From the Guidelines
Bretylium is no longer recommended for use in clinical practice.
Use of Bretylium
- The use of bretylium is not supported by current guidelines due to its potential proarrhythmic properties and lack of evidence showing improved survival rates 1.
- According to the 2024 international consensus on cardiopulmonary resuscitation, there is insufficient data to support the use of bretylium in the treatment of adults in cardiac arrest with shock-refractory VF/pVT 1.
- The 2001 European Society of Cardiology task force on sudden cardiac death states that bretylium is no longer recommended 1.
- Although bretylium was previously used in the treatment of resistant VF and hemodynamically unstable VT, its use is no longer advised due to the availability of more effective and safer alternatives 1.
- The potential side effects and lack of efficacy of bretylium make it an unfavorable choice for use in real-life clinical medicine, and its use should be avoided in favor of more established and recommended treatments.
From the Research
Use of Bretylium
- Bretylium is used as a class III antiarrhythmic agent for the treatment and prevention of ventricular fibrillation and ventricular tachycardia 2, 3, 4, 5, 6
- It is particularly effective in treating life-threatening ventricular arrhythmias that have not responded to first-line antiarrhythmic agents 3, 4, 5
- Bretylium has a unique mechanism of action, involving the release of norepinephrine and subsequent sympathetic ganglionic blockade, which helps to maintain cardiac output and prevent ventricular fibrillation 2, 4
Clinical Applications
- Bretylium is approved for the short-term prevention and treatment of ventricular fibrillation and treatment of life-threatening ventricular arrhythmias and ventricular tachycardia unresponsive to adequate doses of a first-line antiarrhythmic agent 3
- It is also used to treat recurrent ventricular tachycardia and ventricular fibrillation, particularly in patients who have not responded to other antiarrhythmic agents 4, 5, 6
- Bretylium has been shown to be effective in increasing the ventricular fibrillation threshold and preventing the decrease in ventricular fibrillation threshold associated with myocardial ischemia 4
Administration and Side Effects
- Bretylium is typically administered intravenously, with a dose of 5-10 mg/kg over 10-20 minutes 6
- Common side effects of bretylium include hypotension, nausea, and vomiting, particularly with rapid intravenous administration 2, 5, 6
- Bretylium can also cause orthostatic hypotension, which may be ameliorated with tricyclic antidepressants or pressor agents 6