Dronedarone

How it works

It is a benzofuran derivative with mixed class I to IV antiarrhythmic actions, blocking sodium, potassium and calcium channels and exerting antiadrenergic effects to stabilise cardiac rhythm.

Prescribing in practice

• It is contraindicated in permanent atrial fibrillation and in heart failure or left ventricular systolic dysfunction, where it has been associated with increased mortality and cardiovascular events.
• Hepatotoxicity, including cases of serious liver injury, has been reported, so liver function should be checked as advised by the MHRA.
• As an enzyme inhibitor it interacts with several drugs including digoxin and certain statins, and it can raise serum creatinine without a true fall in renal function.

Monitoring

Monitor cardiac rhythm, liver function and pulmonary and renal status, and reassess for progression to permanent atrial fibrillation.

Counselling the patient

• Report yellowing of the skin or eyes, dark urine, or unusual tiredness.
• Report breathlessness or new cough, which should be investigated.
• Attend for scheduled blood tests and rhythm checks.

Evidence & guidelines

The ATHENA trial supported dronedarone's role in non-permanent atrial fibrillation, while the PALLAS trial demonstrated harm in permanent atrial fibrillation, which informs MHRA-restricted use.