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CARDIOVASCULAR SYSTEM › CARDIAC THERAPY › ANTIARRHYTHMICS, CLASS I AND III › Antiarrhythmics, class Ib
aprindine
C01BB04
Forms & Strengths
- Oral capsules: 20 mg
- Oral capsules: 40 mg
- Intravenous solution: 20 mg/mL
Adult Dosing
- Ventricular arrhythmias: Initial 40 to 60 mg orally twice daily, adjusted based on response and plasma levels
- Maintenance: Typically 40 to 100 mg daily in divided doses
- Loading dose (IV): 1 to 2 mg/kg slowly over 10-20 minutes under cardiac monitoring
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
- Use is generally avoided in children unless other antiarrhythmic agents fail and under specialist supervision
Indications
- Life-threatening ventricular arrhythmias refractory to other agents
- Severe supraventricular arrhythmias associated with accessory pathways (Wolff-Parkinson-White syndrome)
Mechanism of Action
- Class IB/IC antiarrhythmic agent (Vaughan Williams classification)
- Blocks fast voltage-gated sodium channels in myocardial cell membranes
- Slows phase 0 depolarization and conduction velocity
- Lengthens effective refractory period and action potential duration in Purkinje fibers and ventricular tissue
Contraindications
- Known hypersensitivity to aprindine
- Second- or third-degree atrioventricular block without a functioning pacemaker
- Sick sinus syndrome
- Severe congestive heart failure
- Severe hepatic impairment
- History of cholestatic jaundice related to aprindine
Adverse Reactions
- Central nervous system: Dizziness, tremor, ataxia, hallucinations, psychosis, peripheral neuropathy
- Cardiovascular: Hypotension, bradycardia, heart block, worsening or new arrhythmias (proarrhythmic effect)
- Gastrointestinal: Nausea, vomiting, anorexia
- Hepatic: Elevated liver enzymes, cholestatic jaundice, hepatitis
- Hematological: Agranulocytosis, thrombocytopenia
Drug Interactions
- CYP3A4 inhibitors (e.g., ketoconazole, macrolides): May increase aprindine plasma concentrations and toxicity
- CYP3A4 inducers (e.g., rifampin, carbamazepine): May decrease aprindine efficacy
- Other antiarrhythmic drugs (e.g., beta-blockers, calcium channel blockers): Potential for additive negative inotropic and chronotropic effects
- Digoxin: May increase serum digoxin levels or additive AV nodal conduction slowing
Curated Content: Needs Vetting Before Put to Clinical Use