Ibutilide fumarate

Описание

Covert was launched in the US and UK for treatment of atrial fibrillation and flutter and can be synthesized in three steps from N-phenyl rnethanesulfonamide. While ibutilide has an asymmetric center, it has been determined that the racemate is equipotent with either enantiomer. The antiarrhythmic action is derived from the compounds ability to prolong the action potential duration and lengthen the refractory period of myocardial tissue. Class Ⅲ antiarrhythrnic agents accomplish this by blocking outward potassium channels, however, ibutilide elicits the same effect by activation of slow inward sodium channels. Recent evidence indicates that it also is a potent blocker of the rapidly acting delayed rectifier potassium current (l_kr)and may block the ATP-inhibited potassium channel.

Химические свойства

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Использование

A methanesulfonanilide antiarrhythmic agent; prologns myocardial action potential duration, predominantly by activation of slow inward sodium current. Antiarrhythmic (class III).

Клиническое использование

Ibutilide (Corvert) is a structural analog of sotalol and produces cardiac electrophysiological effects similar to those of the antiarrhythmic agents in class III.
Ibutilide is approved for the chemical cardioversion of recent-onset atrial fibrillation and atrial flutter. Ibutilide appears to be more effective in terminating atrial flutter than atrial fibrillation. It can also lower the defibrillation threshold for atrial fibrillation resistant to chemical cardioversion.

Побочные эффекты

The major adverse effect associated with the use of ibutilide is the risk of torsades de pointes due to QT prolongation. Other reported adverse cardiovascular events (all 2%) include hypotension and hypertension, bradycardia and tachycardia, and varying degrees of A-V block. The incidence of noncardiac adverse events with the exception of nausea does not differ from that of placebo.

взаимодействия лекарств

Ibutilide has significant drug interactions.

Меры предосторожности

Contraindications to the use of ibutilide include baseline prolongation of the QT interval, use of other QTprolonging drugs, history of torsades de pointes, hypersensitivity to ibutilide, uncorrected hypokalemia or hypomagnesemia, and pregnancy or breast-feeding.