Mexiletine Amiodarone

Are there contraindications to concomitant drug use For instance, tizanidine is contraindicated in patients with concomitant use of CYP450 1A2 inhibitors such as fluvoxamine, amiodarone, mexiletine, propafenone, cimetidine, fluoroquinolones (ciprofloxacin, norfloxacin), rofecoxib, oral contraceptives, and ticlopidine [27]. 

Acetaminophen Amiodarone Carbamazepine Cardiac glycosides Corticosteroids Dicumarol Disopyramide Doxycycline Estrogens Haloperidol Methadone Metyrapone Mexiletine Oral contraceptives Quinidine Theophylline Valproic acid Cyclosporine Dopamine Furosemide Levodopa Levonorgestrel Mebendazole Nondepolarizing muscle relaxant Phenothiazines Sulfonylureas... 

Classes I, III, and IV all involve transmembrane ion channels Classes I and III involve Na+ channels. Class I compounds are designed to block cardiac Na channels in a voltage-dependent manner, similar to local anesthetics. Not surprisingly, many of these Class I agents are either local anesthetics or are structurally based on local anesthetics. Class I compounds include procainamide (7.15), disopyramide (7.16), amiodarone (7.17), lido-caine (7.5), tocainide (7.18), mexiletine (7.19), and flecainide (7.20). The majority of these compounds possess two or three of the fundamental structural building blocks found within local anesthetics. Propranolol (7.21) is the prototypic Class II agent. Class III compounds include molecules that block outward K channels, such as sotalol (7.22) and dofetilide (7.23), and molecules that enhance an inward Na current, such as... 

ANAESTHETICS - LOCAL AMIODARONE, DISOPYRAMIDE, FLECAINIDE, MEXILETINE, PROCAINAMIDE, PROPAFENONE Risk of 1 BP Additive myocardial depression Particular care should be taken to avoid inadvertent intravenous administration during bupivacaine infiltration monitor PR, BP and ECG during epidural administration of bupivacaine... 

CIMETIDINE, RANITIDINE ANTIARRHYTHMICS-AMIODARONE, FLECAINIDE, MEXILETINE, PROCAINAMIDE, PROPAFENONE Likely t plasma concentrations of these antiarrhythmics and risk of adverse effects Cimetidine inhibits CYP2D6-mediated metabolism of flecainide, mexiletine, procainamide and propafenone. Ranitidine is a much weaker CYP2D6 inhibitor. Cimetidine is a potent inhibitor of organic cation transport in the kidney, and the elimination of procainamide is impaired Monitor PR and BP at least weekly until stable. Warn patients to report symptoms of hypotension (lightheadedness, dizziness on standing, etc.). Consider alternative acid suppression therapy... 

Particle-loaded membranes with embedded Cg hydrophobic adsorbents were intensively investigated for several dmg separations. Tricyclic antidepressants, antiarrhythmic dmgs, amiodarone and its metabolite desethylamiodarone, and mexiletine and flecainide were extracted from serum using a 11 mm Cg membrane adsorber with recoveries ranging from 82% to 98% [14,220]. 

Yonezawa E, Matsumoto K, Ueno K, Tachibana M, Hashimoto H, Komamura K, Kamakura S, Miyatake K, Tanaka K. Lack of interaction between amiodarone and mexiletine in cardiac arrhythmia patients. J Clin Pharmacol 2002 42(3) 342-6. 

Zipes DP, Troup PJ. New antiarrhythmic agents amiodarone, aprindine, disopyramide, ethmozin, mexiletine, tocainide, verapamil. Am J Cardiol 1978 41(6) 1005-24. 

Interactions of mexiletine with other cardioactive drugs have been reviewed (48). The most important are beneficial interactions with beta-adrenoceptor antagonists, quinidine, and amiodarone in the suppression of ventricular tachydysrhythmias. During these interactions the... 

Reported bioanalytical applications that use SS-LLE products include both tlie cartridge (tube) format and the microplate format. Some of these applications include the determination of mexiletine [44], amiodarone [45] and other antiarrhythmic drugs [46], proxyphylline [47], 16(3-hydroxystanozolol [48], dextromethorphan [49], and simvastatin [50] from biological fluids. Microplate applications for SS-LLE include a crude purification of crude combinatorial library samples [51], carboxylic acid-based matrix metallo-protease inhibitors [52], and a p3-adrenergic receptor agonist [53]. 

D6 Amiodarone, cimetidine, quinidine, SSRIs Antidepressants, flecainide, lidocaine, mexiletine, opioids... 

A) Adenosine Amiodarone Disopyramide Esmolol Flecainide Lidocaine Mexiletine Procainamide Quinidine Verapamil... 

Amiodarone does not affect the clearance of mexiletine. The concurrent use of mexiletine and amiodarone can be clinically useful. 

The clearance of mexiletine in 10 patients did not differ before and after 1,3 and 5 months concurrent use of amiodarone. In addition, the clearance of mexiletine did not differ between these patients and 155 other patients not taking amiodarone. ... 

Torsade de pointes has been described in a patient taking amiodarone and mexiletine (a class Ib antiarrhythmic). The manufacturers of mexiletine say that this seems to be an isolated case. ... 

Class Ib antiarrhythmics are usually associated with shortening of the QT interval, and could therefore be expected to reduce the QT prolongation and risk of torsade de pointes seen with amiodarone alone (for examples of this effect of mexiletine see also Mexiletine + Beta blockers, p.268 and Mexiletine + Quinidine , p.269. However, note that the UK manufacturer of mexiletine says that it may exacerbate arrhythmias [as all antiarrhythmics may], but also that it may be used concurrently with amiodarone. The two drugs have been used together successfully. ... 

Waleffe A, Mary-Rabine L, L and V, Demoulin JC, Kulbertus HE. Combined mexiletine and amiodarone treatment of refractoiy recurrent ventricular tachycardia. Am Heart J ( 9W) 100,788-93. 

Hoffmann A, Follath F, Burckhardt D. Safe treatment of resistant ventricular arrhythmias with a combination of amiodarone and quinidine or mexiletine. Lancet (1983) i, 704-5. 

Recombinant tumor necrosis factor, myoglobin, ovalbumin, lysozyme and chymotrypsinogen, chymotrypsinogen A, ribonuclease, myoglobin, trypsinogen and lysozyme, tricyclic antidepressants, antiarrhythmic drugs, amiodarone, desethylamiodarone, mexiletine, flecainide, alcohols, phenols, aldehydes, ketones, esters, polar pesticides from water... 

If haemodynamically unstable, the patient received an ICD otherwise, various combinations of antiarrhythmic drugs (such as the combined use of sotalol or mexiletine with amiodarone) were tried ... 

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