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Ailments and Diseases
Published in James Sherifi, General Practice Under the NHS, 2023
The management of cardiac arrhythmia, particularly atrial fibrillation, was through modifying heart rate and myocardial contractility, for which digoxin/digitoxin, commenced by GPs, were the sole agents. Disopyramide was used for ventricular arrhythmia. Anticoagulants were not part of the regime.
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Disopyramide is similar in action to quinidine, and used to treat supraventricular and ventricular arrhythmias. The drug crosses the placenta with fetal levels reaching approximately half those of the mother (Rotmensch et al., 1983). The drug was embryotoxic in laboratory animals when given at several times the human dose, but no pattern or specific malformations were noted (data from the manufacturer’s insert). Disopyramide use during the third trimester has been associated with premature onset of labor (Leonard et al., 1978; Rotmensch et al., 1983). Some authorities have stated this drug is safe for use during the third trimester but no published primary data indicate disopyramide is or is not associated with birth defects. The Swedish Birth Defects Registry included only 3 first trimester exposures (Kallen, 2019).
Hypertrophic Cardiomyopathy
Published in Srilakshmi M. Adhyapak, V. Rao Parachuri, Hypertrophic Cardiomyopathy, 2020
Disopyramide, a class Ia antiarrhythmic agent with potent negative inotropic properties, is an option for controlling HF symptoms in obstructive patients, and is the only drug shown to reduce rest gradient [27]. Its parasympathetic side effects have limited long-term efficacy, decreasing its widespread use [2, 3]. Although beneficial symptomatic responses are often achieved by the administration of cardioactive drugs to patients with HCM, conclusive evidence is lacking that pharmacological strategies can alter natural history or reduce mortality.
Current and emerging pharmacotherapy for the management of hypertrophic cardiomyopathy
Published in Expert Opinion on Pharmacotherapy, 2023
Akiva Rosenzveig, Neil Garg, Shiavax J. Rao, Amreen K. Kanwal, Arjun Kanwal, Wilbert S. Aronow, Matthew W. Martinez
In patients with refractory symptoms despite beta-blockade or calcium channel blockade, as well as persistence of LVOT gradient at rest, disopyramide can be considered [15]. Disopyramide, a class 1a antiarrhythmic that antagonizes the cardiac sodium channel, is generally used to reduce the incidence of atrial fibrillation. However, disopyramide also has a strong negative inotropic effect, making it a potential therapeutic agent for symptomatic patients with HCM associated with LVOTO. Several clinical trials have linked disopyramide with amelioration in left ventricular outflow pressure as well as improvement of myocardial relaxation [13]. A recent retrospective analysis evaluated 372 patients with obstructive HCM from 1981 to 2021 treated with disopyramide therapy. They demonstrated 24% complete response rate (NYHA class I and LVOT gradient <30 mmHg). Interestingly, the presence of NYHA class I or II was an independent predictor of response to disopyramide therapy. Disopyramide also showed a safe pro-arrhythmic profile [19]. Recent improvements in understanding of the pathophysiology of LVOTO have led to more effective management. Further research into HCM targeted therapeutics aims to curb the adverse outcomes linked to HCM.
Multi-modality management of hypertrophic cardiomyopathy
Published in Hospital Practice, 2023
Shiavax J. Rao, Shaikh B. Iqbal, Arjun S. Kanwal, Wilbert S. Aronow, Srihari S. Naidu
Disopyramide’s strong negative inotropic effects prompted utility for treatment of symptomatic HCM with LVOTO [12]. Early studies reported reductions in outflow pressure gradient, and improvement of diastolic dysfunction through enhanced myocardial relaxation [13,14]. Based on more recent studies, the negative inotropic effect of disopyramide is thought to be associated with reduction of intracellular systolic calcium release through reduction of the late sodium current, and ultimately reduction of action potential duration [15,16]. Disopyramide should be avoided in patients with QT-prolongation, and although recent studies have confirmed the safety of this drug in HOCM patients when QTc remains < 520 msec, special attention should be paid in patients already on other QT-prolonging agents [15,17]. This drug should also be avoided in those with urinary retention and narrow angle glaucoma, due to potentiation of those disorders. Disopyramide should not be used as a solitary agent, and instead should be added to a background of beta blockade and/or calcium channel blockade.
Cardiac arrhythmias in pregnant women: need for mother and offspring protection
Published in Current Medical Research and Opinion, 2020
Theodora A. Manolis, Antonis A. Manolis, Evdoxia J. Apostolopoulos, Despoina Papatheou, Helen Melita, Antonis S. Manolis
Quinidine (former FDA category C) has the longest record of use in pregnancy. There are reports of preterm labor, thrombocytopenia, and fetal acoustic nerve injury and ototoxicity noted at high doses61,120. Teratogenicity has not been reported for quinidine. Quinidine has been used successfully for both maternal and, due to the ease of placental transfer, fetal ventricular and supraventricular arrhythmias118,121. Serum-level monitoring is required to avoid proarrhythmia. Procainamide is also considered safe to use during pregnancy and has been used frequently, however its use has been limited to acute therapy, due to the high likelihood of drug-induced lupus reported with chronic use. Particular attention should be paid to monitor for hypotension during its IV administration; slow infusion rate at ≤20–50 mg/min is recommended. Experience with disopyramide in pregnancy is limited.