p.21 抽出テキスト

September 25, 2018 Circulation. 2018;138:e272–e391. DOI: 10.1161/CIR.0000000000000549 e292

CLINICAL STATEMENTS AND GUIDELINES Metoprolol (II)

IV: 5 mg q 5 min up to 3 doses PO: 25–100 mg Extended release qd or q 12 h VT, PVC Beta 1 receptor Sinus rate slowed

AV nodal refractoriness increased t1/2: 3–4 h

Metab: H Excr: U Cardiac: Bradycardia, hypotension, AVB

Other: Dizziness, fatigue, diarrhea, depression, dyspnea

Mexiletine (IB) PO: 150–300 mg q 8 h or q 12 h T, VF, PVC, has a role in patients with LQT3 INa No marked effect on most intervals; QTc can slightly shorten t1/2: 10–14 h

Metab: H Excr: U Cardiac: HF, AVB

Other: Lightheaded, tremor, ataxia, paresthesias, nausea, blood dyscrasias

Nadolol (II) PO: 40–320 mg daily VT, PVC, LQTS, CPVT Beta 1 and 2 receptors Sinus rate slowed

AV nodal refractoriness increased t1/2: 20–24 h

Metab: none Excr: U Cardiac: Bradycardia, hypotension, HF, AVB

Other: Edema, dizziness, cold extremities, bronchospasm

Procainamide (IA) IV: loading dose 10–17 mg/kg at 20–50 mg/ min Maintenance dose: 1–4 mg/min PO (SR preparation): 500–1250 mg q 6 h VT INa, IKr QRS prolonged

QTc prolonged; increased DFT Metab: H

t1/2: 2–5 h; NAPA 6–8 h t1/2 prolonged in renal dysfunction. Anephric: proc 11 h and NAPA 42 h Excr: U Cardiac: TdP; AVB, hypotension and exacerbation of HFrEF

Other: Lupus symptoms, diarrhea, nausea, blood dyscrasias

Propafenone (IC) PO: Immediate release 150–300 mg q 8 h Extended release 225– 425 mg q 12 h VT, PVC (in the absence of structural heart disease) INa, IKr, IKur, Beta receptor, Alpha receptor PR prolonged

QRS prolonged; increased DFT t1/2: 2–10 h or 10–32 h

t1/2: extensive metabolizers 2–10 h; poor metabolizers 10–32 h. Metab: H Excr: U Cardiac: HF, AVB, drug-induced Brugada syndrome

Other: Dizziness, fatigue, nausea, diarrhea, xerostomia, tremor, blurred vision

Propranolol (II) IV: 1–3 mg q 5 min to a total of 5 mg PO: Immediate release 10–40 mg q 6 h; Extended release 60–160 mg q 12 h VT, PVC, LQTS Beta 1 and 2 receptors, INa Sinus rate slowed

AV nodal refractoriness increased t1/2: Immediate release 3–6 h

Extended release 8–10 h Metab: H Excr: U Cardiac: Bradycardia, hypotension, HF, AVB

Other: Sleep disorder, dizziness, nightmares, hyperglycemia, diarrhea, bronchospasm

Quinidine (IA) PO: sulfate salt 200–600 mg q 6 h to q 12 h gluconate salt 324–648 mg q 8 h to q 12 h IV: loading dose: 800 mg in 50 mL infused at 50 mg/min T, VF, (including short QT syndrome, Brugada) INa, Ito, IKr, M, Alpha receptor QRS prolonged

QTc prolonged; increased DFT 1/2: 6–8 h longer in HF, liver cirrhosis, and with older age

Metab: H Excr: U Cardiac: Syncope, TdP, AVB

Other: Dizziness, diarrhea, nausea, esophagitis, emesis, tinnitus, blurred vision, rash, weakness, tremor; blood dyscrasias

Ranolazine (not classified) PO: 500–1000 mg q 12 h VT INa, IKr Sinus rate slowed

Tc prolonged t1/2: 7 h

Metab: H Excr: U 75%, F 25% Cardiac: Bradycardia, hypotension

Other: Headache, dizziness, syncope, nausea, dyspnea

Sotalol (III) IV: 75 mg q 12 h PO: 80–120 mg q 12 h, may increase dose every 3 d; max 320 mg/d VT, VF, PVC IKr, Beta 1 and 2 receptor Sinus rate slowed

QTc prolonged AV nodal refractoriness increased; decreased DFT t1/2: 12 h

Metab: none Excr: U Cardiac: Bradycardia, hypotension, HF, syncope, TdP

Other: Fatigue, dizziness, weakness, dyspnea, bronchitis, depression, nausea, diarrhea

Table 7.  Continued

Antiarrhythmic Medication (Class) and Dose Uses in VA/SCA Target Electrophysiological

Effects Pharmacological

Characteristics Common Adverse Effects

(Continued )

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