Antiarrhythmic Drugs

Definition

Antiarrhythmic drugs are medicines that correct irregular heartbeats and slow down hearts that beat too fast.

Purpose

Normally, the heart beats at a steady, even pace. The pace is controlled by electrical signals that begin in one part of the heart and quickly spread through the whole heart. If something goes wrong with this control system, the result may be an irregular heartbeat, or an arrhythmia. Antiarrhythmic drugs correct irregular heartbeats, restoring the normal rhythm. If the heart is beating too fast, these drugs will slow it down. By correcting these problems, antiarrhythmic drugs help the heart work more efficiently.

Description

Antiarrhythmic drugs are available only with a physician's prescription and are sold in capsule (regular and extended release), tablet (regular and extended-release), and injectable forms. Commonly used antiarrhythmic drugs are disopyramide (Norpace, Norpace CR), procainamide (Procan SR, Pronestyl, Pronestyl-SR), and quinidine (Cardioquin, Duraquin, Quinidex, and other brands). Do not confuse quinidine with quinine, which is a related medicine with different uses, such as relieving leg cramps.

Recommended dosage

The recommended dosage depends on the type of antiarrhythmic drug and other factors. Doses may be different for different patients. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage.

Always take antiarrhythmic drugs exactly as directed. Never take larger or more frequent doses.

Do not stop taking this medicine without checking with the physician who prescribed it. Stopping it suddenly could lead to a serious change in heart function.

Antiarrhythmic drugs work best when they are at constant levels in the blood. To help keep levels constant, take the medicine in doses spaced evenly through the day and night. Do not miss any doses. If taking medicine at night interferes with sleep, or if it is difficult to remember to take the medicine during the day, check with a health care professional for suggestions.

Precautions

Persons who take these drugs should see their physician regularly. The physician will check to make sure the medicine is working as it should and will note any unwanted side effects.

Some people feel dizzy, lightheaded, or faint when using these drugs. This medicine may cause blurred vision or other vision problems. Because of these possible problems, anyone who takes these drugs should not drive, use machines or do anything else that might be dangerous until they have found out how the drugs affect them. If the medicine does cause vision problems, wait until vision is clear before driving or engaging in other activities that require normal vision.

Antiarrhythmic drugs make some people feel lightheaded, dizzy, or faint when they get up after sitting or lying down. To lessen the problem, get up gradually and hold onto something for support if possible.

Anyone taking this medicine should not drink alcohol without his or her physician's approval.

Some antiarrhythmic drugs may change the results of certain medical tests. Before having medical tests, anyone taking this medicine should alert the health care professional in charge.

Anyone who is taking antiarrhythmic drugs should be sure to tell the health care professional in charge before having any surgical or dental procedures or receiving emergency treatment.

Antiarrhythmic drugs may cause low blood sugar in some people. Anyone who experiences symptoms of low blood sugar should eat or drink a food that contains sugar and call a physician immediately. Signs of low blood sugar are:

• anxiety
• confusion
• nervousness
• shakiness
• unsteady walk
• extreme hunger
• headache
• nausea
• drowsiness
• unusual tiredness or weakness
• fast heartbeat
• pale, cool skin
• chills
• cold sweats

Antiarrhythmic drugs may cause dry mouth. To temporarily relieve the discomfort, chew sugarless gum, suck on sugarless candy or ice chips, or use saliva substitutes, which come in liquid and tablet forms and are available without a prescription. If the problem continues for more than 2 weeks, check with a physician or dentist. Mouth dryness that continues over a long time may contribute to tooth decay and other dental problems.

People taking antiarrhythmic drugs may sweat less, which can cause the body temperature to rise. Anyone who takes this medicine should be careful not to become overheated during exercise or hot weather and should avoid hot baths, hot tubs, and saunas. Overheating could lead to heat stroke.

Older people may be especially sensitive to the effects of antiarrhythmic drugs. This may increase the risk of certain side effects, such as dry mouth, difficult urination, and dizziness or lightheadedness.

KEY TERMS

Anxiety— Worry or tension in response to real or imagined stress, danger, or dreaded situations. Physical reactions, such as fast pulse, sweating, trembling, fatigue, and weakness may accompany anxiety.

Arrhythmia— Abnormal heart rhythm.

Asthma— A disease in which the air passages of the lungs become inflamed and narrowed.

Emphysema— A lung disease in which breathing becomes difficult.

Glaucoma— A condition in which pressure in the eye is abnormally high. If not treated, glaucoma may lead to blindness.

Hallucination— A false or distorted perception of objects, sounds, or events that seems real. Hallucinations usually result from drugs or mental disorders.

Heat stroke— A severe condition caused by prolonged exposure to high heat. Heat stroke interferes with the body's temperature regulating abilities and can lead to collapse and coma.

Inflammation— Pain, redness, swelling, and heat that usually develop in response to injury or illness.

Myasthenia gravis— A chronic disease with symptoms that include muscle weakness and sometimes paralysis.

Palpitation— Rapid, forceful, throbbing, or fluttering heartbeat.

Prostate— A donut-shaped gland below the bladder in men that contributes to the production of semen.

Psoriasis— A skin disease in which people have itchy, scaly, red patches on the skin.

Systemic lupus erythematosus (SLE)— A chronic disease that affects the skin, joints, and certain internal organs.

Tourette syndrome— A condition in which a person has tics and other involuntary behavior, such as barking, sniffing, swearing, grunting, and making uncontrollable movements.

Tremor— Shakiness or trembling.

The antiarrhythmic drug procainamide can cause serious blood disorders. Anyone taking this medicine should have regular blood counts and should check with a physician if any of the following symptoms occur:

• joint or muscle pain
• muscle weakness
• pain in the chest or abdomen
• tremors
• wheezing
• cough
• palpitations
• rash, sores, or pain in the mouth
• sore throat
• fever and chills
• loss of appetite
• diarrhea

• dark urine
• yellow skin or eyes
• unusual bleeding or bruising
• dizziness
• hallucinations
• depression

Special conditions

People with certain medical conditions or who are taking certain other medicines may have problems if they take antiarrhythmic drugs. Before taking these drugs, be sure to let the physician know about any of these conditions:

ALLERGIES. Anyone who has had unusual reactions to an antiarrhythmic drug in the past should let his or her physician know before taking this type of medicine again. Patients taking procainamide should let their physicians know if they have ever had an unusual or allergic reaction to procaine or any other "caine-type" medicine, such as xylocaine or lidocaine. Patients taking quinidine should mention any previous reactions to quinine. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

CONGESTIVE HEART DISEASE. Antiarrhythmic drugs may cause low blood sugar, which can be a particular problem for people with congestive heart disease. Anyone with congestive heart disease should be familiar with the signs of low blood sugar (listed above) and should check with his or her physician about what to do if such symptoms occur.

DIABETES. Antiarrhythmic drugs may cause low blood sugar, which can be a particular problem for people with diabetes. Anyone with diabetes should be familiar with the signs of low blood sugar (listed above) and should check with his or her physician about what to do if such symptoms occur.

PREGNANCY. The effects of taking antiarrhythmic drugs in pregnancy have not been studied in humans. In studies of laboratory animals, this medicine increased the risk of miscarriage. In addition, some women who have taken these drugs while pregnant have had contractions of the uterus (womb). Women who are pregnant or who may become pregnant should check with their physicians before taking this medicine. Women who become pregnant while taking this medicine should let their physicians know right away.

BREASTFEEDING. Antiarrhythmic drugs pass into breast milk. Women who are breastfeeding should check with their physicians before taking this medicine.

OTHER MEDICAL CONDITIONS. Before using anti-arrhythmic drugs, people with any of these medical problems should make sure their physicians are aware of their conditions:

• heart disorders such as structural heart disease or inflammation of the heart muscle
• congestive heart failure
• kidney disease
• liver disease
• diseases of the blood
• asthma or emphysema
• enlarged prostate or difficulty urinating
• overactive thyroid
• low blood sugar
• psoriasis
• glaucoma
• myasthenia gravis
• systemic lupus erythematosus

USE OF CERTAIN MEDICINES. Taking antiarrhythmic drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

The most common side effects are dry mouth and throat, diarrhea, and loss of appetite. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Less common side effects, such as dizziness, lightheadedness, blurred vision, dry eyes and nose, frequent urge to urinate, bloating, constipation, stomach pain, and decreased sexual ability, also may occur and do not need medical attention unless they do not go away or they interfere with normal activities.

More serious side effects are not common, but may occur. If any of the following side effects occur, check with the physician who prescribed the medicine as soon as possible:

• fever and chills
• difficult urination
• swollen or painful joints
• pain when breathing
• skin rash or itching

People who are especially sensitive to quinidine may have a reaction to the first dose or doses. If any of these side effects occur after taking quinidine, check with a physician immediately:

• dizziness
• ringing in the ears
• breathing problems
• vision changes
• fever
• headache
• skin rash

Other rare side effects may occur with any anti-arrhythmic drug. Anyone who has unusual symptoms after taking antiarrhythmic drugs should get in touch with his or her physician.

Interactions

Antiarrhythmic drugs may interact with other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. Anyone who takes antiarrhythmic drugs should let the physician know all other medicines he or she is taking. Among the drugs that may interact with antiarrhythmic drugs are:

• other heart medicines, including other antiarrhythmic drugs
• blood pressure medicine
• blood thinners
• pimozide (Orap), used to treat Tourette's syndrome

The list above does not include every drug that may interact with antiarrhythmic drugs. Be sure to check with a physician or pharmacist before combining antiarrhythmic drugs with any other prescription or nonprescription (over-the-counter) medicine.