Class Ia antiarrhythmic with antimuscarinic activity
Brand names: Norpace, Rythmodan
Updated · Methodology
Third line
Disopyramide is a third-line antiarrhythmic for ventricular tachycardia and atrial fibrillation when amiodarone, dronedarone and catheter ablation fail. AEMPS and restrict use because of QT prolongation, neuropathy risk and pronounced antimuscarinic effects (especially in the elderly).
Sources
ICD-10: I47.2 · ICD-11: BC71.0
Blocks fast sodium channels at phase 0 and IKr potassium channels at phase 3, prolonging repolarisation and QT. Strong antimuscarinic activity adds adverse effects (dry mouth, urinary retention). Metabolised by CYP3A4 and to a lesser extent renally.
Limited data. Use only when no alternative exists.
Passes into breast milk. Breastfeeding not recommended.
Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.
3 pairs found. Sorted from critical to minor.
Mechanism
Amiodarone is the strongest clinical QT prolonger and CYP3A4 inhibitor. With disopyramide additive QT effect (each prolongs 30-50 ms).
Symptoms
QTc above 550 ms, syncope, torsades de pointes.
Management
Combination contraindicated. Choose one antiarrhythmic.
Sources
Mechanism
Erythromycin inhibits CYP3A4 (disopyramide metabolism) and itself prolongs QT. Dual torsades risk.
Symptoms
QTc above 500 ms, syncope, torsades de pointes within 3-7 days.
Management
Combination contraindicated. Alternative – azithromycin (no CYP3A4 inhibition or QT effect).
Sources
Mechanism
Disopyramide is broken down in the liver by CYP3A4, and clarithromycin inhibits this enzyme, so disopyramide blood levels rise. Both drugs prolong the QT interval, and their effects on the heart add up.
Symptoms
QT prolongation on the ECG, palpitations, fainting, torsades de pointes. Post-marketing reports also describe hypoglycemia with this combination: sweating, tremor, hunger, confusion.
Management
Avoid the combination. The disopyramide label lists macrolides that inhibit CYP3A4 among combinations that are not recommended (disopyramide label). The US Food and Drug Administration () advises against clarithromycin in patients on class IA antiarrhythmics, including disopyramide (clarithromycin FDA label). Clarithromycin is contraindicated in patients with a history of QT prolongation or ventricular arrhythmia and in those with low potassium or magnesium (clarithromycin label). If the combination cannot be avoided, monitor the ECG, disopyramide blood levels and blood glucose during co-administration (clarithromycin label). Stop disopyramide if the QT interval or QRS duration lengthens by more than 25% (disopyramide label). Check potassium and correct it if needed (disopyramide label).
Sources
Verbatim lines from the interaction sections, in the language of the label
«Drug Interactions: Effects of other drugs on disopyramide pharmacokinetics: In vitro metabolic studies indicated that disopyramide is metabolized by cytochrome P450 3A4 and that inhibitors of this…»FDA, section 7 · Open on DailyMed
«Drug Interactions: Effects of other drugs on disopyramide pharmacokinetics: In vitro metabolic studies indicated that disopyramide is metabolized by cytochrome P450 3A4 and that inhibitors of this…»FDA, section 7 · Open on DailyMed
«Medicamentos que inducen Torsades de pointes: Antiarrítmicos de la clase Ia, como quinidina, procainamida, disopiramida.»AEMPS, section 4.5 · Open on CIMA
«Tratamiento simultáneo con astemizol, terfenadina, disopiramida, cisaprida, pimocida, alcaloides del cornezuelo (como la ergotamina y la dihidroergotamina), simvastatina, atorvastatina o lovastatina.»AEMPS, section 4.3 · Open on CIMA
«La administración conjunta de hidroxizina con fármacos que se sabe que prolongan el intervalo QT y/AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: Additionally, the following other drugs are contraindicated with ketoconazole tablets: methadone, disopyramide, dronedarone, ergot alkaloids such as dihydroergotamine, ergometrine…»FDA, section 4 · Open on DailyMed
«Está contraindicado el uso concomitante de pimozida con fármacos de los que se conoce su efecto de prolongar el intervalo QT (ver sección 4.3 Contraindicaciones), incluyendo ciertos antiarrítmicos…»AEMPS, section 4.5 · Open on CIMA
«Antiarrítmicos: Sotalol no debe combinarse con antiarrítmicos de clase Ia, como disopiramida, quinidina, procainamida y flecainida, ni con otros medicamentos antiarrítmicos de clase III como…»AEMPS, section 4.5 · Open on CIMA
«Antiarrítmicos de Clase-I (ej. quinidina, disopiramida; lidocaína, fenitoína; flecainida, propafenona): Pueden potenciar los efectos sobre el tiempo de conducción auriculoventricular y aumentar el…»AEMPS, section 4.5 · Open on CIMA
«DRUG INTERACTIONS: Disopyramide Quinidine Dofetilide Amiodarone Sotalol Procainamide Not Recommended Disopyramide, Quinidine: There have been postmarketing reports of torsades de pointes occurring…»FDA, section 7 · Open on DailyMed
«Established and Other Potentially Significant Drug Interactions: Cardiac Disorders : ranolazine, ivabradine dronedarone Other antiarrhythmics e.g. amiodarone, bepridil, disopyramide, flecainide…»FDA, section 7 · Open on DailyMed
«- Medicamentos cardiovasculares que prolongan el intervalo QT (ej. quinidina, disopiramida,»AEMPS, section 4.5 · Open on CIMA
«Antiarrítmicos, clase I : los antiarrítimicos Clase I y los fármacos beta-bloqueantes tienen efectos inotrópicos negativos aditivos, lo que puede resultar en efectos adversos hemodinámicos graves en…»AEMPS, section 4.5 · Open on CIMA
«Antiarrítmicos de clase I (quinidina, hidroquinidina, cibenzolina, flecainida, disopiramida, lidocaína, mexiletina, propafenona): puede potenciarse el efecto sobre el tiempo de conducción…»AEMPS, section 4.5 · Open on CIMA
«Antiarrhythmics and Other QT Prolonging Drugs: Discontinue Class I or Class III antiarrhythmic agents for at least three half-lives prior to dosing with sotalol. Class Ia antiarrhythmic drugs, such…»FDA, section 7 · Open on DailyMed
«Drug Interactions:: (See WARNINGS: Concomitant Antiarrhythmic Therapy .) Verapamil hydrochloride injection has been used concomitantly with other cardioactive drugs (especially digitalis) without…»FDA, section 7 · Open on DailyMed
«Uso con medicamentos que prolongan el intervalo QT: Debido a que el tratamiento de deprivación de andrógenos puede prolongar el intervalo QT, se recomienda precaución cuando se administre abiraterona…»AEMPS, section 4.5 · Open on CIMA
«Cuando se prescribe amisulprida con medicamentos que prolongan el intervalo QT por ejemplo antiarritmicos de la clase IA (por ejemplo, quinidina, disopiramida) y antiarritmicos de la clase III (por…»AEMPS, section 4.5 · Open on CIMA
«Antiarrítmicos inductores de torsades de pointes (amiodarona, bretilio, disopiramida, quinidínicos, sotalol).»AEMPS, section 4.5 · Open on CIMA
«Sustancias que pueden desencadenar torsades de pointes: - antiarrítmicos de clase Ia (por ejemplo, quinidina, hidroquinidina, disopiramida)»AEMPS, section 4.5 · Open on CIMA
«Interacciones basadas en CYP3A: Se pueden considerar ajustes de dosis y cuando sea posible, las concentraciones séricas de los fármacos metabolizados principalmente por CYP3A se deben controlar de…»AEMPS, section 4.5 · Open on CIMA
«Established and Other Potentially Significant Interactions: Other antiarrhythmics: e.g., amiodarone disopyramide flecainide mexiletine propafenone quinidine ↑ antiarrhythmics Clinical monitoring is…»FDA, section 7 · Open on DailyMed
«ANTIANGINOSOS/AEMPS, section 4.5 · Open on CIMA
«Foradil Aerolizer, al igual que otros agonistas beta 2 , debe administrarse con precaución a pacientes que están siendo tratados con fármacos tales como quinidina, disopiramida, procainamida…»AEMPS, section 4.5 · Open on CIMA
«Drugs Affecting Glucose Metabolism: A number of medications affect glucose metabolism and may require glimepiride dose adjustment and particularly close monitoring for hypoglycemia or worsening…»FDA, section 7 · Open on DailyMed
«Medicamentos afectados por alteraciones de los niveles de potasio: Antiarrítmicos clase Ia (p.ej., quinidina, hidroquinidina, disopiramida)»AEMPS, section 4.5 · Open on CIMA
«Medicamentos que ocasionan “torsades de pointes”, pero sin limitarse a: - antiarrítmicos del grupo Ia (ej. quinidina, hidroquinidina, disopiramida),»AEMPS, section 4.5 · Open on CIMA
«Se aconseja precaución cuando se recete paliperidona junto con medicamentos que prolongan el i nt e rva l o QT, p. ej., antiarrítmicos de las clases IA (p. ej., quinidina, disopiramida) y III (p…»AEMPS, section 4.5 · Open on CIMA
«Disopiramida: reducción de la eficacia antiarrítmica. Se recomienda una estrecha monitorización clínica y ECG, y si es conveniente, la evaluación de las concentraciones plasmáticas de disopiramida…»AEMPS, section 4.5 · Open on CIMA
«Fármacos que prolongan el intervalo QT: Como ocurre con otros antipsicóticos, se recomienda precaución cuando se recete risperidona con medicamentos que se sabe que prolongan el intervalo QT, tales…»AEMPS, section 4.5 · Open on CIMA
«Established and Other Potentially Significant Drug Interactions: Antiarrhythmics: disopyramide, lidocaine, mexiletine ↑ antiarrhythmics Caution is warranted and therapeutic concentration monitoring…»FDA, section 7 · Open on DailyMed
«Los fármacos antiarrítmicos de clase I (por ej. disopiramida) y la amiodarona pueden tener un efecto potenciador sobre los tiempos de conducción auricular e inducir un efecto inotrópico negativo.»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: Disopyramide is a Type I antiarrhythmic drug with potent negative inotropic and chronotropic effects. Disopyramide has been associated with severe bradycardia, asystole and heart…»FDA, section 7 · Open on DailyMed
«DRUG INTERACTIONS: BISOPROLOL FUMARATE should be used with care when myocardial depressants or inhibitors of AV conduction, such as certain calcium antagonists (particularly of the phenylalkylamine…»FDA, section 7 · Open on DailyMed
«El tratamiento co ncomitante con quinidina, disopiramida, procainamida, fenotiazinas, antihistamínicos (terfenadina) y antidepresivos tricíclicos puede prolongar el intervalo QTc e incrementar el…»AEMPS, section 4.5 · Open on CIMA
«U so concomitante contraindicado: -Atropina y otras sustancias atropínicas (antidepresivos de imipramina, antiparkinsonianos, anticolinérgicos, antiespasmódicos atropínicos, disopiramida…»AEMPS, section 4.5 · Open on CIMA
«Está contraindicado el uso concomitante de las siguientes sustancias: antiarrítmicos de clase IA (p. ej., disopiramida, hidroquinidina, quinidina)»AEMPS, section 4.5 · Open on CIMA
«Drug Interactions: There has been little experience with the coadministration of flecainide acetate and either disopyramide or verapamil . Because both of these drugs have negative inotropic…»FDA, section 7 · Open on DailyMed
«disopiramida,»AEMPS, section 4.5 · Open on CIMA
«Efectos cardiovasculares: Antiarrítmicos de clase IA (p. ej., disopiramida, quinidina).»AEMPS, section 4.5 · Open on CIMA
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Disopyramide is evaluated for the following indications with varying evidence strength: Ventricular tachycardia (evidence tier C). See the full indication matrix with dosing and citations above on this page.
Common side effects of Disopyramide (≥ 1 in 100): Dry mouth, Urinary retention, Constipation, Blurred vision, QT prolongation. See the Safety section for uncommon and serious reactions.
Limited data. Use only when no alternative exists.
Passes into breast milk. Breastfeeding not recommended.
Disopyramide is contraindicated in: Second/third-degree AV block without pacemaker; Cardiogenic shock; Closed-angle glaucoma; Urinary retention (BPH); Combination with QT-prolonging drugs. Full list in the Safety section.
Direct links to regulator labels. Open in a new tab.
Dofetilide, Dronedarone, Flecainide, Hawthorn (Crataegus monogyna / laevigata), Isosorbide mononitrate, Nitroglycerin, Ranolazine, Isosorbide dinitrate