ibutilide (Corvert)

Introduction

Tradename: Corvert. (ibutilide fumarate) Presumptive Group 1c anti-arrhythmic agent.

Indications

• cardioversion of acute atrial fibrillation/flutter of recent onset

Dosage

• 0.01 mg/kg up to 1 mg IV over 10 minutes
• may repeat if no response in 10 minutes Injection (fumarate): 0.1 mg/mL (10 mL).

Pharmacokinetics

• onset of action:
  • within 90 minutes after start of infusion
  • 1/2 of conversions occur during infusion
• extensively metabolized in the liver
• elimination 1/2life 2-12 hours
• parent drug & metabolite eliminated in urine

elimination via liver

elimination via kidney

1/2life = 2-12 hours

Monitor

• continuous EKG for at least 4 hours following infusion until QTc has returned to baseline
• electrolytes (including Mg+2 & K+) should be corrected prior to administration

Adverse effects

• less common (1-10%)
• QT prolongation (Torsades de pointes in 2-8%)
• non-sustained monomorphic & polymorphic ventricular tachycardia
• non-sustained monomorphic ventricular extrasystoles
• supraventricular tachycardia
• hypotension
• bundle-branch block
• AV block
• bradycardia
• hypertension
• palpitations
• headache
• nausea
• uncommon (< 1%)
  • supraventricular extrasystoles, nodal arrhythmia, congestive heart failure, syncope, idioventricular rhythm, sustained monomorphic ventricular tachycardia, renal failure

• drug adverse effects of antiarrhythmic agent, Group IC

Drug interactions

• prolonged refractoriness with:
  • class Ia anti-arrhythmic agents
  • other class III anti-arrhythmic agents
• risk of excessive QT interval prolongation with:
  • phenothiazines
  • tricyclic antidepressants (TCA)
  • cisapride
  • non-sedating antihistamines: astemizole & terfenadine
• masking of signs of digoxin toxicity

• drug interaction(s) of antiarrhythmic agents in combination with diuretics

More general terms

• antiarrhythmic agent, Group IC

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=60752
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=60753
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5281065
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=107872
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3025729