From the Guidelines
Multaq (dronedarone) should only be used in patients with paroxysmal or persistent atrial fibrillation (AF) to help maintain normal heart rhythm, and not in patients with permanent AF or significant cardiovascular disease burden, as it can increase the risk of cardiovascular events and mortality. The typical dosage is 400 mg taken twice daily with morning and evening meals. Multaq works by affecting electrical signals in the heart to stabilize heart rhythm, though it's less effective than amiodarone but has fewer side effects 1.
Key Considerations
- Multaq should not be used in patients with severe heart failure, permanent atrial fibrillation, or liver or lung problems, as it can worsen these conditions 1.
- Common side effects include stomach upset, weakness, and slow heart rate, and patients should have regular heart, liver, and kidney function monitoring while taking this medication 1.
- It's essential to take Multaq exactly as prescribed and not to stop without consulting your doctor, as sudden discontinuation can worsen heart rhythm problems 1.
- Multaq interacts with many medications, so patients should inform their healthcare provider about all medications they're taking 1.
Clinical Evidence
The European Heart Journal study 1 and the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society guidelines 1 support the use of Multaq in patients with paroxysmal or persistent AF, but not in those with permanent AF or significant cardiovascular disease burden. The PALLAS trial, which was stopped prematurely due to an increase in cardiovascular events in the dronedarone arm, highlights the importance of careful patient selection and monitoring when using Multaq 1.
Patient Monitoring
Regular monitoring of heart, liver, and kidney function is crucial while taking Multaq, and patients should be aware of the potential side effects and interactions with other medications 1. By carefully selecting patients and monitoring them closely, healthcare providers can minimize the risks associated with Multaq and maximize its benefits in maintaining normal heart rhythm in patients with paroxysmal or persistent AF.
From the FDA Drug Label
INDICATIONS AND USAGE MULTAQ is an antiarrhythmic drug indicated to reduce the risk of hospitalization for atrial fibrillation (AF) in patients in sinus rhythm with a history of paroxysmal or persistent AF
The use of Multaq (dronedarone) is to reduce the risk of hospitalization for atrial fibrillation (AF) in patients in sinus rhythm with a history of paroxysmal or persistent AF 2.
Key points:
- Indication: Reduce the risk of hospitalization for AF
- Patient population: Patients in sinus rhythm with a history of paroxysmal or persistent AF
- Drug classification: Antiarrhythmic drug
From the Research
Use of Multaq (Dronedarone)
- Dronedarone, also known as Multaq, is a Class III antiarrhythmic agent used for the treatment of atrial fibrillation and atrial flutter 3, 4, 5, 6, 7.
- It has been shown to reduce the risk of cardiovascular hospitalizations and mortality in patients with atrial fibrillation or atrial flutter 3, 4, 6.
- Dronedarone is also associated with a reduced risk of stroke in patients with atrial fibrillation 4.
- The drug has been found to be safer than amiodarone, but less effective in maintaining sinus rhythm 3, 4, 7.
- Dronedarone is not recommended for patients with an ejection fraction <35% and recent decompensated heart failure due to safety concerns 3, 5.
- It can be used for maintenance of sinus rhythm and rate control in patients with atrial fibrillation or atrial flutter 4, 5.
Patient Selection
- Dronedarone should be considered for patients with structural heart disease who have an ejection fraction >35% and no recent decompensated heart failure 3.
- The drug may be used in patients with heart failure with preserved or mildly reduced ejection fraction, but its effectiveness in this population requires further study 6.
- Dronedarone is not recommended for long-term treatment of patients with permanent atrial fibrillation 5.
Safety and Efficacy
- Dronedarone has been found to have a favorable safety profile compared to amiodarone, with fewer adverse effects such as thyroid and pulmonary toxicity 3, 5, 7.
- The drug has been associated with rare hepatic toxicity, and post-marketing data have demonstrated this risk 5.
- Dronedarone has been shown to reduce cardiovascular events in patients with atrial fibrillation or atrial flutter, including those with heart failure 3, 4, 6.