Dosing & Uses
Dosage Forms & Strengths
capsule
- 125mcg
- 250mcg
- 500mcg
Conversion of Atrial Fibrillation/Flutter to Normal Sinus Rhythm
QTc must be <440 msec (or <500 msec with ventricular conduction abnormalities) before initiating first dose; contraindicated if >440 msec (or >500 msec with ventricular conduction abnormalities)
Initial dose
- CrCl >60 mL/min: 500 mcg PO q12hr
- CrCl 40-60 mL/min: 250 mcg PO q12hr
- CrCl 20-40 mL/min: 125 mcg PO q12hr
- CrCl <20 mL/min: Contraindicated
Sinus Rhythm Maintenance After Conversion
- Post initial dose adjustment based on QTc (2-3 hours after initial dose)
- If QTc increases <15% of baseline, continue current dose
- If QTc increases >15% or >500 msec (550 msec with ventricular conduction abnormalities) decrease dose as follows:
- If initial dose 500 mcg q12hr, decrease to 250 mcg q12hr
- If initial dose 250 mcg q12hr, decrease to 125 mcg q12hr
- If initial dose 125 mcg q12hr, decrease to 125 mcg qDay
Monitoring
Must be hospitalized to initiate
Measure QTc 2-3 hours after first 5 doses during inpatient stay
Discontinue dofetilide if at any time after second dose, QTC >500 msec (550 msec with ventricular conduction abnormalities)
Not recommended
Interactions
Interaction Checker
No Results
Contraindicated
Serious - Use Alternative
Significant - Monitor Closely
Minor
Contraindicated (29)
- amiodarone
amiodarone, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- bictegravir
bictegravir will increase the level or effect of dofetilide by decreasing renal clearance. Contraindicated. Bictegravir inhibits organic cation transporter 2 (OCT2) and multidrug and toxin extrusion transporter 1 (MATE1) in vitro. Coadministration with OCT2 and MATE1 substrates may increase their plasma concentrations.
- cimetidine
cimetidine increases levels of dofetilide by decreasing renal clearance. Contraindicated. Risk of prolonged QTc interval.
- cisapride
dofetilide increases toxicity of cisapride by QTc interval. Contraindicated.
- clarithromycin
dofetilide increases toxicity of clarithromycin by QTc interval. Contraindicated.
- disopyramide
disopyramide and dofetilide both increase QTc interval. Contraindicated.
disopyramide, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects. - dolutegravir
dolutegravir will increase the level or effect of dofetilide by decreasing renal clearance. Contraindicated. Dolutegravir inhibits the renal organic cation transporter, OCT2; risk of life-threatening arrhythmias caused by increased systemic exposure to dofetilide
- ethotoin
ethotoin, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- fingolimod
fingolimod increases effects of dofetilide by pharmacodynamic synergism. Contraindicated. Due to increased risk of bradycardia, AV block, and torsade de pointes, concomitant use is contraindicated.
- fosphenytoin
fosphenytoin, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- goserelin
goserelin increases toxicity of dofetilide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- histrelin
histrelin increases toxicity of dofetilide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- ibutilide
dofetilide and ibutilide both increase QTc interval. Contraindicated.
- indapamide
dofetilide and indapamide both increase QTc interval. Contraindicated.
- itraconazole
dofetilide and itraconazole both increase QTc interval. Contraindicated.
itraconazole will increase the level or effect of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Both drugs will increase QT interval - lamotrigine
lamotrigine will increase the level or effect of dofetilide by Other (see comment). Contraindicated. Lamotrigine may significantly increase dofetilide serum concentrations by inhibiting OCT2
- leuprolide
leuprolide increases toxicity of dofetilide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
- lidocaine
lidocaine increases effects of dofetilide by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- mexiletine
mexiletine, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- pentamidine
dofetilide and pentamidine both increase QTc interval. Contraindicated.
- phenytoin
phenytoin, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- pimozide
dofetilide and pimozide both increase QTc interval. Contraindicated.
- procainamide
dofetilide and procainamide both increase QTc interval. Contraindicated.
procainamide, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects. - propafenone
propafenone, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.
- quinidine
quinidine and dofetilide both increase QTc interval. Contraindicated.
quinidine, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects. - saquinavir
dofetilide increases toxicity of saquinavir by QTc interval. Contraindicated.
- sotalol
dofetilide and sotalol both increase QTc interval. Contraindicated.
sotalol, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects. - thioridazine
dofetilide increases toxicity of thioridazine by QTc interval. Contraindicated.
- triptorelin
triptorelin increases toxicity of dofetilide by QTc interval. Contraindicated. Increases risk of torsades de pointes.
Serious - Use Alternative (108)
- alfuzosin
alfuzosin and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- amiodarone
amiodarone will increase the level or effect of dofetilide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
amiodarone and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of amiodarone by QTc interval. Avoid or Use Alternate Drug. - amitriptyline
amitriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- amoxapine
amoxapine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- apomorphine
dofetilide increases toxicity of apomorphine by QTc interval. Avoid or Use Alternate Drug.
- aripiprazole
aripiprazole and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- arsenic trioxide
arsenic trioxide and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of arsenic trioxide by QTc interval. Avoid or Use Alternate Drug. - artemether
artemether and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- artemether/lumefantrine
dofetilide and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- asenapine
dofetilide increases toxicity of asenapine by QTc interval. Avoid or Use Alternate Drug.
- atomoxetine
atomoxetine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- azithromycin
dofetilide increases toxicity of azithromycin by QTc interval. Avoid or Use Alternate Drug.
- ceritinib
ceritinib and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- chloroquine
chloroquine increases toxicity of dofetilide by QTc interval. Avoid or Use Alternate Drug.
- chlorpromazine
chlorpromazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of chlorpromazine by QTc interval. Avoid or Use Alternate Drug. - cimetidine
cimetidine will increase the level or effect of dofetilide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
- ciprofloxacin
dofetilide increases toxicity of ciprofloxacin by QTc interval. Avoid or Use Alternate Drug.
- clarithromycin
clarithromycin and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- clomipramine
clomipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of clomipramine by QTc interval. Avoid or Use Alternate Drug. - clozapine
dofetilide increases toxicity of clozapine by QTc interval. Avoid or Use Alternate Drug.
- darunavir
darunavir increases levels of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Potential for increased toxicity. Use alternatives if available. Increased risk of QT prolongation and cardiac arrhythmias.
- degarelix
dofetilide increases toxicity of degarelix by QTc interval. Avoid or Use Alternate Drug.
- desflurane
desflurane and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- desipramine
desipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of desipramine by QTc interval. Avoid or Use Alternate Drug. - deutetrabenazine
deutetrabenazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- digoxin
digoxin will increase the level or effect of dofetilide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
- disopyramide
dofetilide increases toxicity of disopyramide by QTc interval. Avoid or Use Alternate Drug.
- donepezil
donepezil and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- doxepin
doxepin and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- dronedarone
dofetilide and dronedarone both increase QTc interval. Avoid or Use Alternate Drug.
- droperidol
dofetilide and droperidol both increase QTc interval. Avoid or Use Alternate Drug.
- encorafenib
encorafenib and dofetilide both increase QTc interval. Avoid or Use Alternate Drug. Encorafenib is associated with dose-dependent QTc interval prolongation. Avoid with drugs known to prolong QT interval.
dofetilide increases toxicity of encorafenib by QTc interval. Avoid or Use Alternate Drug. - entrectinib
dofetilide and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
- epinephrine
epinephrine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- epinephrine racemic
epinephrine racemic and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- eribulin
eribulin and dofetilide both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.
dofetilide increases toxicity of eribulin by QTc interval. Avoid or Use Alternate Drug. - erythromycin base
dofetilide and erythromycin base both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin ethylsuccinate
dofetilide and erythromycin ethylsuccinate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin lactobionate
dofetilide and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
- erythromycin stearate
dofetilide and erythromycin stearate both increase QTc interval. Avoid or Use Alternate Drug.
- escitalopram
dofetilide increases toxicity of escitalopram by QTc interval. Avoid or Use Alternate Drug.
escitalopram increases toxicity of dofetilide by QTc interval. Avoid or Use Alternate Drug. - ezogabine
dofetilide increases toxicity of ezogabine by QTc interval. Avoid or Use Alternate Drug. Slight and transient QT-prolongation observed, particularly when dose titrated to 1200mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.
- fexinidazole
fexinidazole and dofetilide both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
- flecainide
dofetilide and flecainide both increase QTc interval. Avoid or Use Alternate Drug. Additive cardiac effects.
- fluconazole
dofetilide and fluconazole both increase QTc interval. Avoid or Use Alternate Drug.
- fluphenazine
fluphenazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- formoterol
dofetilide and formoterol both increase QTc interval. Avoid or Use Alternate Drug.
- gemifloxacin
dofetilide increases toxicity of gemifloxacin by QTc interval. Avoid or Use Alternate Drug.
- glasdegib
dofetilide and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.
- haloperidol
dofetilide and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.
- hydrochlorothiazide
hydrochlorothiazide increases levels of dofetilide by decreasing renal clearance. Contraindicated. Risk of prolonged QTc interval.
- hydroxychloroquine sulfate
hydroxychloroquine sulfate and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of hydroxychloroquine sulfate by QTc interval. Avoid or Use Alternate Drug. - imipramine
imipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- inotuzumab
inotuzumab and dofetilide 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.
dofetilide increases toxicity of inotuzumab by QTc interval. Avoid or Use Alternate Drug. - isradipine
dofetilide increases toxicity of isradipine by QTc interval. Avoid or Use Alternate Drug.
- ivosidenib
ivosidenib and dofetilide 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.
- ketoconazole
dofetilide and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.
- lefamulin
lefamulin and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- lofepramine
lofepramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- lopinavir
dofetilide increases toxicity of lopinavir by QTc interval. Avoid or Use Alternate Drug.
- lumefantrine
dofetilide and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
- macimorelin
macimorelin and dofetilide 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.
- maprotiline
maprotiline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of maprotiline by QTc interval. Avoid or Use Alternate Drug. - mefloquine
mefloquine increases toxicity of dofetilide by QTc interval. Avoid or Use Alternate Drug. Mefloquine may enhance the QTc prolonging effect of high risk QTc prolonging agents.
dofetilide increases toxicity of mefloquine by QTc interval. Avoid or Use Alternate Drug. - methyclothiazide
methyclothiazide increases levels of dofetilide by decreasing renal clearance. Contraindicated. Risk of prolonged QTc interval.
- mifepristone
dofetilide increases toxicity of mifepristone by QTc interval. Avoid or Use Alternate Drug.
- mobocertinib
mobocertinib and dofetilide both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.
- moxifloxacin
dofetilide and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.
- nilotinib
dofetilide and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
- nortriptyline
nortriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of nortriptyline by QTc interval. Avoid or Use Alternate Drug. - octreotide
dofetilide and octreotide both increase QTc interval. Avoid or Use Alternate Drug.
- octreotide (Antidote)
dofetilide and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.
- ondansetron
dofetilide 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.
- osilodrostat
dofetilide and osilodrostat both increase QTc interval. Avoid or Use Alternate Drug. Dose dependent QT prolongation - avoid drugs known to prolong the QT interval
- osimertinib
dofetilide increases toxicity of osimertinib by QTc interval. Avoid or Use Alternate Drug.
- oxaliplatin
oxaliplatin will increase the level or effect of dofetilide by Other (see comment). Avoid or Use Alternate Drug. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.
- panobinostat
dofetilide 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.
- perphenazine
perphenazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- pimavanserin
dofetilide and pimavanserin both increase QTc interval. Avoid or Use Alternate Drug. Coadministration may increase the risk of QT prolongation and cardiac arrhythmia.
- pitolisant
dofetilide and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.
- procainamide
dofetilide will increase the level or effect of procainamide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
- prochlorperazine
prochlorperazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- promazine
promazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- promethazine
promethazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- protriptyline
protriptyline and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- quinidine
quinidine will increase the level or effect of dofetilide by basic (cationic) drug competition for renal tubular clearance. Avoid or Use Alternate Drug.
dofetilide increases toxicity of quinidine by QTc interval. Avoid or Use Alternate Drug. - ribociclib
ribociclib and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
dofetilide increases toxicity of ribociclib by QTc interval. Avoid or Use Alternate Drug. - rilpivirine
dofetilide increases toxicity of rilpivirine by QTc interval. Avoid or Use Alternate Drug.
- romidepsin
dofetilide and romidepsin both increase QTc interval. Avoid or Use Alternate Drug.
- sertraline
dofetilide increases toxicity of sertraline by QTc interval. Avoid or Use Alternate Drug.
- siponimod
siponimod, dofetilide. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Because of the potential additive effects on heart rate, siponimod should generally not be initiated in patients taking QT prolonging drugs with known arrhythmogenic properties, heart rate lowering calcium channel blockers, or other drugs that may decrease heart rate. If treatment considered, obtain cardiology consult regarding switching to non-heart-rate lowering drugs or appropriate monitoring for treatment initiation.
- solifenacin
dofetilide increases toxicity of solifenacin by QTc interval. Avoid or Use Alternate Drug.
- sorafenib
dofetilide increases toxicity of sorafenib by QTc interval. Avoid or Use Alternate Drug.
- sunitinib
dofetilide increases toxicity of sunitinib by QTc interval. Avoid or Use Alternate Drug.
- tafenoquine
tafenoquine will increase the level or effect of dofetilide by Other (see comment). Avoid or Use Alternate Drug. Tafenoquine inhibits organic cation transporter-2 (OCT2) and multidrug and toxin extrusion (MATE) transporters in vitro. Avoid coadministration with OCT2 or MATE substrates. If coadministration cannot be avoided, monitor for substrate-related toxicities and consider dosage reduction if needed based on product labeling of the coadministered drug.
- tetrabenazine
dofetilide increases toxicity of tetrabenazine by QTc interval. Avoid or Use Alternate Drug.
- thioridazine
thioridazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- toremifene
dofetilide 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.
- trazodone
trazodone and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- trifluoperazine
trifluoperazine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- trilaciclib
trilaciclib will decrease the level or effect of dofetilide by Other (see comment). Avoid or Use Alternate Drug. Avoid coadministration of trilaciclib (OCT2, MATE1, and MATE-2K inhibitor) with dofetilide. Consider potential benefits of trilaciclib against risk of QT interval prolongation with increased dofetilide blood levels.
- trimipramine
trimipramine and dofetilide both increase QTc interval. Avoid or Use Alternate Drug.
- umeclidinium bromide/vilanterol inhaled
dofetilide 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
dofetilide, 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 dofetilide both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended.
- vilanterol/fluticasone furoate inhaled
dofetilide 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
dofetilide increases toxicity of vorinostat by QTc interval. Avoid or Use Alternate Drug.
- ziprasidone
dofetilide and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.
Monitor Closely (85)
- alfuzosin
dofetilide and alfuzosin both increase QTc interval. Use Caution/Monitor.
- amitriptyline
dofetilide increases toxicity of amitriptyline by QTc interval. Use Caution/Monitor.
- amoxapine
dofetilide increases toxicity of amoxapine by QTc interval. Use Caution/Monitor.
- arformoterol
dofetilide increases toxicity of arformoterol by QTc interval. Use Caution/Monitor.
- atazanavir
atazanavir increases levels of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of QT prolongation and cardiac arrhythmias.
- azithromycin
azithromycin and dofetilide both increase QTc interval. Use Caution/Monitor.
- bedaquiline
dofetilide and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely
- bosutinib
bosutinib and dofetilide both increase QTc interval. Use Caution/Monitor.
- bupivacaine
bupivacaine, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive cardiac effects.
- capecitabine
capecitabine and dofetilide both increase QTc interval. Use Caution/Monitor.
- ciprofloxacin
ciprofloxacin and dofetilide both increase QTc interval. Use Caution/Monitor. Ciprofloxacin elicits minimal effects on QT interval. Caution if used in combination with other drugs known to affect QT interval or in patients with other risk factors.
- citalopram
dofetilide and citalopram both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
- clofazimine
dofetilide increases toxicity of clofazimine by QTc interval. Modify Therapy/Monitor Closely.
- crizotinib
crizotinib and dofetilide both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
dofetilide increases toxicity of crizotinib by QTc interval. Use Caution/Monitor. - dabrafenib
dabrafenib and dofetilide both increase QTc interval. Use Caution/Monitor.
- dasatinib
dasatinib and dofetilide both increase QTc interval. Modify Therapy/Monitor Closely.
dofetilide increases toxicity of dasatinib by QTc interval. Use Caution/Monitor. - deutetrabenazine
dofetilide and deutetrabenazine both increase QTc interval. Modify Therapy/Monitor Closely. For patients requiring deutetrabenazine doses >24 mg/day and are taking other drugs known to prolong QTc, assess the QTc interval before and after increasing the dose of deutetrabenazine or other medications known to prolong QTc.
- dolasetron
dofetilide and dolasetron both increase QTc interval. Modify Therapy/Monitor Closely.
- erdafitinib
erdafitinib increases levels of dofetilide by decreasing renal clearance. Modify Therapy/Monitor Closely. Consider alternatives that are not OCT2 substrates or consider reducing the dose of OCT2 substrates based on tolerability.
- ezogabine
ezogabine, dofetilide. 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.
- fluoxetine
dofetilide and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- fluphenazine
dofetilide increases toxicity of fluphenazine by QTc interval. Use Caution/Monitor.
- fluvoxamine
fluvoxamine and dofetilide both increase QTc interval. Modify Therapy/Monitor Closely.
- fosamprenavir
fosamprenavir increases levels of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of QT prolongation and cardiac arrhythmias.
- foscarnet
dofetilide and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.
- fostemsavir
dofetilide and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
- gemtuzumab
dofetilide and gemtuzumab both increase QTc interval. Use Caution/Monitor.
- hydrochlorothiazide
dofetilide will increase the level or effect of hydrochlorothiazide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- iloperidone
dofetilide and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- indacaterol, inhaled
dofetilide increases toxicity of indacaterol, inhaled by QTc interval. Use Caution/Monitor.
- indinavir
indinavir increases levels of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of QT prolongation and cardiac arrhythmias.
- lapatinib
dofetilide and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.
- lenvatinib
dofetilide 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 dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
- levofloxacin
dofetilide and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.
- lofexidine
dofetilide and lofexidine both increase QTc interval. Use Caution/Monitor. ECG monitoring is recommended.
- lopinavir
lopinavir increases levels of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of QT prolongation and cardiac arrhythmias.
- memantine
dofetilide will increase the level or effect of memantine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- metformin
dofetilide will increase the level or effect of metformin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- methadone
dofetilide and methadone both increase QTc interval. Modify Therapy/Monitor Closely.
- methyclothiazide
dofetilide will increase the level or effect of methyclothiazide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- midodrine
dofetilide will increase the level or effect of midodrine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- mifepristone
mifepristone, dofetilide. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.
- nelfinavir
nelfinavir increases levels of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of QT prolongation and cardiac arrhythmias.
- nizatidine
nizatidine will increase the level or effect of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.
- ofloxacin
dofetilide will increase the level or effect of ofloxacin by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
dofetilide and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely. - olanzapine
dofetilide increases toxicity of olanzapine by QTc interval. Use Caution/Monitor. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances.
- olodaterol inhaled
dofetilide 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
- osilodrostat
osilodrostat and dofetilide both increase QTc interval. Use Caution/Monitor.
- osimertinib
osimertinib and dofetilide both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.
- ozanimod
ozanimod and dofetilide 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.
- paliperidone
dofetilide and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- paroxetine
dofetilide and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.
- pasireotide
dofetilide and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.
- pazopanib
dofetilide and pazopanib both increase QTc interval. Use Caution/Monitor.
- perphenazine
dofetilide increases toxicity of perphenazine by QTc interval. Use Caution/Monitor.
- ponesimod
ponesimod, dofetilide. Either increases effects of the other by QTc interval. Use Caution/Monitor. Consult cardiologist if considering treatment. Class III (eg, amiodarone, dofetilide, sotalol) anti-arrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.
- posaconazole
dofetilide and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.
- propafenone
dofetilide increases toxicity of propafenone by QTc interval. Use Caution/Monitor.
- protriptyline
dofetilide increases toxicity of protriptyline by QTc interval. Use Caution/Monitor.
- quetiapine
quetiapine, dofetilide. 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.
dofetilide increases toxicity of quetiapine by QTc interval. Use Caution/Monitor. - quinine
dofetilide will increase the level or effect of quinine by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
dofetilide and quinine both increase QTc interval. Use Caution/Monitor. - ranolazine
dofetilide and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.
- rilpivirine
rilpivirine increases toxicity of dofetilide by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.
- risperidone
dofetilide and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.
- ritonavir
ritonavir increases levels of dofetilide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Potential for increased toxicity. Use alternatives if available. Increased risk of QT prolongation and cardiac arrhythmias.
- selpercatinib
selpercatinib increases toxicity of dofetilide by QTc interval. Use Caution/Monitor.
- sodium sulfate/?magnesium sulfate/potassium chloride
sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of dofetilide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
- sodium sulfate/potassium sulfate/magnesium sulfate
sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of dofetilide by QTc interval. Use Caution/Monitor. Consider predose and post-colonoscopy ECGs in patients at increased risk of serious cardiac arrhythmias. .
- sorafenib
sorafenib and dofetilide both increase QTc interval. Use Caution/Monitor.
- sulfamethoxazole
sulfamethoxazole will increase the level or effect of dofetilide by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
sulfamethoxazole and dofetilide both increase QTc interval. Modify Therapy/Monitor Closely. - tacrolimus
dofetilide increases toxicity of tacrolimus by QTc interval. Use Caution/Monitor.
- telavancin
dofetilide and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.
- tenofovir DF
tenofovir DF increases levels of dofetilide by decreasing renal clearance. Use Caution/Monitor. Potential for increased toxicity. .
- triamterene
dofetilide will increase the level or effect of triamterene by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- triclabendazole
triclabendazole and dofetilide both increase QTc interval. Use Caution/Monitor.
- trimethoprim
dofetilide will increase the level or effect of trimethoprim by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
dofetilide and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely. - trimipramine
dofetilide increases toxicity of trimipramine by QTc interval. Use Caution/Monitor.
- tropisetron
dofetilide and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.
- vardenafil
dofetilide increases toxicity of vardenafil by QTc interval. Use Caution/Monitor.
- vemurafenib
dofetilide increases toxicity of vemurafenib by QTc interval. Use Caution/Monitor.
- venlafaxine
dofetilide and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.
- verapamil
dofetilide will increase the level or effect of verapamil by basic (cationic) drug competition for renal tubular clearance. Use Caution/Monitor.
- voclosporin
voclosporin, dofetilide. Either increases effects of the other by QTc interval. Use Caution/Monitor.
- voriconazole
dofetilide and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.
Minor (1)
- isavuconazonium sulfate
isavuconazonium sulfate will increase the level or effect of dofetilide by Other (see comment). Minor/Significance Unknown. Isavuconazonium sulfate, an OCT2 inhibitor, may increase the effects or levels of OCT2 substrates.
Adverse Effects
>10%
Headache (11%)
1-10%
Chest pain (10%)
Dizziness (8%)
Insomnia (4%)
Respiratory tract infection (7%)
Dyspnea (6%)
Rash (3%)
Flu-like syndrome (4%)
Back pain (3%)
Ventricular tachycardia (3-4%)
Torsade de pointes (3% in HF patients and 0.9% in patients with recent MI)
Nausea (5%)
Diarrhea (3%)
Frequency Not Defined
AV block, QTc interval prolongation, torsades de pointes, ventricular arrhythmias
Difficulty sleeping
Liver damage
Cough
Paresthesia
Angioedema
Warnings
Black Box Warnings
Hospitalize minimum of 3 days during initiation or reinitiation to minimize risk of induced arrhythmia
Facility must provide CrCl calculations, continuous ECG monitoring, and resuscitation for at least 3 days when initiating or restarting therapy
Experienced personnel who manage serious arrhythmias & setting required
Monitoring
- Baseline & continuous ECG during therapy
- Do not initiate if baseline QTc >440 msec (500 msec in patients w/ ventricular conduction problems)
- Do not initiate if heart rate <60 bpm
- Baseline CrCl determines initial dosage; dosage adjustments determined by QTc changes
- Reevaluate renal function and QTc q3mth or more often if medically required
Contraindications
Hypersensitivity
Congenital or acquired long QT syndromes; do not use with baseline QTc >440 msec (500 msec with ventricular conduction abnormalities)
Concomitant use of cation transport system inhibitors (eg, verapamil, cimetidine, trimethoprim, ketoconazole, prochlorperazine, dolutegravir and megestrol); each of these drugs cause a substantial increase in dofetilide plasma concentrations
Severe renal impairment: CrCl <20 mL/min
Cautions
Atrioventricular block, bradycardia, electrolyte imbalance, patients taking potassium-depleting diuretics, moderate QT interval prolongation prior to treatment, proarrhythmic events, liver disease, renal impairment
Coadministration of drugs that prolong QT interval and other antiarrhythmic agents: phenothiazines, cisapride, bepridil, TCAs, oral macrolides, class I or class III antiarrhythmics & amiodarone
Grapefruit juice may increase levels; avoid concurrent use
Magnesium and potassium serum levels should be maintained within normal range to avoid QTc prolongation
Pregnancy & Lactation
Pregnancy Category: C
Lactation: excretion in milk unknown/not recommended
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
Blocks channels carrying delayed rectifier potassium currents, IKr
Markedly prolongs action potential as a result of delayed repolarization
Absorption
Bioavailability: >90%
Peak Plasma Time: 2-3 hr
Onset: 2 hr
Duration: 4 hr
Distribution
Protein Bound: 60-70%
Vd: 3-4 L/kg
Metabolism
50% of absorbed dose metabolized in liver by CYP3A4 to inactive metabolites
Metabolites: No quantifiable metabolites found in plasma, 5 metabolites identified in urine
Elimination
Half-Life: 10 hr
Excretion: 80% urine; <10% feces
Images
| BRAND | FORM. | UNIT PRICE | PILL IMAGE |
|---|---|---|---|
| Tikosyn oral - | 125 mcg capsule |  | |
| Tikosyn oral - | 500 mcg capsule |  | |
| Tikosyn oral - | 250 mcg capsule |  | |
| dofetilide oral - | 500 mcg capsule |  | |
| dofetilide oral - | 250 mcg capsule |  | |
| dofetilide oral - | 125 mcg capsule |  | |
| dofetilide oral - | 500 mcg capsule |  | |
| dofetilide oral - | 250 mcg capsule |  | |
| dofetilide oral - | 125 mcg capsule |  | |
| dofetilide oral - | 500 mcg capsule |  | |
| dofetilide oral - | 250 mcg capsule |  | |
| dofetilide oral - | 125 mcg capsule |  | |
| dofetilide oral - | 500 mcg capsule |  | |
| dofetilide oral - | 125 mcg capsule |  | |
| dofetilide oral - | 250 mcg capsule |  | |
| dofetilide oral - | 500 mcg capsule | | |
| dofetilide oral - | 125 mcg capsule | | |
| dofetilide oral - | 250 mcg capsule | |
Copyright © 2010 First DataBank, Inc.
Patient Handout
dofetilide oral
DOFETILIDE - ORAL
(doh-FET-ill-ide)
COMMON BRAND NAME(S): Tikosyn
WARNING: Though this medication often gives great benefits to people with irregular heartbeat, it may rarely cause a serious new irregular heartbeat. When starting, restarting, or increasing your dose with this drug, your doctor will recommend that you stay in the hospital for at least 3 days for proper monitoring.
USES: This medication is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as atrial fibrillation/flutter). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat. Dofetilide 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: Read the Medication Guide provided by your pharmacist before you start taking dofetilide and each time you get a refill. If you have any questions, ask your doctor or pharmacist.Take this medication by mouth, usually twice daily with or without food or as directed by your doctor. To reduce your risk of serious side effects, it is very important to take this medication exactly as prescribed.The dosage is based on your medical condition, kidney function, and response to treatment.Use this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.Tell your doctor if your condition does not improve or if it worsens.
SIDE EFFECTS: Headache, dizziness, or nausea 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.Seek immediate medical attention if any of these rare but serious side effects occur: chest pain, 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 dofetilide, 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: kidney problems, liver disease.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).Dofetilide 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 dofetilide, 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 dofetilide safely.Older adults may be more sensitive to the side effects of this drug, especially QT prolongation (see above).During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.It is unknown if this drug passes into breast milk. Consult your doctor before breast-feeding.
DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.Some products that may interact with this drug include: dolutegravir, fingolimod.Many drugs besides dofetilide may affect the heart rhythm (QT prolongation), including amiodarone, pimozide, procainamide, quinidine, saquinavir, sotalol, macrolide antibiotics (such as clarithromycin, erythromycin), and certain quinolone antibiotics (such as sparfloxacin), among others. (See also Precautions section.)Other medications can affect the removal of dofetilide from your body, which may affect how dofetilide works. Examples include hydrochlorothiazide, indapamide, itraconazole, ketoconazole, lamotrigine, megestrol, prochlorperazine, tafenoquine, trilaciclib, trimethoprim, verapamil, among others.Avoid taking cimetidine while being treated with dofetilide. Ask your doctor or pharmacist about other medications for heartburn/upset stomach.
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 dizziness, fainting.
NOTES: Do not share this medication with others.Laboratory and/or medical tests (such as EKG, kidney function) should be performed before you start dofetilide and periodically during your treatment to monitor your progress or check for side effects. Consult your doctor for more details.
MISSED DOSE: If you miss a 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 between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines 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 for more details about how to safely discard your product.
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.
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.
