From the FDA Drug Label
MULTAQ is contraindicated in patients in atrial fibrillation (AF) who will not or cannot be cardioverted into normal sinus rhythm MULTAQ should only be initiated in patients in sinus rhythm who are receiving appropriate antithrombotic therapy
Dronedarone (Multaq) should not be initiated in a patient with new-onset atrial fibrillation (Afib) until the patient has been cardioverted into normal sinus rhythm and is receiving appropriate antithrombotic therapy, such as Apixaban (Eliquis).
- The patient should be cardioverted into normal sinus rhythm before starting Dronedarone (Multaq) 1.
- The patient should receive appropriate antithrombotic therapy, such as Apixaban (Eliquis), before starting Dronedarone (Multaq) 1.
From the Research
Initiation of Dronedarone in Atrial Fibrillation Patients
- Dronedarone is recommended as a second-line treatment option for non-permanent atrial fibrillation in patients whose atrial fibrillation is not controlled by first-line therapy, usually including beta-blockers 2.
- It is essential to consider the patient's cardiovascular risk factors, such as hypertension, diabetes mellitus, previous transient ischemic attack, stroke, or systemic embolism, left atrial diameter, left ventricular ejection fraction, and age 2.
- Dronedarone should not be initiated in patients with unstable New York Heart Association (NYHA) class III or IV heart failure or those with impaired left ventricular function (NYHA class III/IV) and hemodynamic instability 3, 2.
- The daily dosage of dronedarone is 400 mg twice daily, administered orally 3.
Considerations for Patients on Apixaban
- There is no direct evidence in the provided studies regarding the initiation of dronedarone in patients with new-onset atrial fibrillation who are already on apixaban.
- However, it is crucial to consider the patient's overall clinical profile, including their cardiovascular risk factors and any potential interactions between dronedarone and apixaban 2, 4.
Clinical Evidence and Recommendations
- Dronedarone has been shown to reduce the incidence of atrial fibrillation recurrence and cardiovascular hospitalizations in patients with paroxysmal and persistent atrial fibrillation 5, 4.
- The drug has a relatively good safety profile, with lower pulmonary and thyroid toxicity compared to amiodarone 6.
- However, the use of dronedarone in patients with unstable hemodynamic conditions has been associated with an increased risk of mortality 6.