ibutilide


ibutilide

 [ĭ-bu´tĭ-līd] a cardiac depressant used in treatment of atrial arrhythmias; administered by intravenous infusion as the fumarate salt.

ibutilide

(eye-byoo-ti-lide) ibutilide,

Corvert

(trade name)

Classification

Therapeutic: antiarrhythmics
Pregnancy Category: C

Indications

Rapid conversion of recent-onset atrial flutter or fibrillation to normal sinus rhythm, including management of atrial flutter or fibrillation occurring within 1 wk of coronary artery bypass or cardiac valve surgery.

Action

Activates slow inward current of sodium in cardiac tissue, resulting in delayed repolarization, prolonged action potential duration, and increased refractoriness.Mildly slows sinus rate and AV conduction.

Therapeutic effects

Conversion to normal sinus rhythm.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.Distribution: Unknown.Metabolism and Excretion: Highly metabolized by the liver, one metabolite is active; metabolites excreted by kidneys.Half-life: 6 hr (2–12 hr).

Time/action profile (antiarrhythmic effect)

ROUTEONSETPEAKDURATION
IVwithin 30–90 minunknownup to 24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity.Use Cautiously in: HF or left ventricular dysfunction (↑ risk of more serious arrhythmias during infusion); Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <18 yr (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • headache

Cardiovascular

  • arrhythmias (most frequent)

Gastrointestinal

  • nausea

Interactions

Drug-Drug interaction

Amiodarone, disopyramide, procainamide, quinidine, and sotalol should not be given concurrently or within 4 hr because of additive effects on refractoriness.Proarrhythmic effects may be ↑ by phenothiazines, tricyclic and tetracyclicantidepressants, some antihistamines, and histamine H2-receptor blocking agents ; concurrent use should be avoided.

Route/Dosage

Atrial Fibrillation/FlutterIntravenous (Adults ≥60 kg) 1 mg infusion; may be repeated 10 min after end of first infusion.Intravenous (Adults <60 kg) 0.01 mg/kg infusion; may be repeated 10 min after end of first infusion.Atrial Fibrillation/Flutter After Cardiac SurgeryIntravenous (Adults ≥60 kg) 0.5 mg infusion, may be repeated once.Intravenous (Adults <60 kg) 0.005 mg/kg infusion, may be repeated once.

Availability (generic available)

Solution for injection: 0.1 mg/mL

Nursing implications

Nursing assessment

  • Monitor ECG continuously throughout and for 4 hr after infusion or until QT interval normalizes. Discontinue if arrhythmia terminates or if sustained ventricular tachycardia, prolonged QT, or QT develops. Ibutilide may have proarrhythmic effects. These arrhythmias may be serious and potentially life threatening. Clinicians trained to treat ventricular arrhythmias, medications, and equipment (defibrillator/cardioverter) should be available during therapy and monitoring of patient.

Potential Nursing Diagnoses

Decreased cardiac output (Indications)

Implementation

  • Oral antiarrhythmic therapy may be instituted 4 hr after ibutilide infusion.
  • Intravenous Administration
  • pH: 4.6.
  • Intermittent Infusion: Diluent: May be administered undiluted or diluted in 50 mL of 0.9% NaCl or D5W. Diluted solution is stable for 24 hr at room temperature or 48 hr if refrigerated.Concentration: Undiluted: 0.1 mg/mL; Diluted: 0.017 mg/mL.
  • Rate: Administer over 10 min.
  • Additive Incompatibility: Information unavailable; do not admix with other solutions or medications.

Patient/Family Teaching

  • Inform patient of the purpose of ibutilide.

Evaluation/Desired Outcomes

  • Conversion of recent-onset atrial flutter or fibrillation to normal sinus rhythm.