Step 3. Factors such as reduced creatinine clearance or certain dofetilide drug interactions will increase dofetilide plasma concentration. Patients continuing on TIKOSYN after successful electrical cardioversion should continue to be monitored by electrocardiography for 12 hours post cardioversion, or a minimum of 3 days after initiation of TIKOSYN therapy, whichever is greater.Before initiating TIKOSYN therapy, previous antiarrhythmic therapy should be withdrawn under careful monitoring for a minimum of three (3) plasma half-lives. QT interval prolongation is directly related to dofetilide plasma concentrations. Dofetilide (Tikosyn®) ... A repeat EKG is performed 2 to 3 hours after the first dose to assess the QTc interval. At 2–3 hours after each subsequent dose of TIKOSYN, determine the QTc (for in-hospital doses 2–5). If heart rate is less than 60 beats per minute, QT interval should be used. Because of the unpredictable pharmacokinetics of amiodarone, TIKOSYN should not be initiated following amiodarone therapy until amiodarone plasma levels are below 0.3 mcg/mL or until amiodarone has been withdrawn for at least three months.If TIKOSYN needs to be discontinued to allow dosing of other potentially interacting drug(s), a washout period of at least two days should be followed before starting the other drug(s).This website is intended for informational and entertainment purposes only and is not intended to replace any professional medical advice.This field is for validation purposes and should be left unchanged.
Calculation of the creatinine clearance for all patients must precede administration of the first dose of dofetilide. In clinical trials, TIKOSYN was administered to patients previously treated with oral amiodarone only if serum amiodarone levels were below 0.3 mg/L or amiodarone had been withdrawn for at least three months.There is currently no legal information available for this drug.There are currently no FDA safety alerts available for this drug.There is currently no manufacturer warning information available for this drug.There are currently no FDA labeling changes available for this drug.TIKOSYN is indicated for the maintenance of normal sinus rhythm (delay in time to recurrence of atrial fibrillation/atrial flutter [AF/AFl]) in patients with atrial fibrillation/atrial flutter of greater than one week duration who have been converted to normal sinus rhythm. QT interval prolongation is directly related to dofetilide plasma concentration.
Dose 3 QTc: _____ msec ; Adapted with permission from UNC Healthcare Approved by UHS P&T Committee 02/2018 Bethany A. Kalich, PharmD, BCPS-AQ … QT interval prolongation is directly related to dofetilide plasma concentrations. 1 Food. Administer the adjusted TIKOSYN dose and begin continuous ECG monitoring. If the QTc interval has increased > 15% or if the QTc is > 500Msec (550Msec in patients with ventricular conduction abnormalities), the dose of dofetilide must be decreased. TIKOSYN is indicated for the conversion of atrial fibrillation and atrial flutter to normal sinus rhythm.
Previous toleration of higher doses does not eliminate the need for rehospitalization.The maximum recommended dose in patients with a calculated creatinine clearance greater than 60 mL/min is 500 mcg BID; doses greater than 500 mcg BID have been associated with an increased incidence of Torsade de Pointes.A patient who misses a dose should NOT double the next dose. Starting dose for conversion and maintenance TIKOSYN is contraindicated when the baseline QTc interval is >440 msec. Factors such as reduced creatinine clearance or certain dofetilide drug interactions will increase dofetilide plasma concentration. TIKOSYN is contraindicated in patients with congenital or acquired long QT syndromes, a baseline QT interval or QTc >440 msec (500 msec in patients with ventricular conduction abnormalities), severe renal impairment (calculated creatinine clearance <20 mL/min), or known hypersensitivity to TIKOSYN. TIKOSYN is supplied for oral administration in three dosage strengths: 125 mcg (0.125 mg) orange and white capsules, 250 mcg (0.25 mg) peach capsules, and 500 mcg (0.5 mg) peach and white capsules.