Dofetilide Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Arrhythmias

125 mcg once a day to 500 mcg twice a day
Dose is based on creatinine clearance and QTc interval prolongation. Dose is adjusted 2 to 3 hours after first dose based QTc interval.

First dose:
Creatinine clearance (Clcr) must be at least 20 mL/min.
Clcr = 20 to less than 40 mL/min =125 mcg twice a day
Clcr = 40 to 60 mL/min =250 mcg twice a day
Clcr greater than 60 mL/min = 500 mcg twice a day

Second dose - based on QTc interval increase:
15 % or less increase = continue dosage
greater than 15% increase = decrease dose as follows:
if first dose was 500 mcg BID, then use 250 mcg BID;
if first dose was 250 mcg BID, then use 125 mcg BID;
if first dose was 125 mcg BID, then use 125 mcg once a day.
If at any time QTc becomes greater the 500 msec (550 msec in patient with ventricular conduction abnormalities), drug should be discontinued.

Renal Dose Adjustments

First dose:
Creatinine clearance (Clcr) must be at least 20 mL/min.
Clcr = 20 to 39 mL/min = 125 mcg twice a day
Clcr = 40 to 60 mL/min = 250 mcg twice a day
Clcr greater than 60 mL/min = 500 mcg twice a day

Liver Dose Adjustments

No dosage adjustment required for patients with mild or moderate hepatic impairment. Dofetilide should be used with particular caution in patients with severe hepatic impairment.

Dose Adjustments

First dose:
Creatinine clearance (Clcr) must be at least 20 mL/min.
Clcr = 20 to < 40 mL/min =125 mcg twice a day
Clcr = 40 to 60 mL/min =250 mcg twice a day
Clcr > 60 mL/min = 500 mcg twice a day

Second dose - based on QTc interval increase:
15 % or less increase = continue dosage
greater than 15% increase = decrease dose as follows:
if first dose was 500 mcg BID, then use 250 mcg BID;
if first dose was 250 mcg BID, then use 125 mcg BID;
if first dose was 125 mcg BID, then use 125 mcg once a day.
If at any time QTc becomes greater the 500 msec (550 msec in patient with ventricular conduction abnormalities), drug should be discontinued.

Precautions

Drug must be initiated or reinitiated in hospital or similar specialized setting. Requires frequent EKG and renal monitoring. QTc interval must be greater than 440 msec and creatinine clearance must be at least 20 mL/min. Do NOT double the next dose if a dose is missed. Take next dose at usual time. Patient should contact doctor immediately if they experience severe or prolonged diarrhea, sweating, vomiting, or loss of appetite or thirst. Electrolyte imbalances are very dangerous. Caution patient on over-the-counter and herbal/natural preparations. Safety and effectiveness have not been established in pediatric patients (less than 18 years of age).

Dialysis

No data available

Other Comments

Available only to hospitals and prescribers who have received special education. Patients started or restarted on dofetilide should be placed for a minimum of three days in a facility that can provide calculations of creatinine clearance, continuous electrocardiographic monitoring, and cardiac resuscitation.

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