CORRECT USE OF PROPAFENONE
The
use of Propafenone in patients with severe heart
failure (NYHA Class III-IV) should be avoided. In
patients with mild cardiac failure (NYHA Class II)
haemodynamic compensation must be achieved before
Propafenone administration. In addition, cardiac
function should be monitored while administering the
drug to such patients.
In the event of a
deterioration in pump function, Propafenone should be
discontinued.
Particular
care should be observed in associating Propafenone
with other drugs having a negative inotropic effect.
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Excitation/Conduction
disturbances |
Propafenone does not
affect sinus rate in patients with normal sinus node
function.
In
patients with sick sinus syndrome, the drug can cause
a further dysfunction in sinus node automaticity
and/or sino-atrial block. Thus, Propafenone should
not be used in such patients in the absence of a
pacemaker.
Propafenone should not
be used in patients with bifascicular block. The
appearance of depression in cardiac conduction during
Propafenone administration is usually a sign of a
pre-existing latent conduction defect. This is often
associated with high doses of the drug and requires a
dosage reduction or, possibly, drug discontinuation.
A
widening (up to 18%) of the QRS is an expression of
the drug’s electrophysiological effect, and is
not considered an expression of toxicity.
Propafenone is
extensively metabolised in the liver. Therefore it
should be administered with caution, and at a reduced
dosage in patients with severe hepatic dysfunction.
In these cases, it can be useful to monitor the PR
and the QRS duration on the ECG.
End-stage
renal disease does not appear to have a clinically
significant effect on the pharmacokinetic parameters
of Propafenone.
In one study, the
values of plasma half-life, clearance and
distribution volume after the intravenous
administration of 70 mg Propafenone in 3 min were
found to be similar in patients with normal renal
function, renal failure and end-stage renal disease.(60)
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Obstructive
pulmonary disease |
Because
of its moderate anti-adrenergic effect, Propafenone,
particularly at high dosages, can cause further
bronchial obstruction in patients with severe
obstructive lung disease.
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