| Name: |
BRETYLIUM TOSYLATE (BretylateR) |
| Classification: |
antiarrhythmic; antifibrillatory activity
- used for ventricular arrhythmias when other agents of choice are ineffective
- suppression of ventricular fibrillation occurs within minutes but suppression of ventricular tachycardia or premature contractions may not begin until 20 minutes to 6 hours after administration
- should not be used in place of more rapidly acting antiarrhythmic agents
- not effective in treating Torsades de Pointes
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| Dose: |
|
| Administration: |
IV Infusion:
2 gm/500 mL D5W, NS, RL
- for treatment of ventricular fibrillation, should be given undiluted as quickly as possible
- administer intermittent doses by IV infusion over 8 minutes, diluted to a concentration of 10 mg/mL (ie. 500 mg/50 mL)
- reduce dosage in renal failure
|
| Adverse Effects: |
- transient hypertension at start of therapy
- hypotension
- dysrhythmias
- nausea + vomiting with rapid IV administration
- aggravates digoxin toxicity
- hyperthermia
|
| Caution: |
- caution in renal failure; dose reduction required
|
| Contraindications: |
- in complete heart block or type II second degree heart block unless functional pacemaker in place (can suppress a ventricular escape rhythm)
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| Drug Interactions: |
- bretylium + quinidine = antagonism of bretylium's antiarrhythmic effect
- bretylium + sympathomimetics = enhanced sympathomimetic effect
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| Monitoring Therapy: |
- HR
- ECG
- BP
- cardiac index
- electrolytes
- arterial lactate
- digoxin level (if patient on digoxin)
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| CCTC Protocol: |
- May be administered by IV infusion by an approved RN in CCTC.
- Continuous infusions must be administered by infusion pump.
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