Disopyramide

Indications
 Oral
Supraventricular and ventricular arrhythmias
Adult: 300-800 mg daily in divided doses (as conventional capsules every 6 hr; as extended-release capsules every 12 hr), adjusted according to patient's response.
Child: 12-18 yr: 6-15 mg/kg daily; 4-12 yr: 10-15 mg/kg daily; 1-4 yr: 10-20 mg/kg daily; <1 yr: 10-30 mg/kg daily.
CrCl (ml/min)Dosage Recommendation
>40400 mg daily in divided doses.
30-40100 mg every 8 hr; avoid modified release preparations.
15-30100 mg every 12 hr; avoid modified release preparations.
<15100 mg every 24 hr; avoid modified release preparations.
Hepatic impairment: 400 mg daily in divided doses. Liver cirrhosis: consider a therapeutic range 50% lower than in patients with normal hepatic function.
Intravenous
Supraventricular and ventricular arrhythmias
Adult: 2 mg/kg (max: 150 mg) by slow inj at a rate of ≤30 mg/min, followed by 200 mg by mouth immediately upon completion of inj and every 8 hr for 24 hr. If arrhythmia recurs, repeat IV inj but not exceeding 300 mg in the 1st hr and 800 mg in 24 hr. Alternatively, initial IV inj may be followed by IV infusion of 0.4 mg/kg/hr (or 20-30 mg/hr) Max: 800 mg daily.
Renal impairment: Dose adjustments may be required.
Hepatic impairment: Dose adjustments may be required.

Special Populations: Reduce dose in patients with hepatic or renal impairment.
Contraindications
 Patients with complete heart block; glaucoma; predisposition to urinary retention; myasthenia gravis. Sinus node disease in absence of pacemaker. Cardiomyopathy. Cardiogenic shock. Hypotension. Hypersensitivity. Children.
Warnings / Precautions
 Conduction disorders or uncompensated heart failure. Pregnancy and lactation. Renal and hepatic failure. Family history of glaucoma. Correct potassium deficiency.
Adverse Reactions
 Impotence, constipation, difficulty in micturition, dry mouth, blurred vision, nausea, bloating, abdominal pain, vomiting, diarrhoea, colic. Psychosis, depression, skin rashes, dizziness, fatigue, muscle weakness, headache, cholestatic jaundice, elevated liver enzymes, thrombocytopenia, agranulocytosis, ventricular tachycardia and fibrillation, heart failure, hypotension, conduction disturbances.
Potentially Fatal: Urinary retention, severe cardiovascular depression if given as rapid IV inj. High risk of recurrence of failure in patients with history of congestive cardiac failure. Negative inotropic effect especially prominent in patients with cardiomyopathy, hypertension and uncompensated cardiac failure.
Overdose Reactions
 Symptoms: Anticholinergic side effects, loss of consciousness, hypotension, respiratory arrest, episodes of apnoea, cardiac conduction disturbances, arrhythmias, bradycardia, CHF, asystole and seizures. Management: Fast and aggressive treatment needed even without any symptoms, as it can be fatal. Empty stomach by emesis or gastric lavage. Treatment is supportive with ECG monitoring. Haemodialysis or charcoal haemoperfusion (preferred) may be useful.
Drug Interactions
 Avoid other Class I antiarrhythmics and other cardiac depressants including β-blockers except in life-threatening arrhythmias. Risk of worsening of arrhythmias, precipitation of new arrhythmias and ventricular fibrillation when used with other anti-arrhythmics. Reduced efficacy when co-admin with phenytoin.
Potentially Fatal: Enhanced antimuscarinic effects with other antimuscarinic drugs. Potentiates negative chronotropic and inotropic effects of β-blockers and verapamil. Potentiates inhibitory effect on the conduction system produced by digitalis. Potentiates QT interval prolongation produced by TCAs and amiodarone.
See Below for More disopyramide Drug Interactions
Mechanism of Actions
 Disopyramide is a Ia antiarrhythmic agent which acts by decreasing myocardial excitability and conduction velocity. It lengthens the effective refractory period of the atrium. It also possesses antimuscarinic and negative inotropic effects.
Absorption: Readily and almost completely absorbed from the GI tract (oral); peak plasma concentrations after 0.5-3 hr.
Distribution: Crosses the placenta and enters the breast milk. Protein-binding: 50-65%.
Metabolism: Hepatic: Partial metabolism; converted to mono-N-dealkylated disopyramide (also has antiarrhythmic and antimuscarinic properties).
Excretion: Mainly in the kidneys via urine (50% as unchanged, 20% as N-dealkylated metabolite and 10% as other metabolites; via the faeces (10% of the dose). 4-10 hr (elimination half-life); may be increased in cardiac failure, renal and hepatic impairment.
Storage Conditions
 Intravenous: Store below 30°C. Oral: Store below 30°C.
ATC Classification
 C01BA03 - disopyramide ; Belongs to class Ia antiarrhythmics.
Storage
 Intravenous: Store below 30°C. Oral: Store below 30°C.
Available As
  • Disopyramide 100 mg
  • Disopyramide 150 mg

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