What is the indication for Tikosyn (Dofruide), a class III antiarrhythmic medication?

From the Guidelines

Tikosyn (dofetilide) is indicated for the ongoing management of symptomatic supraventricular tachycardia (SVT) in patients who are not candidates for, or prefer not to undergo, catheter ablation and in whom beta blockers, diltiazem, flecainide, propafenone, or verapamil are ineffective or contraindicated. According to the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1, dofetilide may be reasonable for ongoing management in patients with symptomatic SVT who meet the above criteria. The guideline recommends that dofetilide should be reserved for patients who are not candidates for catheter ablation and for whom other medications are ineffective or cannot be prescribed due to the potential for proarrhythmia. Key points to consider when prescribing Tikosyn include:

• The potential for proarrhythmia, which requires careful patient selection and monitoring
• The need for dose adjustment based on creatinine clearance and QT interval
• The importance of regular monitoring of kidney function, electrolytes, and ECG throughout treatment
• The contraindication of concomitant use with certain medications that prolong QT interval or inhibit renal cation transport. As noted in the guideline, dofetilide was found to be effective in a trial of 122 patients randomized to dofetilide, propafenone, or placebo, with a probability of remaining free of SVT after 6 months of treatment of 50% for dofetilide, 54% for propafenone, and 6% for placebo, with P<0.001 for either dofetilide or propafenone compared with placebo 1.

From the FDA Drug Label

TIKOSYN is indicated for the maintenance of normal sinus rhythm (delay in time to recurrence of atrial fibrillation/atrial flutter [AF/AFl]) in patients with atrial fibrillation/atrial flutter of greater than one week duration who have been converted to normal sinus rhythm TIKOSYN is indicated for the conversion of atrial fibrillation and atrial flutter to normal sinus rhythm

The indication for Tikosyn (Dofetilide) is for:

• Maintenance of normal sinus rhythm in patients with atrial fibrillation/atrial flutter of greater than one week duration
• Conversion of atrial fibrillation and atrial flutter to normal sinus rhythm 2

From the Research

Indication for Tikosyn (Dofetilide)

• Tikosyn (Dofetilide) is a class III antiarrhythmic medication indicated for the conversion of atrial fibrillation and atrial flutter and maintenance of sinus rhythm in symptomatic patients with persistent arrhythmia 3, 4.
• The medication is approved for the treatment of atrial fibrillation (AF) and atrial flutter (AFl) and has been shown to be effective in converting patients to normal sinus rhythm (NSR) 3, 5, 6, 7.
• Dofetilide has been used off-label with success in patients with paroxysmal atrial fibrillation and atrial flutter, as well as atrial tachycardia and ventricular tachycardia 4.

Clinical Use

• The medication should be initiated in a hospital setting with continuous electrocardiographic monitoring and evaluation of renal function and serum electrolytes 3, 6, 7.
• Doses should be selected according to the QT interval and estimated creatinine clearance, and caution should be used to avoid torsade de pointes ventricular tachycardia, especially in patients with heart failure, hypertrophy, bradycardia, and female gender 6.
• Dofetilide has an acceptable safety profile when initiated under hospital monitoring and dosed according to creatinine clearance, and is well tolerated in patients with acceptable renal function and a normal QT interval 4.