Long-term oral antiarrhythmic therapy with mexiletine.

Q: What does this research mean for the field?

Long-term oral mexiletine therapy has limited value in managing patients at risk of sudden death due to a high incidence of severe side effects and breakthrough major ventricular arrhythmias despite therapeutic plasma concentrations. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

N P Campbell; J.F. Pantridge; A A Adgey

doi:10.1136/hrt.40.7.796

July 1, 1978HeartOpen Access

Long-term oral antiarrhythmic therapy with mexiletine.

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Why the study?

Does oral mexiletine control or prevent ventricular arrhythmias in patients with ischaemic heart disease?

Key Points

To assess the efficacy, safety, and tolerability of long-term oral mexiletine for managing and preventing ventricular arrhythmias in ischaemic heart disease.
Administered oral mexiletine (most commonly 200, 250, or 300 mg every 8 hours) to N=48 patients with ischaemic heart disease.
Followed patients over a treatment duration ranging from 2 days to more than 1 year (median follow-up of 3 months).
No ventricular arrhythmias were detected in more than 50% of patients during therapy.
Major ventricular arrhythmias occurred in 14 of 48 patients (29%) while the majority maintained plasma drug levels within the therapeutic range.
Severe adverse effects developed in 15 of 48 patients (31%).

Structured PICO

Does oral mexiletine control or prevent ventricular arrhythmias in patients with ischaemic heart disease?

P

Population

48 patients with ischaemic heart disease requiring control or prevention of ventricular arrhythmias

I

Intervention

Oral mexiletine (most frequently 200, 250, and 300 mg 8-hourly) for a median of 3 months

O

Outcome

Control or prevention of ventricular arrhythmiassurrogate

Oral mexiletine has limited efficacy and high toxicity for the long-term management of ventricular arrhythmias in patients with ischemic heart disease.

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Implication

Supports caution with oral mexiletine for ventricular arrhythmias; leaves open its utility pending randomized data.

Abstract

Forty-eight patients with ischaemic heart disease received oral mexiletine for the control or prevention of ventricular arrhythmias. The most frequently used doses were 200, 250, and 300 mg 8-hourly. The treatment period varied from 2 days to more than 1 year (median 3 months). No ventricular arrhythmias were detected in more than one-half of the patients. Severe side effects occurred in 15 (31%) of the 48 patients. Major ventricular arrhythmias were observed in 14 (29%) of the 48 patients at a time when the majority had plasma concentrations within the therapeutic range. The value of mexiletine in the management of patients at risk of sudden death is likely to be limited.

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Cite This Study

Campbell et al. (1978) studied this question.

synapsesocial.com/papers/6a1c777ff63f086470a161d6 https://doi.org/10.1136/hrt.40.7.796

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Long-term oral antiarrhythmic therapy with mexiletine.

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Long-term oral antiarrhythmic therapy with mexiletine.

Key Points

Structured PICO

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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