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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Mexiletine is a local anesthetic similar to lidocaine in action. Also like lidocaine, it is an antiarrhythmic agent (Zipes and Troup, 1978). Primary use of mexiletine is to treat ventricular arrhythmias (ventricular tachycardia, premature ventricular contractions). No studies of congenital anomalies in infants exposed to mexiletine have been published. A few anecdotal case reports suggest no adverse effects on the fetus or on labor, but the importance of such observations is not clear. Mexiletine was not teratogenic in mice, rats, and rabbits (data from the manufacturer’s insert). Cord blood concentrations of this drug were similar to maternal levels, and therapeutic levels may be found in breast milk (Timmis et al., 1980). However, breastfeeding is not contraindicated when the mother is using mexiletine (American Academy of Pediatrics, 2001). It is an old FDA category C drug. Only 5 infants were exposed to mexiletine during the first trimester in Swedish Birth Defects Registry (Kallen, 2019).
Nonopioid and Adjuvant Analgesic Agents
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
Mexiletine is an antiarrhythmic medicine that is structurally related to lidocaine, but it can be given orally. While it was thought to be useful as an oral analog of lidocaine, its efficacy in neuropathic pain is very poor and not predicted by the response to lidocaine. However, it can be very useful in the treatment of neuropathic pain caused by erythromelalgia, a rare genetic disorder of NaV1.7 sodium channels, where attacks of acute neuropathic pain occur. In all other neuropathic pain states, treatment guidelines advise against the use of mexiletine (Finnerup et al, 2015).
Analytical Toxicology of Vitreous Humor
Published in Steven H. Y. Wong, Iraving Sunshine, Handbook of Analytical Therapeutic Drug Monitoring and Toxicology, 2017
Mexiletine is a class IB antiarrhythmic drug used in the treatment of ventricular arrhythmias. Kempton et al.80 reported the suicidal death of one individual who ingested this drug. Blood concentrations showed some site dependence, suggesting post-mortem redistribution. The concentration in vitreous humor was approximately the same as the lower blood concentration.
Mexiletine for ventricular arrhythmias in patients with chronic coronary syndrome: a cohort study
Published in Acta Cardiologica, 2022
Giacomo Mugnai, Carla Paolini, Stefano Cavedon, Alessandro Mecenero, Cosimo Perrone, Claudio Bilato
Mexiletine is an antiarrhythmic (Class IB) agent which inhibits the inward sodium current in cardiac cells, reducing the rate of rise of the cardiac action potential and decreasing automaticity in the Purkinje fibres. In addition, the sodium channel blockade leads to a marked delay in recovery from channel’s inactivation leading to a prolongation of the effective refractory period. The present pilot study sought to analyse the effectiveness and tolerability of mexiletine in patients with refractory ventricular arrhythmias and ischaemic heart disease, when the conventional therapeutical strategy failed.
Mexiletine (NaMuscla) for the treatment of myotonia in non-dystrophic myotonic disorders
Published in Expert Opinion on Orphan Drugs, 2020
Karen J. Suetterlin, Dipa Raja Rayan, Emma Matthews, Michael G Hanna
There was only one serious adverse event in the n-of-1 trial. This was an allergic skin reaction. However, 90% of patients in the n-of-1 trial had at least one adverse reaction [21]. By far the most frequent adverse reaction is gastrointestinal discomfort. This was true for the RCT [20], n-of-1 trial [21] and a retrospective case series review [16]. Gastrointestinal symptoms may require dyspeptic therapy in order to achieve adequate dose titration of mexiletine [16]. Other adverse effects of mexiletine include headache, nausea, palpitations, insomnia, and tremor [16,20,21].
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
Mexiletine, an oral analogue which is structurally similar to lidocaine, also freely crosses the placenta, however, again, teratogenicity has not been linked to its use123. Mexiletine is a former FDA pregnancy category C medication, however, its use may still be safe in pregnancy.