p.20 抽出テキスト

Verapamil 5–10-mg (0.075– 0. 15-mg/kg) IV bolus over 2 min If no response, can give an additional 10 mg (0.15 mg/kg) 30 min after first dose; then infusion at 0.005 mg/ kg/min Hypotension, worsening HF in patients with pre-existing ventricular dysfunction, pulmonary edema in patients with hypertrophic cardiomyopathy, bradycardia •  AV block greater than first degree or SA node dysfunction (in absence of pacemaker) •  Decompensated systolic HF/LV dysfunction •  Drugs with SA and/or AV nodal–blocking properties •  Hypotension† •  Cardiogenic shock •  WPW with AF/atrial flutter •  Hepatic or renal dysfunction •  Verapamil is a moderate CYP3A4 inhibitor and also inhibits P-glycoprotein •  Contraindicated with dofetilide •  Itraconazole, bosutinib, ceritinib, cilostazol, colchicine, cyclosporine, everolimus, dabigatran, edoxaban, flecainide, ibrutinib, ivabradine, olaparib, posaconazole, ranolazine, rivaroxaban, rifampin, silodosin, simeprevir, rivaroxaban, rifampin, simvastatin, topotecan, trabectedin, vincristine, voriconazole, grapefruit juice Cardiac glycosides

Digoxin 0.25–0.5-mg IV bolus Can repeat 0.25-mg IV bolus, up to maximum dose of 1.0 mg over 24 h (ie, maximum loading dose 8–12 mcg/kg), given at 6–8-h intervals; maintenance dose based on patient’s age, lean body weight, renal function, and concomitant drugs (IV 2.4–3.6 mcg/kg/d) Anorexia, nausea, vomiting, visual changes and cardiac arrhythmias if digoxin toxicity (associated with levels >2 ng/mL, although symptoms may also occur at lower levels) •  Renal dysfunction •  WPW with AF/atrial flutter •  AV block greater than first degree or SA node dysfunction (in absence of pacemaker) •  Drugs with AV nodal-blocking properties •  Digoxin is a P-glycoprotein substrate •  Dronedarone (reduce dose by at least 50%), amiodarone (reduce dose by 30%–50%) •  Verapamil, clarithromycin, cyclosporine, erythromycin, flecainide, itraconazole, posaconazole, propafenone, voriconazole: Monitor digoxin levels •  A large retrospective study suggested an increased risk in mortality in patients who were treated with digoxin for newly diagnosed AF or atrial flutter; although the data were collected from a population that was different from SVT patients, digoxin should be used with caution.118 Class III antiarrhythmic agents

Amiodarone 150 mg IV over 10 min Infusion at 1 mg/min (360 mg) over next 6 h; then 0.5 mg/min (540 mg) over remaining 18 h Hypotension, bradycardia, phlebitis, QT prolongation, torsades de pointes (rare), increased INR •  Sinus or AV conduction disease (in absence of pacemaker) •  Inflammatory lung disease (acute) •  Hepatic dysfunction •  Drugs with SA and/or AV nodal–blocking properties •  Amiodarone is a substrate of and inhibits p-glycoprotein and CYP2C9 (moderate), CYP2D6 (moderate), and CYP3A4 (weak); amiodarone is a substrate for CYP3A4 (major) and CYP2C8 (major);amiodarone is an inhibitor of OCT2 •  Reduce warfarin dose by 50% and reduce digoxin dose by 30%–50% •  Agalsidase alfa, agalsidase beta, azithromycin, bosutinib, ceritinib, colchicine, dabigatran, edoxaban, flecainide, ivabradine, ledipasvir/sofosbuvir, lopinavir, lopinavir/ritonavir, lovastatin, nelfinavir, pazopanib, propafenone, simvastatin, ritonavir, rivaroxaban, saquinavir, sofosbuvir, topotecan, vincristine, grapefruit juice

(Continued )

Table 6.  Continued

Drug Initial Dose Subsequent or Maintenance Dose Potential Adverse

Effects Precautions (Exclude or Use With

Caution) and Interactions

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