Arrhythmias (unspecified)
Other antiarrhythmic drugs may be used when clinically indicated.
Class 1 anti-arrhythmics (membrane stabilising drugs).
On specialist advice.
On specialist advice.
Orally, ventricular arrhythmias, 100mg twice daily; max 400mg daily, reduced after 3-5 days if possible; supraventricular arrhythmias, 50mg twice daily; max 300mg daily.
Orally, ventricular arrhythmias, 100mg twice daily; max 400mg daily, reduced after 3-5 days if possible; supraventricular arrhythmias, 50mg twice daily; max 300mg daily.
Other anti-arrhythmics.
On specialist advice.
On specialist advice.
On specialist advice.
On specialist advice.
On specialist advice.
On specialist advice.
On specialist advice.
On specialist advice.
On specialist advice.
Prescribing Notes:
- Flecainide injection [unlicensed preparation] may be used on specialist advice.
- Class III antiarrhythmics including amiodarone and sotalol may cause QT prolongation and atypical VT (torsades de pointes); they should be given with extreme caution with drugs known to prolong the QT interval including clarithromycin, erythromycin, chloroquine, haloperidol, lithium, tricyclic antidepressants, citalopram, methadone, chlorpromazine and domperidone. Consult BNF or QT prolongation website for full information. In addition, low potassium will greatly enhance the QT prolonging action and so care must be taken with patients on diuretics. Sotalol should be avoided in patients on diuretics or with hypokalaemia.
- Patients prescribed antiarrhythmic medicines should be warned to report immediately any symptoms that might suggest worsening (or new onset) arrhythmias such rapid palpitations, dizzy spells or blackouts. Patients experiencing these symptoms should have an ECG and should be referred urgently to cardiology for further assessment if (i) there is evidence of QT interval prolongation (>500ms) or significant new arrhythmias (e.g. any degree of heart block), or (ii) the new symptoms are sufficiently serious to merit referral even if the ECG shows no new findings.
- Intravenous digoxin should only be prescribed where patients are ‘nil by mouth’.
- A common, but commonly missed side effect with atropine use is acute confusion.
History Notes
16/02/2022
East Region Formulary content agreed.
On specialist advice.
Prescribing Notes:
- Toxicity can often be managed by discontinuing digoxin and correcting any electrolyte abnormalities.
- DigiFab is available for reversal of life-threatening overdosage.
History Notes
16/02/2022
East Region Formulary content agreed.
Other anti-arrhythmics.
For dose, refer to BNF for Children.
Beta-adrenoceptor blockers – non-selective.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
Anti-arrhythmics Class III.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
Anti-arrhythmics Class IC. Flecainide – also available as 150mg/15ml solution for injection ampoules [Unlicensed Medicine].
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
Beta-adrenoceptor blockers.
Dose as per initiating specialist.
Dose as per initiating specialist.
Cardiac glycosides.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
For dose, refer to BNF for Children.
Prescribing Notes:
- Anti-arrhythmics are complex agents; with the exception of adenosine, intravenous injections or infusions should not be given without consultation with paediatric cardiologist.
- Adenosine is the only intravenous agent that can be given without specialist advice. Cardiology should be informed if it has been administered.
- Propranolol may be used in larger doses for hypertrophic cardiomyopathy on advice from a cardiologist.
- Nadolol or propranolol may be initiated by a cardiologist for prolonged QT syndrome.
- Flecainide suspension [unlicensed preparation] has a local anaesthetic effect and should be given at least 30minutes before or after food. Milk, infant formula and dairy products may reduce absorption, separate doses from feeds.
- For oral digoxin therapy dose should be rounded to the nearest 5micrograms to assist administering the dose.
- Calcium channel blockers may also be used; choice follows specialist guidance.
- Although beta-blockers are not recommended in patients with asthma, they are often given on advice from a cardiologist without ill effect in such situations. They are not usually prescribed where there are good alternatives.
- Different strengths of medicines formulations are included; preparations available on wards should be carefully considered, taking safety and practicality into consideration.
History Notes
19/06/2023
East Region Formulary content agreed - ERFC 07/06/2023.
On specialist advice.
Prescribing Notes:
- Digoxin toxicity can often be managed by discontinuing digoxin and correcting any electrolyte abnormalities.
History Notes
19/06/2023
East Region Formulary content agreed - ERFC 07/06/2023.