurrent therapy is required, monitor cardiac function carefully, particularly blood pressure. A dosage adjustment for the beta blocker may be required.
- protamine
propafenone increases effects of protamine by decreasing metabolism. Use Caution/Monitor.
- quetiapine
quetiapine, propafenone. 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.
- quinacrine
quinacrine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- quinine
propafenone and quinine both increase QTc interval. Use Caution/Monitor.
- ranolazine
ranolazine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- rifabutin
rifabutin will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- rifampin
rifampin will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
rifampin decreases levels of propafenone by increasing metabolism. Use Caution/Monitor. - rifaximin
propafenone increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
- rilpivirine
rilpivirine increases toxicity of propafenone by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsade de Pointes.
- rolapitant
rolapitant will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Rolapitant may increase plasma concentrations of CYP2D6 substrates for at least 28 days following rolapitant administration.
- secobarbital
secobarbital decreases levels of propafenone by increasing metabolism. Use Caution/Monitor.
- selpercatinib
selpercatinib increases toxicity of propafenone by QTc interval. Use Caution/Monitor.
- sevelamer
sevelamer decreases levels of propafenone by increasing elimination. Use Caution/Monitor.
- sevoflurane
sevoflurane and propafenone both increase QTc interval. Use Caution/Monitor.
- sorafenib
sorafenib and propafenone both increase QTc interval. Use Caution/Monitor.
- St John's Wort
St John's Wort will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- talazoparib
propafenone will increase the level or effect of talazoparib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Talazoparib is a P-glycoprotein (P-gp) substrate; coadministration with P-gp inhibitors may increase talazoparib systemic exposure.
- tamoxifen
propafenone decreases effects of tamoxifen by decreasing metabolism. Use Caution/Monitor. Inhibition of CYP2D6 metabolism to tamoxifen's active metabolite, endoxifen.
- terbinafine
terbinafine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Modify Therapy/Monitor Closely. Assess need to reduce dose of CYP2D6-metabolized drug.
- timolol
propafenone will increase the level or effect of timolol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- tipranavir
tipranavir will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- tolterodine
propafenone will increase the level or effect of tolterodine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Use caution when prescribing propafenone concurrently with tolterodine. Concomitant use of propafenone and tolterodine may cause QT prolongation.
- tramadol
propafenone decreases effects of tramadol by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite.
propafenone decreases effects of tramadol by decreasing metabolism. Use Caution/Monitor. Decreased conversion of tramadol to active metabolite. - triclabendazole
triclabendazole and propafenone both increase QTc interval. Use Caution/Monitor.
- trifluoperazine
propafenone will increase the level or effect of trifluoperazine by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
- triptorelin
triptorelin increases toxicity of propafenone by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.
- valbenazine
valbenazine and propafenone both increase QTc interval. Use Caution/Monitor.
- venlafaxine
venlafaxine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.
Minor (71)
- amobarbital
amobarbital will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- aprepitant
aprepitant will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- aripiprazole
propafenone will increase the level or effect of aripiprazole by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- armodafinil
armodafinil will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- artemether/lumefantrine
artemether/lumefantrine will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- atazanavir
atazanavir will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- bosentan
bosentan will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- budesonide
budesonide will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- butabarbital
butabarbital will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- butalbital
butalbital will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- codeine
propafenone will increase the level or effect of codeine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
propafenone decreases effects of codeine by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of codeine to active metabolite morphine. - conivaptan
conivaptan will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cortisone
cortisone will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- cyclosporine
cyclosporine will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- darifenacin
darifenacin will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dasatinib
dasatinib will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dexamethasone
dexamethasone will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- dexfenfluramine
propafenone will increase the level or effect of dexfenfluramine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- dextroamphetamine
propafenone will increase the level or effect of dextroamphetamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- dextromethorphan
propafenone will increase the level or effect of dextromethorphan by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- DHEA, herbal
DHEA, herbal will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- donepezil
propafenone will increase the level or effect of donepezil by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- efavirenz
efavirenz will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- encainide
propafenone will increase the level or effect of encainide by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- eslicarbazepine acetate
eslicarbazepine acetate will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- etravirine
etravirine will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fesoterodine
propafenone will increase the level or effect of fesoterodine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- fluconazole
fluconazole will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fludrocortisone
fludrocortisone will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- food
food increases levels of propafenone by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.
- fosamprenavir
fosamprenavir will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fosaprepitant
fosaprepitant will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- fosphenytoin
fosphenytoin will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- galantamine
propafenone will increase the level or effect of galantamine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- grapefruit
grapefruit will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- griseofulvin
griseofulvin will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- hydrocortisone
hydrocortisone will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- indinavir
indinavir will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- lapatinib
lapatinib will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- lily of the valley
propafenone, lily of the valley. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown.
- loratadine
propafenone will increase the level or effect of loratadine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- lumefantrine
lumefantrine will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- marijuana
marijuana will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- methylprednisolone
methylprednisolone will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- metronidazole
metronidazole will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- miconazole vaginal
miconazole vaginal will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nelfinavir
nelfinavir will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nevirapine
nevirapine will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- nifedipine
nifedipine will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- oxcarbazepine
oxcarbazepine will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- oxycodone
propafenone decreases effects of oxycodone by decreasing metabolism. Minor/Significance Unknown. Decreased conversion of oxycodone to active metabolite morphine.
- pentobarbital
pentobarbital will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- perhexiline
propafenone will increase the level or effect of perhexiline by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- phenobarbital
phenobarbital will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- phenytoin
phenytoin will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- posaconazole
posaconazole will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- prednisone
prednisone will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- primidone
primidone will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- quinupristin/dalfopristin
quinupristin/dalfopristin will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- rifabutin
rifabutin decreases levels of propafenone by increasing metabolism. Minor/Significance Unknown.
- rifapentine
rifapentine will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- ritonavir
ritonavir will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- rufinamide
rufinamide will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- secobarbital
secobarbital will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- sertraline
sertraline will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown. Monitor the EKG in patients receiving concurrent propafenone and sertraline. Doses of propafenone may need to be reduced.
- theophylline
propafenone increases levels of theophylline by decreasing renal clearance. Minor/Significance Unknown.
- topiramate
topiramate will decrease the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- tropisetron
propafenone will increase the level or effect of tropisetron by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown.
- verapamil
verapamil will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- voriconazole
voriconazole will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
- zafirlukast
zafirlukast will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.
Adverse Effects
>10%
Unusual taste (7-23%)
Dizziness/lightheadedness (7-15%)
N/V (3-11%)
1-10%
Constipation (4-8%)
Headache (2-6%)
Intraventricular conduction delay (4%)
Fatigue (6%)
Blurred vision (3%)
Weakness (3%)
Dyspnea (2%)
Wild complex tachycardia (2%)
Bradycardia (2%)
Palpitations (2%)
Tremor (2%)
Anorexia (2%)
Diarrhea (2%)
Ataxia (2%)
1°AV block (2-5%)
Angina (5%)
Palpitations (3%)
CHF (2-3% )
Chest pain (2%)
Bradyarrhythmia (2%)
AF (1%)
Bundle branch block (1%)
2nd degree AV block (1%)
Hypotension (1%)
Sinus arrest (1%)
Frequency Not Defined
Lethargy
Rash
Dyspepsia
Dry mouth
Agranulocytosis
Hepatotoxicity (rare)
Systemic lupus erythematosus (rare)
Bronchospasm (rare)
Postmarketing Reports
Cardiovascular: Atrial flutter, AV dissociation, cardiac arrest, flushing, hot flashes, sick sinus syndrome, sinus pause or arrest, supraventricular tachycardia
Neurologic/psychiatric: Abnormal dreams/speech/vision, apnea, coma, confusion, depression, memory loss, numbness, paresthesias, psychosis/mania, seizures, tinnitus, unusual smell sensation, vertigo
Hepatic: Cholestasis, elevated LFTs, gastroenteritis, hepatitis
Hematologic: Agranulocytosis, anemia, bruising, granulocytopenia, increased bleeding time, leukopenia, purpura, thrombocytopenia
Alopecia
Eye irritation
Hyponatremia/inappropriate ADH secretion
Impotence
Increased glucose
Kidney failure
Positive ANA
Lupus erythematosus
Muscle cramps
Muscle weakness
Nephrotic syndrome
Pain
Pruritus
Warnings
Black Box Warnings
NHLBI’s Cardiac Arrhythmia Suppression Trial (CAST): Excessive mortality or nonfatal cardiac arrest (7.7%) shown with encainide or flecainide, compared with placebo (3%)
Applicability of CAST results to other populations (eg, patients without recent MI) is uncertain; therefore, reserve use of class IC antiarrhythmics for life-threatening ventricular arrhythmias
Considering known proarrhythmic properties of propafenone and lack of evidence of improved survival for any antiarrhythmic drug in patients without life-threatening arrhythmias, use should be reserved for patients with life-threatening ventricular arrhythmias
Contraindications
Hypersensitivity
Bradycardia, asthma/bronchospastic disorders or severe obstructive pulmonary disease, marked hypotension, cardiogenic shock, intraventricular disorders of impulse generation and/or conduction including sick sinus node and syndrome AV block (unless artificial pacemaker present), electrolyte imbalances, CHF, severe hypotension, myasthenia gravis
Known Brugada syndrome
Concomitant ritonavir therapy
Cautions
May alter pacemaker thresholds
Elevated ANA titers reported with use; may consider discontinuing therapy in symptomatic patients with positive ANA titers
Use caution in patients with hematologic disorders, myasthenia gravis (may exacerbate condition), hepatic/renal impairment
Use with caution in patients with hypersensitivity to propranolol
There is a potential for increased mortality post-MI, as with encainide and flecainide (other class ICs)
May cause new or worsened arrhythmias; proarrhythmic effects include sudden death and life-threatening ventricular arrhythmias such as ventricular fibrillation, ventricular tachycardia, asystole, and torsade de pointes; important to evaluate patient electrocardiographically prior to and during therapy to determine whether response supports continued treatment; because propafenone prolongs QRS interval in electrocardiogram, changes in the QT interval are difficult to interpret
Through CYP3A inhibition, grapefruit juice consumption may decrease elimination (ie, increase serum levels)
Correct electrolyte imbalance, especially hypomagnesemia or hypokalemia before initiating therapy and throughout
Plasma concentration has poor correlation to antiarrhythmia effect
New or worsening HF may occur; propafenone exerts a negative inotropic activity on myocardium as well as beta-blockade effects and may provoke overt heart failure; CHF attributable to propafenone HCl develops rarely (less than 0.2%) in subjects with ventricular arrhythmia who had no previous history of CHF
Slows AV conduction and may cause AV block
Brugada syndrome may be unmasked after exposure to propafenone; perform ECG after initiation and discontinue the drug if changes are suggestive of Brugada Syndrome
Agranulocytosis reported (most within first 2 months of treatment)
Highly metabolized by liver; severe liver impairment increases bioavailability by 70%; carefully monitor patients with impaired hepatic function for excessive pharmacological effects
Pregnancy & Lactation
Pregnancy
There are no studies in pregnant women; available data from published case reports and several decades of postmarketing experience with use in pregnancy have not identified any drug-associated risks of miscarriage, birth defects, or adverse maternal or fetal outcomes; untreated arrhythmias during pregnancy may pose a risk to pregnant woman and fetus; the drug and its metabolite, 5-OH-propafenone, cross the placenta in humans
Incidence of VT is increased and may be more symptomatic during pregnancy; ventricular arrhythmias most often occur in pregnant women with underlying cardiomyopathy, congenital heart disease, valvular heart disease, or mitral valve prolapse; breakthrough arrhythmias may occur during pregnancy, as therapeutic treatment levels may be difficult to maintain due to increased volume of distribution and increased drug metabolism inherent in pregnant state
The drug and its metabolite have been shown to cross placenta; adverse reactions such as fetal/neonatal arrhythmias have been associated with use of other antiarrhythmic agents by pregnant women; fetal/neonatal monitoring for signs and symptoms of arrhythmia is recommended during and after treatment of pregnant women
Animal data
- In animal studies, propafenone was not teratogenic; at maternally toxic doses (ranging from 2 to 6 times maximum recommended human dose [MRHD]), there was evidence of adverse developmental outcomes when administered to pregnant rabbits and rats during organogenesis or when administered to pregnant rats during mid-gestation through weaning of their offspring
Infertility
- Based on human and animal studies, may transiently impair spermatogenesis in males; reversible decreases in spermatogenesis have been demonstrated in monkeys, dogs, and rabbits after lethal or near-lethal intravenous doses of the drug
Labor or Delivery
- Risk of arrhythmias may increase during labor and delivery; patients should be monitored continuously for arrhythmias during labor and delivery
Lactation
Propafenone and its active metabolite, 5-OH-propafenone, are present in human milk, but levels are likely to be low; there are no data on effects on breastfed infant or on milk production
The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for propafenone and any potential adverse effects on breastfed infant from propafenone or from underlying maternal condition
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
Class IC antiarrhythmic; slows conduction in cardiac tissue by altering transport of ion across membranes; causes slight prolongation of AV nodal refractory periods; decreases rate of rise of action potential without affecting its duration
Absorption
Bioavailability: 3.4% (150 mg IR); 10.6% (300 mg IR)
Peak serum time: 2-3.5 hr (IR); 3-8 hr (ER)
Distribution
Protein bound: 95%
Vd: 252 L (adults)
Metabolism
Metabolism: Via CYP2D6 to 5-hydroxypropafenone; via CYP1A2 and CYP3A4 to N-depropylpropafenone
Metabolites: 5-hydroxypropafenone (active), N-depropylpropafenone (active), at least 9 other metabolites
Enzymes inhibited: CYP2D6
Elimination
Half-life: 2-10 hr (extensive metabolizers); 10-32 hr (poor metabolizers)
Dialyzable: No (HD)
Total body clearance: 1-1.3 L/kg/hr
Excretion: Urine; feces
Pharmacogenomics
Approximately 7-10% of whites and 3-8% of African Americans lack the capacity to metabolize CYP2D6 substrates and are classified as poor metabolizers (PMs)
Increased exposure may lead to cardiac arrhythmias and exaggerated beta-adrenergic blocking activity
Because of propafenone’s metabolism by CYP2D6, deficiency of this isoenzyme is potentially hazardous
Genetic testing laboratories
- The Roche Cytochrome AmpliChip P450 2D6/2C19 Genotyping and Phenotyping Assay can be used to identify 26 different alleles of CYP2D6
- LabCorp (http://www.labcorp.com/); testing for CYP2D6 variants
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| propafenone oral - | 225 mg capsule |  | |
| propafenone oral - | 325 mg capsule |  | |
| propafenone oral - | 425 mg capsule |  | |
| propafenone oral - | 225 mg capsule |  | |
| propafenone oral - | 225 mg tablet |  | |
| propafenone oral - | 425 mg capsule |  | |
| propafenone oral - | 300 mg tablet |  | |
| propafenone oral - | 225 mg tablet |  | |
| propafenone oral - | 325 mg capsule |  | |
| propafenone oral - | 150 mg tablet |  | |
| propafenone oral - | 425 mg capsule |  | |
| propafenone oral - | 325 mg capsule |  | |
| propafenone oral - | 225 mg capsule |  | |
| propafenone oral - | 300 mg tablet |  | |
| propafenone oral - | 225 mg tablet |  | |
| propafenone oral - | 150 mg tablet |  | |
| propafenone oral - | 150 mg tablet |  | |
| propafenone oral - | 225 mg tablet |  | |
| propafenone oral - | 150 mg tablet |  | |
| propafenone oral - | 225 mg capsule |  | |
| propafenone oral - | 425 mg capsule |  | |
| propafenone oral - | 325 mg capsule |  | |
| Rythmol SR oral - | 425 mg capsule | | |
| Rythmol SR oral - | 325 mg capsule | | |
| Rythmol SR oral - | 225 mg capsule | |
Copyright © 2010 First DataBank, Inc.
Patient Handout
propafenone oral
PROPAFENONE - ORAL
(pro-puh-FEN-own)
COMMON BRAND NAME(S): Rythmol
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 paroxysmal supraventricular tachycardia and atrial fibrillation). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat. Propafenone is known as an anti-arrhythmic drug. It works by blocking the activity of 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 as directed by your doctor, usually every 8 hours.The dosage is based on your 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.Avoid eating grapefruit or drinking grapefruit juice while using this medication unless your doctor or pharmacist says you may do so safely. Grapefruit can increase the chance of side effects with this medicine. Ask your doctor or pharmacist for more details.Tell your doctor if your condition does not improve or if it worsens.
SIDE EFFECTS: See also Warning section.Dizziness, headache, metallic/salty taste in the mouth, nausea/vomiting, constipation, anxiety, and tiredness 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: signs of infection (such as sore throat that doesn't go away, high fever, severe chills, weakness), signs of liver problems (such as nausea/vomiting that doesn't stop, stomach/abdominal pain, yellowing eyes/skin, dark urine), 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 propafenone, 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: breathing problems (such as asthma, chronic bronchitis, emphysema), kidney problems, liver problems, myasthenia gravis, a certain inherited heart condition (Brugada Syndrome).Propafenone 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 propafenone, 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 propafenone safely.This drug may 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).Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).This medication can affect fertility in males. Ask your doctor for more details.During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.This medication passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: See also How to Use section.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.Many drugs besides propafenone may affect the heart rhythm (QT prolongation), including amiodarone, dofetilide, flecainide, pimozide, procainamide, quinidine, sotalol, macrolide antibiotics (such as clarithromycin, erythromycin), and certain quinolone antibiotics (such as sparfloxacin), among others.Other medications can affect the removal of propafenone from your body, which may affect how propafenone works. Examples include asunaprevir, desipramine, ketoconazole, orlistat, phenobarbital, phenytoin, ritonavir, certain HIV protease inhibitors (such as tipranavir), among others.Propafenone can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include digoxin, fezolinetant, imipramine, metoprolol, propranolol, warfarin, 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: severe dizziness, very slow heartbeat, new irregular heartbeat, fainting.
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 May 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
Adding plans allows you to compare formulary status to other drugs in the same class.
To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.
Adding plans allows you to:
- View the formulary and any restrictions for each plan.
- Manage and view all your plans together – even plans in different states.
- Compare formulary status to other drugs in the same class.
- Access your plan list on any device – mobile or desktop.
