Ibutilide (Corvert®)
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Class:
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Class III Antiarrhythmic agent
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Actions:
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Blocks potassium channels
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Prolongs action potential duration (prolonged QT interval)
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Indications:
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Stable atrial flutter (within 90 days–preferably 48 hours–of onset)
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Stable atrial fibrillation with duration ≤ 48 hours
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Pharmacokinetics:
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Onset: 30 minutes
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Half-Life: 6 hours
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Adverse Effects:
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Pro-arrhythmic effects: sustained and unsustained polymorphic ventricular tachycardia
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AV blocks, bundle branch block, PVC's, bradycardia, tachycardia, hypotension, prolonged QT interval
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Headache, nausea
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Signs of Toxicity:
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prolonged QT interval > 0.44 seconds
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life-threatening arrhythmias
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Contraindications:
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QT interval > 0.44 seconds [Risk of polymorphic ventricular tachycardia]
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Hypersensitivity to ibutilide
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Hypokalemia, hypomagnesemia
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Safety during pregnancy, lactation or with children not established (Category C).
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Dosages & Routes:
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IV infusion:
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[adults ≥ 60 kg] 1 mg in 50 ml infused over 10 minutes (may repeat once in 10 minutes)
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[adults < 60 kg] 0.01 mg/kg in 50 ml infused over 10 minutes (may repeat once in 10 minutes)
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Nursing Implications:
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Drug Interactions: Greater potential for proarrhythmic effects if concurrent with phenothiazines, tricyclic antidepressants, amiodarone, disopyramide, quinidine, procainamide, or sotalol.
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Drug Incompatibilities: Do not mix with other drugs.
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Continuous BP and cardiac monitoring should be present during ibutilide therapy and for the next 4-6 hours.
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Defibrillator and resuscitation cart should be at bedside during ibutilide therapy.
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Establish baseline serum electrolyte levels for potassium and magnesium prior to ibutilide therapy.
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Conversion to normal sinus rhythm (NSR) generally occurs within 30 minutes of initiation of ibutilide therapy.
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Intervention of choice for stable atrial flutter or atrial fibrillation is elective synchronized cardioversion.
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References:
American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 56). Salem, MA: AHA.
Dirks, J.L. (2010) Cardiovascular therapeutic management. In L.D. Urden, K.M. Stacy, & M.E. Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., pp. 544-545). St. Louis: Mosby Elsevier.
Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., pp. 172-173, 521, 621). St. Louis: Saunders Elsevier.
Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007). Prentice Hall Nurse's Drug Guide 2007 (pp. 828-829). Upper Saddle River, NJ: Pearson Prentice Hall.
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