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Tikosyn
Tikosyn (generic name: dofetilide) is a prescription medication used to treat certain types of abnormal heart rhythms, specifically atrial fibrillation and atrial flutter. It belongs to the class of drugs known as antiarrhythmics and works by helping the heart maintain a normal, steady rhythm. Tikosyn is often prescribed for patients who have not responded well to other antiarrhythmic medications or for those with recurrent arrhythmias. It is typically used in a hospital setting when starting treatment to monitor the patient’s heart rhythm and adjust the dosage as necessary.
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Frequently Asked Questions
How long does it take for Tikosyn to work?
Tikosyn starts working shortly after administration, but patients are usually monitored in the hospital for a few days to ensure the drug is effective and safe. It may take a few days to achieve the desired heart rhythm control.
Can I stop taking Tikosyn abruptly?
No, you should not stop taking Tikosyn without consulting your doctor. Stopping the medication suddenly may lead to a return of arrhythmias, which could be life-threatening.
What should I do if I miss a dose of Tikosyn?
If you miss a dose, take it as soon as you remember, unless it is close to the time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Do not double up on doses.
Can Tikosyn cure atrial fibrillation?
Tikosyn does not cure atrial fibrillation but helps control the heart rhythm and reduce the risk of recurrence. It is often used for long-term management of arrhythmias.
What should I avoid while taking Tikosyn?
Avoid medications and supplements that can prolong the QT interval or interact with Tikosyn. Always consult your doctor before taking new medications. Additionally, be mindful of maintaining normal potassium and magnesium levels.
Comprehensive Drug Guide
How Does Tikosyn Work?
Tikosyn works by blocking potassium channels in the heart, which prolongs the action potential duration and refractory period. This helps prevent abnormal electrical signals in the heart that cause atrial fibrillation or atrial flutter. By stabilizing the heart's electrical activity, Tikosyn reduces the risk of recurrent episodes of abnormal heart rhythms.
Common Dosages
- 125 mcg, 250 mcg, and 500 mcg oral capsules
The initial dosage is determined based on kidney function and other individual factors, with dose adjustments as necessary based on response and monitoring.
Typical Dosing
- The typical starting dose of Tikosyn is based on the patient's creatinine clearance (a measure of kidney function).
- The most common starting dose is 500 mcg twice daily, but it may be adjusted to 250 mcg or 125 mcg twice daily depending on kidney function.
- Dosing adjustments are often made based on the patient's heart rhythm and kidney function, particularly during the first few days of therapy.
Typical Dosing
FDA Approved Indications
- Atrial Fibrillation (AFib)
- Atrial Flutter
- Conversion of atrial fibrillation or flutter to normal sinus rhythm
- Maintenance of normal sinus rhythm after successful conversion of AFib or atrial flutter
Who Shouldn't Take Tikosyn?
- Congenital or acquired long QT syndrome, a condition that can cause dangerous heart arrhythmias
- Severe kidney impairment, as the drug is excreted through the kidneys and can accumulate in the body
- Concurrent use of medications that prolong the QT interval (e.g., certain antifungals, antibiotics, or antipsychotics)
Advice From The Pharmacist
- Tikosyn should be taken exactly as prescribed, typically twice a day. Do not skip doses or take extra doses without consulting your healthcare provider.
- Tikosyn treatment often requires initial hospitalization for monitoring of your heart rhythm and kidney function.
- Avoid taking any over-the-counter medications, herbal supplements, or other prescription drugs without consulting your healthcare provider, as many can interact with Tikosyn and increase the risk of arrhythmias.
- Ensure that you attend regular follow-up appointments for heart monitoring, including ECGs, to check your heart's electrical activity.
- Store Tikosyn at room temperature and protect it from moisture.
Side Effects of Tikosyn
Common Side Effects
- Headache
- Dizziness
- Nausea
- Diarrhea
- Fatigue
Uncommon/Severe Side Effects
- Prolonged QT interval, which can lead to a potentially fatal arrhythmia called torsades de pointes
- Severe dizziness or fainting due to arrhythmias
- Shortness of breath or chest pain
- Swelling in the legs or ankles, indicating fluid retention or worsening heart failure
Risks and Warnings of Tikosyn
- QT Prolongation and Torsades de Pointes: Tikosyn can prolong the QT interval, leading to an increased risk of a life-threatening arrhythmia called torsades de pointes. Patients must be monitored carefully, particularly when starting the medication or adjusting the dose.
- Kidney Function: Since Tikosyn is eliminated via the kidneys, impaired kidney function can lead to drug accumulation and increased risk of toxicity. Regular monitoring of kidney function is essential, especially in older adults.
- Electrolyte Imbalance: Low levels of potassium or magnesium in the blood can increase the risk of arrhythmias while taking Tikosyn. Patients may need to have their electrolyte levels monitored regularly.
Interactions with Tikosyn
Common Drug Interactions
- Medications that prolong the QT interval: Combining Tikosyn with other drugs that prolong the QT interval (e.g., amiodarone, sotalol, macrolide antibiotics) can increase the risk of torsades de pointes.
- Diuretics: Diuretics that cause potassium or magnesium loss (e.g., furosemide) can increase the risk of arrhythmias while taking Tikosyn.
- Verapamil: This medication can increase Tikosyn levels in the blood, raising the risk of dangerous side effects.
- Ketoconazole, itraconazole, or cimetidine: These medications can inhibit the breakdown of Tikosyn, leading to increased levels in the body and raising the risk of QT prolongation.
Alternatives to Tikosyn
- Amiodarone: Another antiarrhythmic often used for the treatment of atrial fibrillation or flutter. It may be used when Tikosyn is not well-tolerated.
- Sotalol: A beta-blocker with antiarrhythmic properties that is also used to maintain normal sinus rhythm in patients with atrial fibrillation or flutter.
- Propafenone: Another antiarrhythmic that helps maintain normal heart rhythm in patients with arrhythmias.
- Dronedarone: A newer antiarrhythmic used for atrial fibrillation and atrial flutter, typically for patients who have already achieved normal sinus rhythm.
