Disopyramide hypotension caused

On the basis of this report, and on reports of studies in animals and from the known risks associated with the concurrent use of beta blockers (see Disopyramide -i- Beta blockers , p.252), the UK manufacturer warns about combining disopyramide and other drugs [such as verapamil] that may have additive negative inotropic effects. However, they do point out that in some specific circumstances combinations of antiarrhythmie drugs (they specifically name digoxin, beta blockers and verapamil for the control of atrial fibrillation) may be beneficial. They note that severe hypotension caused by disopyramide has usually been associated with cardiomyopathy or uncompensated congestive heart failure. However, the US manufacturer advises that until more data is available, disopyramide should not be given within 48 hours before or 24 hours after verapamil. ... 

Dryness of the mouth and throat caused by die cholinergic blocking action of this drug also may occur. The nurse provides an adequate amount of fluid and instructs die patient to take frequent sips of water to relieve diis problem. In addition, postural hypotension may occur during die first few weeks of disopyramide therapy. The patient is advised to make position changes slowly. In some instances, the patient may require assistance in getting out of the bed or chair. 

Negative inotropic effect Disopyramide can worsen cardiac failure and occasionally causes hypotension. 

Quinidine causes cinchonism (headache, vertigo, tinnitus) cardiac depression gastrointestinal upset and allergic reactions (eg, thrombocytopenic purpura). As noted in Chapter 13, quinidine reduces the clearance of digoxin and may increase the serum concentration of the glycoside to dangerous levels. Procainamide causes hypotension (especially when used parenterally) and a reversible syndrome similar to lupus erythematosus. Disopyramide has... 

V 1 1 IV. 6 hr half-life, partially metabolized in liver, low plasma protein binding. Hypersensitivity to amrinone. Amrinone increases diuresis in patients on diuretics. Digitalis inotropy and risk of toxicity increased (amrinone causes hypokalemia). Excessive hypotension with disopyramide. If cellular supplies of cAMP are depleted, amrinone will not be effective. Capable of increasing myocardial contraction even in the presence of p-adrenergic antagonists. 

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