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Verapamil 120 mg daily in divided or single dose with longacting formulations 480 mg daily in divided or single dose with long-acting formulations Hypotension, worsening HF in patients with pre-existing ventricular dysfunction, pulmonary edema in patients with hypertrophic cardiomyopathy, bradycardia, abnormal liver function studies •  AV block greater than first degree or SA node dysfunction (in absence of pacemaker) •  Decompensated systolic HF/severe LV dysfunction •  Hypotension† •  WPW with AF/atrial flutter •  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, ranolazine, rivaroxaban, rifampin, silodosin, simeprevir, rivaroxaban, rifampin, simvastatin, topotecan, trabectedin, vincristine, grapefruit juice Cardiac glycosides

Digoxin Loading: 0.5 mg, with additional 0.125–0.25mg doses administered at 6–8-h intervals until evidence of adequate effect (maximum dose 8–12 mcg/ kg over 24 h) 0.25 mg QD Maintenance: 0.125–0.25 mg QD, with dosing based on patient’s age, lean body weight, and renal function and drug interactions; occasionally down to 0.0625 mg in cases of renal impairment (trough serum digoxin level 0.5 to 1 ng/mL) Bradycardia, heart block, anorexia, nausea, vomiting, visual changes and cardiac arrhythmias in cases of 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 SA and/or AV nodal–blocking properties •  Reduce dose by 30%–50% when administering with amiodarone and by 50% when administering with dronedarone •  Monitor digoxin concentrations with verapamil, clarithromycin, erythromycin, itraconazole, cyclosporine, propafenone, flecainide Class Ic antiarrhythmic agents

Flecainide 50 mg every 12 h 150 mg every 12 h (PR and QRS intervals should be monitored. May consider monitoring flecainide plasma levels, keeping trough plasma levels below 0.7–1.0 mcg/mL) Atrial flutter with 1:1 AV conduction‡, QT prolongation, torsades de pointes, worsening HF, bradycardia •  Sinus or AV conduction disease (in absence of pacemaker) •  Cardiogenic shock •  Avoid in structural heart disease (including ischemic heart disease) •  Atrial flutter (unless concomitant AV nodal therapy to avoid 1:1 conduction) •  Brugada syndrome •  Renal dysfunction •  Hepatic dysfunction •  QT-prolonging drugs •  Amiodarone, digoxin, ritonavir, saquinavir, tipranavir Propafenone 150 mg every 8 h (immediate release); 225 mg every 12 h (extended release) 300 mg every 8 h (immediate release); 425 mg every 12 h (extended release) (PR and QRS interval should be monitored. Consider dosage reduction with hepatic impairment) Atrial flutter with 1:1 AV conduction‡, QT prolongation, torsades de pointes, bradycardia, bronchospasm •  Sinus or AV conduction disease (in absence of pacemaker) •  Cardiogenic shock •  Hypotension •  Reactive airway disease Avoid in structural heart disease (including ischemic heart disease) •  Atrial flutter (unless concomitant AV nodal therapy to avoid 1:1 conduction) •  Brugada syndrome •  Hepatic dysfunction •  QT-prolonging drugs •  Drugs with SA and/or AV nodal–blocking properties •  Amiodarone, ritonavir, saquinavir, tipranavir

(Continued )

Table 7.  Continued

Drug Initial Daily Dose(s) Maximum Total Daily

Maintenance Dose Potential Adverse

Effects Precautions (Exclude or Use With Caution) and Interactions

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