Drug Name
Generic Name : ibutilide fumarate
Brand Name: Corvert
Classification: Antiarrhythmic (predominately class III)
Pregnancy Category C
Dosage & Route
ADULTS > 60 KG (132 LB)
- 1 vial (1 mg) infused over 10 min; may be repeated after 10 min if arrhythmia is not terminated.
ADULTS < 60 KG
- 0.1 mL/kg (0.01 mg/kg) infused over 10 min; may be repeated after 10 min if arrhythmia is not terminated.
PEDIATRIC PATIENTS
- Not recommended.
Therapeutic actions
- Ibutilide is a methanesulfonanilide derivative class III antiarrhythmic agent. It prolongs repolarisation and refractoriness without affecting conduction. Antiarrhythmic action may result from activation of slow, inward current (predominantly sodium) at very low concentrations.
Indications
- Rapid conversion of atrial fibrillation or flutter of recent onset to sinus rhythm; most effective in arrhythmias of < 90 days’ duration
Adverse effects
- Heart block, hypotension, hypertension, bradycardia, palpitations; headache; nausea, vomiting.
- Potentially Fatal: Arrhythmias (including torsade de pointes).
Contraindications
- Lactation. QTc interval >440 msec.
Nursing considerations
Assessment
- History: Hypersensitivity to ibutilide; second- or third-degree AV heart block, time of onset of atrial arrhythmia; prolonged QTc intervals; pregnancy, lactation; ventricular arrhythmias
- Physical: Orientation; BP, P, auscultation, ECG; R, adventitious sounds
Interventions
- Determine time of onset of arrhythmia and potential benefit before beginning therapy. Conversion is more likely in patients with arrhythmias of short (< 90 days’) duration.
- WARNING: Ensure that patient is adequately anticoagulated, generally for at least 2 wk, if atrial fibrillation lasts > 2–3 days.
- Monitor ECG continually during and for at least 4 hr after administration. Be alert for possible arrhythmias, including PVCs, sinus tachycardia, sinus bradycardia, varying degrees of block at time of conversion.
- BLACK BOX WARNING: Keep emergency equipment readily available during and for at least 4 hr after administration; can cause potentially life-threatening arrhythmias.
- Provide appointments for continued follow-up, including ECG monitoring; tendency to revert to atrial arrhythmia after conversion increases with length of time patient was in abnormal rhythm.
Teaching points
- This drug can only be given by intravenous infusion. You will need ECG monitoring during and for 4 hours after administration.
- Arrange for follow-up medical evaluation, including an ECG, which is important to monitor the effect of the drug on your heart.
- You may experience these side effects: Rapid or irregular heartbeat (usually passes shortly), headache.
- Report chest pain, difficulty breathing, numbness or tingling.