How to use propafenone, a classic anti-arrhythmic drug, safely? Doctor reminds: remember 5 points

Propafenone is a commonly used anti-arrhythmic drug. It was first synthesized in 1970. By the 1980s, propafenone began to be used clinically and saved many patients’ lives. Today, although radiofrequency ablation has a high success rate in the treatment of arrhythmias, drugs such as propafenone are still the cornerstone of anti-arrhythmia treatment. Propafenone is mainly used clinically for the prevention of paroxysmal ventricular tachycardia and supraventricular tachycardia, preexcitation syndrome with supraventricular tachycardia, atrial flutter or atrial fibrillation, and various types of premature beats The treatment has the advantages of rapid onset, broad spectrum of anti-arrhythmia, high efficacy, good tolerance, less side effects, and higher safety. Usage and dosage: Propafenone is well absorbed in the gastrointestinal tract and eliminated by both liver and kidney. The plasma concentration can reach a peak after 2 to 3 hours. ① Oral: 100 to 200 mg each time, 3 to 4 times a day. The maintenance dose is 300 to 600 mg per day, taken in 2 to 4 times. Note that propafenone should be swallowed with a drink or food at the same time after meals, and should not be chewed. ② Intravenous injection: 70 mg each time, diluted with 5% glucose solution, and slowly injected within 10 minutes; if necessary, repeat once every 10 to 20 minutes, the total amount does not exceed 210 mg. After intravenous bolus injection, it is changed to intravenous infusion (to maintain the treatment), with a drip rate of 0.5 to 1 mg/min, or oral maintenance. Matters needing attention ① Adverse reactions: Propafenone can cause adverse reactions such as dizziness, headache, movement disorders and oral metal odor, and can also cause congestive heart failure, especially for patients with a history of heart failure. In addition, it can cause lupus-like facial rash and a kind of rash pustulosis (mainly manifested as dirty rash with fever and increased white blood cells). ②Severe myocardial damage; severe bradycardia; liver and kidney dysfunction; patients with marked hypotension; pregnant women and lactating women should use propafenone with caution. In addition, since elderly patients may experience a drop in blood pressure after treatment, and are prone to damage to liver and kidney function, propafenone should also be used with caution. ③When clinicians use propafenone to treat patients with paroxysmal tachycardia, they must strictly grasp the contraindications of the drug. Patients with sinus node dysfunction without pacemaker protection; patients with severe atrioventricular block; patients with double bundle branch block; patients with severe congestive heart failure; patients with cardiogenic shock; patients with severe hypotension; coronary heart disease myocardium Patients with ischemia; patients with myocardial infarction; patients with organic heart disease with cardiac insufficiency and those allergic to propafenone should be disabled. ④ Propafenone should be used strictly in accordance with the instructions and usage in the instructions. Remember not to overdose. Once overdose of propafenone, the symptoms are most obvious after 3 hours, including hypotension, drowsiness, bradycardia, atrioventricular block, etc., Occasionally, convulsions or severe ventricular arrhythmias can occur. Therefore, during the use of propafenone, the patient’s vital signs should be closely observed and monitored by electrocardiogram; once the patient is cardioversion, the use of propafenone should be stopped immediately to avoid accidents. If there is a high degree of sinus or atrioventricular conduction block, intravenous injection of sodium lactate, atropine, isoproterenol, etc. can be rescued. ⑤ If you miss taking propafenone tablets, it is not suitable to take it again, because too much medication at one time may cause bradycardia or even syncope. In short, propafenone, as an anti-arrhythmic drug, deserves us to understand it and use it reasonably and safely. (Some of the pictures in the article are from the source network, and the copyright belongs to the original author. Thank you for the picture author. If you find any violation of your copyright, please contact me and I will delete it.)