Adverse extra-cardiac effects

ADVERSE EXTRA CARDIAC EFFECTS

Severe extra-cardiac effects are also common with the antiarrhythmics; these tend to be drug-specific.

  • Class IA drugs
    • Quinidine
      • Associated with cinchonism, a syndrome characterized by nausea, vomiting, diarrhea and a variety of CNS effects (tinnitus, headache, auditory and visual disturbances, and vertigo), Hypotension, Can cause elevated serum digoxin concentrations, hypersensitivity reactions (rashes, fever, angioneurotic edema, hepatitis) and reversible thrombocytopenia
    • Procainamide
      • Hypotension, Lupus like syndrome, gastrointestinal symptoms, Adverse CNS effects, Hypersensitivity reactions: fever, agranulocytosis (can lead to fatal infections)
  • Class IB drugs
    • Lidocaine
      • CNS effects: CNS depression or CNS stimulation
    • Phenytoin
      • Neurological effects: drowsiness, ataxia, vertigo, nausea, nystagmus
  • Class IC drugs
    • Encainide, flecainide
      • Neurological effects (10-15% with flecainide): Dizziness, tremor, agitation, headache, visual disurbances
      • G.I. upset
  • Class II drugs
    • Bronchospasm, sudden withdrawal can precipitate angina, a cardiac arrhythmia, or myocardial infarction
    • Acebutolol associated with arthritis, myalgia, arthalgia, lupus-like syndrome, pulmonary complications
  • Class III drugs
    • Amiodarone
      • Pulmonary toxicity and fibrosis, hepatic dysfunction
      • Asymptomatic corneal deposits occur in all patients
      • Many CNS symptoms
      • Hypothyroidism or hyperthyroidism
      • Cutaneous photosensitivity and blue-grey discoloration of skin
      • Peripheral neuropathy
      • Enhances the effect of warfarin and increases the serum concentrations of digoxin, quinidine, procainamide, and other drugs
    • Bretylium
      • Hypotension,Increased sensitivity to catecholamine
  • Class IV drugs
    • Verapamil
      • Hypotension, Dizziness, headache, fatigue, Peripheral edema, G. I. effects, can increase serum concentrations of digoxin and may interact with many other drugs
    • Diltiazem
      • Hypotension, but fewer g.i. effects than verapamil
  • Other agents
    • Digoxin
      • Many adverse side effects: Anorexia, nausea, vomiting, diarrhea, abdominal pain, headache, confusion, abnormal vision
    • Adenosine
      • hypotension, flushing, Transient dyspnea, chest discomfort (non-myocardial)  and Metallic taste.
Last modified: Wednesday, 25 April 2012, 11:37 AM