Class III antiarrhythmic

Dronedarone

Brand names: Multaq

Adult dose

Dose: 400mg BD with food

Route: Oral

Frequency: BD

Clinical pearls

NICE TA197: maintenance of sinus rhythm in non-permanent AF without HF or LV dysfunction
ESC AF guidelines
MHRA Drug Safety Update: hepatotoxicity, pulmonary toxicity, increased mortality in permanent AF / HF — strict patient selection

Contraindications

Permanent AF
NYHA III–IV heart failure
LV systolic dysfunction
Severe hepatic impairment
Bradycardia / AV block
Concurrent strong CYP3A4 inhibitors
QT prolongation
Pregnancy/breastfeeding

Side effects

Hepatotoxicity (severe — boxed warning)
Heart failure
Pulmonary toxicity
QT prolongation
GI upset
Photosensitivity
Bradycardia
Increased creatinine (artefactual)

Interactions

Strong CYP3A4 inhibitors
Digoxin (toxicity)
Statins (myopathy)
Warfarin
QT-prolonging drugs

Monitoring

LFTs (baseline, monthly ×6, then periodic)
ECG (QT, rhythm)
Renal function
Pulmonary symptoms
Echo (LV function)

Reference: BNF; NICE TA197; ESC AF guidelines; MHRA Drug Safety Update; https://bnf.nice.org.uk/drugs/dronedarone/. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways