Understanding Rate and Rhythm Control Drugs A Program for Patients & Caregivers Prepared by Kristen Campbell, PharmD, AACC Last reviewed: September 2017

Today’s Program Rate control strategies for AFib Rhythm control strategies for AFib Common side effects and things to remember Resources for support

Rate Control Medications

Rate Control Goal: Regulate your heart rate (pulse) to reduce symptoms Beta Blockers Calcium Channel Blockers Metoprolol (Lopressor/Toprol XL) Carvedilol (Coreg) Propranolol (Inderal) Atenolol (Tenormin) Bisoprolol (Zebeta) Nebivolol (Bystolic) Nadolol (Corgard) Diltiazem (Cardizem & others) Verapamil (Calan, Verelan)

Beta Blockers Beta-adrenergic blocking agents Block the effects of epinephrine (adrenaline) Cause the heart to beat more slowly and with less force Controls irregular rhythm Reduces blood pressure

Beta Blockers Side Effects Things to Remember Slow heart rate Feeling tired Cold hands or feet Weight gain Shortness of breath Do not stop taking unless instructed by provider

Calcium Channel Blockers Prevent calcium from entering cells in the heart and blood vessel walls Reduces blood pressure Some cause the heart to beat more slowly Controls irregular rhythm

Calcium Channel Blockers Side Effects Things to Remember Slow heart rate Feeling tired Constipation Dizziness Do not stop taking unless instructed by provider

Rhythm Control Medications

Rhythm Control Goal: Achieve and maintain regular rhythm These drugs work directly on heart tissue and slow impulses throughout the heart Require close monitoring by providers Talk about whether to use rhythm control with your health care professional Considerations: type of AFib, symptoms, other health conditions, anticoagulation

Rhythm Control Drug-Drug Interactions Drug-Food Interactions Many potential & many serious Can occur with short-term medications (antibiotics) Can occur with over-the-counter medications Report ALL medications to ALL providers Use the same pharmacy for all prescriptions If you can’t, report all medications to each pharmacy Drug-Food Interactions Grapefruit Juice cocktails, sodas

Flecainide (Tambocor) Dosing: Taken twice a day Side Effects: Headache Dizziness Things to Remember: Do not use if you have a history of heart attack or heart failure Call your doctor if you have: Chest pain Fainting New or worse heartbeat that does not feel normal Change in eyesight

Propafenone (Rythmol) Dosing: Taken 2-3 times a day Side Effects: Upset stomach Nausea Dizziness Change in taste Things to Remember: Do not use if you have a history of heart attack or heart failure Call your doctor if you have: Chest pain Fainting New or worse heartbeat that does not feel normal

Amiodarone (Pacerone, Cordarone) Dosing: Taken once a day Side Effects: Nausea Dizziness Amiodarone affects multiple organ systems in the body – liver, lungs, eyes, thyroid, nerves, brain and skin Things to Remember: You will need to have regular bloodwork and eye exams You may get sunburned more easily

Things to look for while you are on Amiodarone Wear a hat while in sun Need to follow up with your primary care and cardiovascular physician regarding regular surveillance Interacts with a lot of medications. Please make sure to check with your doc

Dofetilide (Tikosyn) Dosing: Taken two times a day Side Effects: Headache Dizziness This drug can be started only in the hospital. ECG should be monitored to make sure that you don’t develop bad ventricular arrhythmias Things to Remember: You will need bloodwork and ECG testing every 3-4 months Avoid grapefruit juice Make sure your potassium (K) and magnesium (Mg) levels are OK Has many drug-to-drug interactions. Check with your doctors and pharmacy when a new medication is given to you

Sotalol (Betapace) Dosing: Taken two times a day Side Effects: Slow heart rate Dizziness, fatigue, shortness of breath This drug may be started in the hospital. ECG should be monitored to make sure that you don’t develop bad ventricular arrhythmias Counseling Points: You may be admitted to the hospital to begin sotalol You will need bloodwork and ECG testing every 3-4 months Make sure to have adequate K and Mg replacements

Dronedarone (Multaq) Dosing: Taken two times a day Side Effects: Upset stomach Dizziness Diarrhea Counseling Points: Should not be taken if you have heart failure

Resources for Support and Information   CardioSmart is an ongoing patient education and empowerment initiative offered by the American College of Cardiology. Our mission is to help individuals prevent, treat and manage cardiovascular disease. www.CardioSmart.org

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