Rythmol SR Side Effects

Generic Name: propafenone

Please note - some side effects for Rythmol SR may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA at http://www.fda.gov/medwatch/ or 1-800-FDA-1088 (1-800-332-1088).

Side Effects of Rythmol SR - for the Consumer

Rythmol SR Sustained-Release Capsules

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome when using Rythmol SR Sustained-Release Capsules:

Change in taste; constipation; dizziness; drowsiness; gas; lightheadedness; tiredness.

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; chest pain; chills; excessive thirst; fast, slow, or irregular heartbeat; fever; loss of appetite; muscle weakness; prolonged diarrhea; shortness of breath; sore throat; sweating; swelling of the hands or feet; tremor; unexplained weakness; unusual bruising or bleeding; vomiting.

Rythmol SR Side Effects - for the Professional

Rythmol SR

Of the total number of subjects in Phase III clinical studies of Rythmol SR (propafenone hydrochloride) 45.7 percent were 65 and over, while 15.7 percent were 75 and over. No overall differences in safety or effectiveness were observed between these subjects and younger subjects, but greater sensitivity of some older individuals at higher doses cannot be ruled out. The effect of age on the pharmacokinetics and pharmacodynamics of propafenone has not been studied.

No clinically important differences in incidence of adverse reactions were noted by age, or gender. Too few non-White patients were enrolled to assess adverse events according to race. Adverse events occurring in 2% or more of the patients in any of the ERAFT propafenone SR treatment groups and not listed in Table 2 include the following: bundle branch block left, bundle branch block right, conduction disorders, sinus bradycardia and hypotension.

Other adverse events reported with propafenone clinical trials not already listed in Table 3 include the following adverse events by body and preferred term.

BLOOD AND LYMPHATIC SYSTEM DISORDERS:  Anemia, lymphadenopathy, spleen disorder, thrombocytopenia.

CARDIAC DISORDERS: Angina unstable, arrhythmia, atrial hypertrophy, atrioventricular block, bundle branch block, bunch branch block left, bundle branch block right, cardiac arrest, cardiac disorder, conduction disorder, coronary artery disease, extrasystoles, myocardial infarction, nodal arrhythmia, palpitations, pericarditis, sinoatrial block, sinus arrest, sinus arrhythmia, sinus bradycardia, supraventricular extrasystoles, supraventricular tachycardia, ventricular arrhythmia, ventricular extrasystoles, ventricular hypertrophy.

EAR AND LABYRINTH DISORDERS: Hearing impaired, tinnitus, vertigo.

EYE DISORDERS: Eye hemorrhage, eye inflammation, eyelid ptosis, miosis, retinal disorder, visual acuity reduced.

GASTROINTESTINAL DISORDERS: Abdominal distension, abdominal pain, dry throat, duodenitis, dyspepsia, dysphagia, eructation, gastritis, gastroesophageal reflux disease, gingival bleeding, glossitis, glossodynia, gum pain, halitosis, intestinal obstruction, melena, mouth ulceration, pancreatitis, peptic ulcer, rectal bleeding, sore throat.

GENERAL DISORDERS AND ADMINISTRATION SITE CONDITIONS: Chest pain, feeling hot, hemorrhage, malaise, pain, pyrexia.

HEPATO-BILIARY DISORDERS: Hepatomegaly.

INVESTIGATIONS: Abnormal electrocardiogram, abnormal heart sounds, abnormal liver function tests, abnormal pulse, carotid bruit, decreased blood chloride, decreased blood pressure, decreased blood sodium, decreased hemoglobin, decreased neutrophil count, decreased platelet count, decreased prothrombin level, decreased red blood cell count, decreased weight, electrocardiogram QT prolonged, glycosuria present, heart rate irregular, increased alanine aminotransferase, increased aspartate aminotransferase, increased blood bilirubin, increased blood cholesterol, increased blood creatinine, increased blood glucose, increased blood lactate dehydrogenase, increased blood pressure, increased blood prolactin, increased blood triglycerides, increased blood urea, increased blood uric acid, increased eosinophil count, increased gamma-glutamyltransferase, increased monocyte count, increased prostatic specific antigen, increased prothrombin level, increased weight, increased white blood cell count, ketonuria present, proteinuria present.

METABOLISM AND NUTRITION DISORDERS: Anorexia, dehydration, diabetes mellitus, gout, hypercholesterolemia, hyperglycemia, hyperlipidemia, hypokalemia.

MUSCULOSKELETAL, CONNECTIVE TISSUE AND BONE DISORDERS: Arthritis, bursitis, collagen-vascular disease, costochondritis, joint disorder, muscle cramps, muscle spasms, myalgia, neck pain, pain in jaw, sciatica, tendonitis.

NERVOUS SYSTEM DISORDERS: Amnesia, ataxia, balance impaired, brain damage, cerebrovascular accident, dementia, gait abnormal, hypertonia, hypothesia, insomnia, paralysis, paresthesia, peripheral neuropathy, speech disorder, syncope, tongue hypoesthesia.

PSYCHIATRIC DISORDERS: Decreased libido, emotional disturbance, mental disorder, neurosis, nightmare, sleep disorder.

RENAL AND URINARY DISORDERS: Dysuria, nocturia, oliguria, pyuria, renal failure, urinary casts, urinary frequency, urinary incontinence, urinary retention, urine abnormal.

REPRODUCTIVE SYSTEM AND BREAST DISORDERS: Breast pain, impotence, prostatism.

RESPIRATORY, THORACIC AND MEDIASTINAL DISORDERS: Atelectasis, breath sounds decreased, chronic obstructive airways disease, cough, epistaxis, hemoptysis, lung disorder, pleural effusion, pulmonary congestion, rales, respiratory failure, rhinitis, throat tightness.

SKIN AND SUBCUTANEOUS TISSUE DISORDERS: Alopecia, dermatitis, dry skin, erythema, nail abnormality, petechiae, pruritis, sweating increased, urticaria.

VASCULAR DISORDERS: Arterial embolism limb, deep limb venous thrombosis, flushing, hematoma, hypertension, hypertensive crisis, hypotension, labile blood pressure, pallor, peripheral coldness, peripheral vasucal disease, thrombosis.

Laboratory

Propafenone prolongs the PR and QRS intervals in patients with atrial and ventricular arrythmias. Prolongation of the QRS interval makes it difficult to interpret the effect of propafenone on the QT interval.

In RAFT, the distribution of the maximum changes in QTc compared to baseline over the study in each patient was similar in the Rythmol SR 225 mg BID, 325 mg BID, and 425 mg BID and placebo dose groups. Similar results were seen in the ERAFT study.

Side Effects by Body System

General

The Cardiac Arrhythmia Suppression Trial (CAST) revealed significantly higher mortality associated with some class IC antiarrhythmic agents in patients with a recent history (more than six days but less than two years prior to study) of myocardial infarction and asymptomatic non-life-threatening ventricular arrhythmias relative to placebo (5.1% versus 2.3%). Use of propafenone in this context is potentially harmful.

The safety and tolerability of propafenone after long-term administration has been reported. After 14 months, 60% of patients discontinued therapy, but only 15% discontinued therapy due to side effects. Overall, 59% of patients experienced at least 1 side effect, and the incidence was related to dose and age > 65 years. The overall incidence of side effects was not related to structural heart disease. However, cardiovascular toxicity including arrhythmia aggravation, heart failure, and serious conduction disturbances occurred more often in those with heart disease (20% vs. 13%).

Cardiovascular

Accelerated ventricular tachycardias refractory to overdrive pacing in patients on propafenone, who had arrhythmias previously responsive to overdrive pacing, have been reported.

Cardiovascular side effects may be serious. Two to four percent of patients have experienced a proarrhythmic effect. Propafenone slows conduction throughout the myocardial conduction system with very little effect on repolarization, resulting in a prolonged PR interval and QRS complex. Cases of bradycardia, sinus pauses and arrest, accelerated reentrant tachycardia, AV block, and ventricular tachycardia, including torsades de pointes, have been reported.

Propafenone has negative inotropic activity. Preexisting congestive heart failure has been aggravated in 9% of patients and new congestive heart failure induced in 5% of patients.

Nervous system

A 68 year-old man with ocular myasthenia gravis developed generalized myasthenia with ptosis, diplopia, dysarthria, dysphagia, and limb weakness within hours after beginning propafenone 450 mg per day. It is believed that propafenone, by blocking fast sodium channels, may interfere with the generation of propagation of the motor end-plate potential.

Nervous system side effects have included dizziness in 7%, headaches in 5%, ataxia in 1% to 3%, and fatigue in less than 1% of patients. Rare cases of exacerbation of myasthenia gravis and peripheral neuropathy have been associated with the use of propafenone.

Gastrointestinal

Gastrointestinal side effects have included general gastrointestinal upset in 3%, constipation in 4%, a metallic taste in 9%, and nausea or vomiting in approximately 2% of patients.

Respiratory

Respiratory side effects have included dyspnea, wheezing, and bronchoconstriction. These side effects have not exclusively been reported in patients with preexisting reactive airways disease.

Limited data indicate that the plasma concentration of propafenone is not correlated with respiratory complaints, although caution is recommended particularly when daily doses exceed 450 mg. Propafenone is associated with a significant decrease in the average dose of methacholine required to reduce the forced expiratory volume in 1 second (FEV1) by 20% and an increase in the use of beta-agonist inhalers in patients with asthma.

A case of wheezing and decreased expiratory flow rates has been associated with propafenone in a 50-year-old woman with no history of reactive airways disease and who had previously received atenolol and metoprolol without problems.

Hematologic

Hematologic side effects have been rare. A meta-analysis of all adverse drug events associated with propafenone yielded 4 cases of agranulocytosis. The reported rate is 1 case per 10,000 prescriptions per year. Anemia, granulocytopenia, increased bleeding time, leukopenia, purpura, and thrombocytopenia have occurred.

Profound neutropenia associated with bone marrow evidence of myeloid injury has been reported in at least 4 cases. Each patient recovered completely within 7 to 30 days after drug withdrawal.

Hepatic

Propafenone associated liver injury appears to be secondary to hepatocellular injury, cholestasis, or a combination of these. In some cases an allergic reaction has been suspected, while in at least one case, an idiosyncratic toxicity of propafenone metabolites in the biliary epithelial cells was suspected. There are no known fatalities or cases in which the drug had to be discontinued due to elevated liver function tests.

Hepatic side effects been reported. The overall incidence of hepatotoxicity is estimated to be 0.1% to 0.2%.

Immunologic

Immunologic side effects including the rare development of a lupus-like syndrome have been reported in at least two cases. An elevated ANA titer has been reported in 0.7% of patients.

A 63-year-old woman with hypertension, coronary artery disease, and ventricular tachycardia developed a facial photosensitive rash, generalized erythema, and an elevated ANA titer in a homogenous and speckled pattern within 2 months after beginning propafenone 300 mg every 8 hours. The clinical and laboratory abnormalities resolved within 1 month of drug discontinuation and reappeared upon rechallenge with propafenone.

Psychiatric

A 39-year-old woman with a history of congestive heart failure and symptomatic premature ventricular depolarizations developed paresthesias, insomnia, paranoia, hallucinations, and frank psychosis within 24 hours after starting propafenone 300 mg every 12 hours. The syndrome resolved within 2 to 3 days after discontinuation of the drug and institution of haloperidol. The patient subsequently did well off of haloperidol, on an alternative antiarrhythmic agent.

A 61-year-old man with a history of sick sinus syndrome, chronic atrial fibrillation, and premature ventricular depolarizations developed amnesia and disorientation within six days after starting propafenone. His mental status deterioration resolved within six to seven hours after discontinuing therapy. Comparable adverse effects have been associated with an analogous agent, propranolol.

Psychiatric abnormalities have been limited to a case of frank psychosis and a case of global amnesia.

Ocular

Ocular side effects of blurred vision (4%), abnormal vision(2%), and eye irritation (less than 1%) have been reported.

Dermatologic

Dermatologic side effects including at least one case of acute generalized exanthematous pustulosis, which resolved within 3 days after discontinuation of propafenone, has been reported.

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