From the Guidelines
Oral medications such as Amiodarone, Beta-blockers, and antiarrhythmic drugs like Flecainide and Propafenone are commonly used to treat ventricular tachycardia, with the choice of medication depending on the type of ventricular tachycardia, underlying heart disease, and patient-specific factors. The treatment of ventricular tachycardia (VT) involves the use of various oral medications, including antiarrhythmic drugs, beta-blockers, and calcium channel blockers. According to the 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 1, the following medications are recommended for the treatment of VT:
- Amiodarone (200-400 mg/day), a Class III antiarrhythmic agent, is effective for long-term management of VT, but its use is associated with significant side effects, including pulmonary and hypothyroidism, neuropathies, and hepatotoxicity.
- Beta-blockers (various doses), such as metoprolol, carvedilol, and atenolol, help by slowing heart rate and reducing the heart's workload, and are recommended for the treatment of VT, especially in patients with underlying heart disease.
- Flecainide (200-400 mg/day) and Propafenone (450-900 mg/day), Class IC antiarrhythmic agents, may be used in patients without structural heart disease, but their use is associated with significant side effects, including pro-arrhythmia and QT prolongation.
- Mexiletine (450-900 mg/day), a Class IB agent, is sometimes used as adjunctive therapy for the treatment of VT.
- Sotalol (160-320 mg/day), a Class III antiarrhythmic agent, is effective for long-term management of VT, but its use is associated with significant side effects, including QT prolongation and Torsade de Pointes. The choice of medication depends on the type of ventricular tachycardia, underlying heart disease, and patient-specific factors, such as the presence of structural heart disease, left ventricular ejection fraction, and concomitant medical conditions. Regular monitoring is essential as these medications can have significant side effects and may require dose adjustments based on response and tolerance.
From the FDA Drug Label
Amiodarone HCl injection is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to other therapy. Amiodarone HCl injection also can be used to treat patients with VT/VF for whom oral amiodarone is indicated, but who are unable to take oral medication During or after treatment with amiodarone HCl injection, patients may be transferred to oral amiodarone therapy
The oral medication used to treat ventricular tachycardia is amiodarone (PO) 2.
- Key points:
- Amiodarone is used for the treatment of ventricular tachycardia.
- Patients may be transferred to oral amiodarone therapy after treatment with amiodarone HCl injection. Another oral medication that may be used is dofetilide (PO), although the provided text does not directly state its use for ventricular tachycardia, it does mention its use for treating arrhythmias and the risk of Torsade de Pointes, a type of ventricular tachycardia 3.
From the Research
Oral Medications for Ventricular Tachycardia
The following oral medications are used to treat ventricular tachycardia:
- Amiodarone: a class III antiarrhythmic agent that has been shown to be effective in treating ventricular tachycardia and ventricular fibrillation 4, 5, 6
- Mexiletine: a class I antiarrhythmic agent that can be used in combination with amiodarone to treat refractory recurrent ventricular tachycardia 7
- Disopyramide: a class I antiarrhythmic agent that has been used to treat ventricular arrhythmias, although its efficacy in ventricular tachycardia is not as well established as amiodarone 4, 6
- Aprindine: a class I antiarrhythmic agent that has been used to treat ventricular arrhythmias, although its efficacy in ventricular tachycardia is not as well established as amiodarone 6
- Encainide: a class I antiarrhythmic agent that has been used to treat ventricular arrhythmias, although its efficacy in ventricular tachycardia is not as well established as amiodarone 4
- Quinidine: a class I antiarrhythmic agent that has been used to treat ventricular arrhythmias, although its efficacy in ventricular tachycardia is not as well established as amiodarone 4
- Procainamide: a class I antiarrhythmic agent that has been used to treat ventricular arrhythmias, although its efficacy in ventricular tachycardia is not as well established as amiodarone 4
Efficacy and Safety of Oral Medications
The efficacy and safety of these oral medications have been evaluated in several studies:
- Amiodarone has been shown to be effective in treating ventricular tachycardia and ventricular fibrillation, with a response rate of 69-75% 4, 5
- The combination of mexiletine and amiodarone has been shown to be effective in treating refractory recurrent ventricular tachycardia, with a response rate of 100% in one study 7
- However, amiodarone can cause significant toxicity, including tremor, nausea, visual halos, thyroid function abnormalities, and pulmonary interstitial infiltrates, in approximately 50% of patients 5
- The other oral medications listed above can also cause significant side effects, and their efficacy and safety in ventricular tachycardia are not as well established as amiodarone 4, 6, 7