p.19 抽出テキスト

Table 6.  Acute Drug Therapy for SVT, Intravenous Administration*

Drug Initial Dose Subsequent or Maintenance Dose Potential Adverse

Effects Precautions (Exclude or Use With

Caution) and Interactions

Nucleoside

Adenosine 6-mg rapid IV bolus (injected into IV as proximal or as close to the heart as possible), administered over 1–2 s, followed by rapid saline flush If no result within 1–2 min, 12-mg rapid IV bolus; can repeat 12-mg dose 1 time. The safe use of 18-mg bolus doses has been reported.117 Transient AV block, flushing, chest pain, hypotension, or dyspnea, AF can be initiated or cause decompensation in the presence of pre-excitation, PVCs/ventricular tachycardia, bronchospasm (rare), or coronary steal. Minor side effects are usually transient because of adenosine’s very short half-life. •  AV block greater than first degree or SA node dysfunction (in absence of pacemaker) •  Reactive airway disease •  Concomitant use of verapamil or digoxin •  WPW Beta blockers

Esmolol 500-mcg/kg IV bolus over 1 min Infusion at 50–300 mcg/ kg/min, with repeat boluses between each dosing increase Hypotension, worsening HF, bronchospasm, bradycardia •  AV block greater than first degree or SA node dysfunction (in absence of pacemaker) •  Decompensated systolic HF •  Hypotension •  Cardiogenic shock •  Reactive airway disease •  Renal dysfunction •  Drugs with SA and/or AV nodal–blocking properties Metoprolol tartrate 2.5–5.0-mg IV bolus over 2 min Can repeat 2.5- to 5.0mg IV bolus in 10 min, up to 3 doses Hypotension, worsening HF, bronchospasm, bradycardia •  AV block greater than first degree or SA node dysfunction (in absence of pacemaker) •  Decompensated systolic HF •  Hypotension •  Reactive airway disease •  Drugs with SA and/or AV nodal–blocking properties Propranolol 1 mg IV over 1 min Can repeat 1 mg IV at 2-min intervals, up to 3 doses Hypotension, worsening HF, bronchospasm, bradycardia •  AV block greater than first degree or SA node dysfunction (in absence of pacemaker) •  Cardiogenic shock •  Reactive airway disease •  Decompensated HF •  Hypotension •  Hepatic or renal dysfunction •  Drugs with SA and/or AV nodal–blocking properties Nondihydropyridine calcium channel antagonists

Diltiazem 0.25-mg/kg IV bolus over 2 min Infusion at 5–10 mg/h, up to 15 mg/h Hypotension, worsening HF in patients with pre-existing ventricular dysfunction, bradycardia, abnormal liver function studies, acute hepatic injury (rare) •  AV block greater than first degree or SA node dysfunction (in absence of pacemaker) •  WPW with AF/atrial flutter •  Hypotension† •  Decompensated systolic HF/LV dysfunction •  Drugs with SA and/or AV nodal–blocking properties •  Hepatic or renal dysfunction •  Diltiazem is a substrate of CYP3A4 (major) and a moderate CYP3A4 inhibitor •  Apixaban, itraconazole, bosutinib, ceritinib, cilostazol, cyclosporine, everolimus, ibrutinib, idelalisib, ivabradine, lomitapide, olaparib, posaconazole, ranolazine, rifampin, simeprevir, voriconazole

(Continued )

Downloaded from http://ahajournals.org by on October 7, 2026