What is the cost of mexiletine (anti-arrhythmic medication)?

Cost of Mexiletine

The cost of mexiletine varies significantly depending on formulation and dosage, with prices ranging from approximately $875 per year for treatment of arrhythmias to over $30,000 per year in Europe for orphan drug indications like nondystrophic myotonia. 1, 2

Cost Information by Indication

For Arrhythmia Treatment

• Mexiletine for cardiac arrhythmias has been shown to be more cost-effective than older antiarrhythmic agents like quinidine ($1,239/year) and procainamide ($1,911/year) 1
• Annual cost for arrhythmia treatment: approximately $875 (based on older data) 1
• Standard dosing: 200-300 mg 3-4 times daily 3

For Neuropathic Pain

• When used for painful diabetic peripheral neuropathy, mexiletine is available as an oral formulation, though cost data specifically for this indication is not provided in the evidence 4
• Regular ECG monitoring is necessary when using mexiletine for neuropathic pain, which may add to the overall treatment cost 4

For Nondystrophic Myotonia (Europe)

• In Europe, after registration as an orphan drug for nondystrophic myotonia, prices increased dramatically to €30,707-60,730 per patient per year (based on 600 mg daily) 2
• Cost-based pricing model calculations suggest a fair price would be:
  • Minimum scenario: €452 per patient per year
  • Maximum scenario: €1,996 per patient per year
  • Innovative drug scenario: €6,685 per patient per year 2

Cost Factors to Consider

1. Dosage Requirements:

   • Typical maintenance dose: 200-300 mg 3-4 times daily for arrhythmias 3
   • Higher doses may be required for certain conditions, increasing costs

2. Monitoring Costs:

   • ECG monitoring is necessary when using mexiletine for certain indications like neuropathic pain 4
   • These additional monitoring requirements add to the overall treatment cost

3. Formulation:

   • Oral formulations are most common and generally less expensive than IV formulations
   • IV administration requires medical supervision, adding to costs 3

4. Insurance Coverage:

   • Coverage varies widely by insurance plan and indication
   • Prior authorization may be required

Clinical Considerations

Mexiletine has several advantages that may justify its cost in certain situations:

• Lower risk of organ toxicity compared to quinidine and procainamide 1
• Minimal effects on hemodynamic variables and cardiac function in patients with or without pre-existing left ventricular dysfunction 5
• Effective in a significant proportion of patients refractory to other treatments 5

However, side effects are common (though usually manageable):

• Gastrointestinal side effects occur in up to 40% of patients
• Neurological side effects (tremor, dizziness, memory loss) occur in approximately 10% of patients 6

When evaluating the cost-effectiveness of mexiletine, clinicians should consider both the direct medication costs and the potential savings from avoiding complications or alternative treatments that may be more expensive or less effective.