From the Guidelines
Patients on Multaq (dronedarone) should be monitored with regular liver function tests, including AST and ALT, as well as ECG parameters, to facilitate early detection of potential hepatotoxicity and QT prolongation. When monitoring patients on Multaq (dronedarone), healthcare providers should regularly check liver function tests, renal function, electrolytes, and ECG parameters 1. Before starting treatment, baseline liver enzymes (ALT, AST), serum creatinine, potassium, magnesium, and a baseline ECG should be obtained. Liver function tests should be repeated within the first 6 months of therapy, as dronedarone can cause hepatotoxicity 1. ECG monitoring is important to assess QT interval and heart rate, as dronedarone can cause QT prolongation. Some studies suggest that serum creatinine levels typically increase by about 0.1-0.2 mg/dL with dronedarone initiation due to inhibition of tubular secretion rather than actual kidney damage, so this should be monitored but doesn't necessarily indicate renal injury 1. However, the most recent and highest quality study recommends monitoring AST and ALT within the first 6 months of therapy 1. Potassium and magnesium levels should be maintained within normal ranges to reduce the risk of arrhythmias. Additionally, thyroid function tests should be checked periodically since dronedarone contains iodine and may affect thyroid function. Complete blood counts should also be monitored, particularly in patients on concomitant anticoagulation therapy. It is essential to prioritize the monitoring of liver function tests and ECG parameters, as recommended by the most recent guidelines 1. In clinical practice, it is crucial to weigh the benefits and risks of dronedarone therapy and adjust the monitoring strategy accordingly, taking into account the patient's individual risk factors and medical history. The monitoring strategy should be tailored to the patient's specific needs, with a focus on preventing and detecting potential adverse effects, such as hepatotoxicity and QT prolongation 1.
From the FDA Drug Label
Consider obtaining periodic hepatic serum enzymes, especially during the first 6 months of treatment, but it is not known whether routine periodic monitoring of serum enzymes will prevent the development of severe liver injury If hepatic injury is suspected, promptly discontinue MULTAQ and test serum enzymes, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase, as well as serum bilirubin, to establish whether there is liver injury.
The labs that should be monitored in patients taking Multaq (Dronedarone) include:
- Hepatic serum enzymes:
- Aspartate aminotransferase (AST)
- Alanine aminotransferase (ALT)
- Alkaline phosphatase
- Serum bilirubin 2
From the Research
Laboratory Monitoring for Patients Taking Multaq (Dronedarone)
The following laboratory tests should be monitored in patients taking Multaq (Dronedarone):
- Liver function tests (LFTs), including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) 3, 4, 5
- Serum creatinine levels, although it is noted that dronedarone can cause an isolated increase in serum creatinine levels, and alternative markers such as cystatin C may be more reliable for estimating true renal function 6, 7
- Renal function tests, including cystatin C and creatinine clearance 6
Frequency of Laboratory Monitoring
- LFTs should be monitored periodically, especially within the first 6 months of use 3
- Renal function tests should be monitored as needed, with consideration of alternative markers such as cystatin C 6