propafenone (Rx)

Brand and Other Names:Rythmol, Rythmol SR
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Dosing & Uses

AdultPediatric

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

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Interactions

Interaction Checker

and propafenone

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            Contraindicated (2)

            • dofetilide

              propafenone, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.

            • tipranavir

              tipranavir increases levels of propafenone by decreasing metabolism. Contraindicated.

            Serious - Use Alternative (56)

            • 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.

            • 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.

            • 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.

            • 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.

            • deutetrabenazine

              deutetrabenazine 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

            • entrectinib

              propafenone and entrectinib 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.

            • 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.

            • 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.

            • hydroxychloroquine sulfate

              hydroxychloroquine sulfate 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.

            • 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.

            • 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.

            • 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

            • 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.

            • 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.

            • 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.

            • 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.

            Monitor Closely (143)

            • 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

            • 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.

            • 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.

            • 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.

            • 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

              ombitasvir/paritaprevir/ritonavir & dasabuvir 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.

            • 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.

            • venlafaxine

              venlafaxine will increase the level or effect of propafenone by affecting hepatic enzyme CYP2D6 metabolism. Use Caution/Monitor.

            • warfarin

              propafenone increases effects of warfarin by decreasing 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.

            • 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.

            • modafinil

              modafinil will decrease 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.

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            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

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            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

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            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.

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            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
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            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Rythmol SR oral
            -
            425 mg capsule
            Rythmol SR oral
            -
            325 mg capsule
            Rythmol SR oral
            -
            225 mg capsule
            propafenone oral
            -
            425 mg capsule
            propafenone oral
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            325 mg capsule
            propafenone oral
            -
            425 mg capsule
            propafenone oral
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            225 mg capsule
            propafenone oral
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            150 mg tablet
            propafenone oral
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            300 mg tablet
            propafenone oral
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            225 mg tablet
            propafenone oral
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            150 mg tablet
            propafenone oral
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            225 mg capsule
            propafenone oral
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            425 mg capsule
            propafenone oral
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            225 mg tablet
            propafenone oral
            -
            150 mg tablet
            propafenone oral
            -
            300 mg tablet
            propafenone oral
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            325 mg capsule
            propafenone oral
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            225 mg tablet
            propafenone oral
            -
            225 mg tablet
            propafenone oral
            -
            150 mg tablet
            propafenone oral
            -
            425 mg capsule
            propafenone oral
            -
            325 mg capsule
            propafenone oral
            -
            225 mg capsule
            propafenone oral
            -
            325 mg capsule
            propafenone oral
            -
            225 mg capsule

            Copyright © 2010 First DataBank, Inc.

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            Patient Handout

            Patient Education
            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, usually every 8 hours or as directed by your doctor.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 persist or worsen, 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 any of these rare but very serious side effects occur: signs of infection (such as high fever, severe chills, weakness, persistent sore throat), signs of liver problems (such as persistent nausea/vomiting, 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).Seek immediate medical attention if any of these rare but serious side effects occur: fainting, faster/more irregular heartbeat, severe dizziness.A very serious allergic reaction to this drug is rare. However, seek immediate medical attention 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 that you are using this medication.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, rifampin, and certain HIV protease inhibitors (such as ritonavir, 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, 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.Laboratory and/or medical tests (such as EKG) should be performed periodically to monitor your progress or check for side effects. 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 August 2021. Copyright(c) 2021 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.

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            Formulary

            FormularyPatient Discounts

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

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

            Adding plans allows you to:

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

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

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