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Mexiletine Disease Interactions

There are 6 disease interactions with mexiletine:

Major

Antiarrhythmics (Includes mexiletine) ↔ cardiovascular dysfunction

Major Potential Hazard, Low plausibility. Applies to: Hypotension, Congestive Heart Failure

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

References

  1. Halkin H, Meffin P, Melmon KL, Rowland M "Influence of congestive heart failure on blood levels of lidocaine and its active monodeethylated metabolite." Clin Pharmacol Ther 17 (1975): 669-76
  2. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  3. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  4. "Product Information. Quinidex (quinidine)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  5. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  6. Ravid S, Podrid PJ, Lampert S, Lown B "Congestive heart failure induced by six of the newer antiarrhythmic drugs." J Am Coll Cardiol 14 (1989): 1326-30
  7. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  8. Swiryn S, Kim SS "Quinidine-induced syncope." Arch Intern Med 143 (1983): 314-6
  9. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  10. Prescott LF, Adjepon-Yamoah KK, Talbot RG "Impaired lignocaine metabolism in patients with myocardial infarction and cardiac failure." Br Med J 1 (1976): 939-41
  11. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  12. "Product Information. Quiniglute (quinidine)." Berlex, Richmond, CA.
  13. Ochs HR, Grube E, Greenblatt DJ, Arendt R "Intravenous quinidine in congestive cardiomyopathy." Eur J Clin Pharmacol 19 (1981): 173-6
  14. Crouthamel WG "The effect of congestive heart failure on quinidine pharmacokinetics." Am Heart J 90 (1975): 335-9
  15. Gottlieb SS, Packer M "Deleterious hemodynamic effects of lidocaine in severe congestive heart failure." Am Heart J 118 (1989): 611-2
  16. Thomson P, Melmon K, Richardson J, Cohn K Steinbrunn W, Cudihee R, Rowland M "Lidocaine pharmacokinetics in advanced heart failure, liver disease, and renal failure in humans." Ann Intern Med 78 (1973): 499-508
  17. Singh SN, Fletcher RD, Fisher SG, et al. "Amiodarone in patients with congestive heart failure and asymptomatic ventricular arrhythmia." N Engl J Med 333 (1995): 77-82
View all 17 references
Major

Antiarrhythmics (Includes mexiletine) ↔ proarrhythmic effects

Major Potential Hazard, High plausibility. Applies to: Arrhythmias

Antiarrhythmic agents can induce or worsen ventricular arrhythmias. Ventricular tachycardia, ventricular fibrillation, and torsades de pointes have occurred in some patients. Patients with underlying cardiac dysfunction, bradycardia, hypokalemia, hypomagnesemia, or high antiarrhythmic serum concentrations are at increased risk for drug-induced arrhythmias. Therapy with antiarrhythmics should be used with extreme caution in patients with or predisposed to arrhythmias. Evidence of improved survival is lacking for use of antiarrhythmic therapy in asymptomatic, non-life-threatening arrhythmias. Therapy with antiarrhythmic agents should be reserved for patients with life-threatening arrhythmias.

References

  1. Andrivet P, Beaslay V, Canh VD "Torsades de pointe with flecainide-amiodarone therapy." Intensive Care Med 16 (1990): 342-3
  2. "Product Information. Tambocor (flecainide)." 3M Pharmaceuticals, St. Paul, MN.
  3. "Product Information. Adenocard (adenosine)." Fujisawa, Deerfield, IL.
  4. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals, Wilmington, DE.
  5. Said SAM, Somer ST, Luttikhuis HAO "Flecainide-induced JT prolongation, t wave inversion and ventricular tachycardia during treatment for symptomatic atrial fibrillation." Int J Cardiol 44 (1994): 285-7
  6. Nora MO, Chandrasekaran K, Hammill SC, Reeder GS "Prolongation of ventricular depolarization: ECG manifestation of mexiletine toxicity." Chest 95 (1989): 925-8
  7. "Product Information. Procan SR (procainamide)." Parke-Davis, Morris Plains, NJ.
  8. Morganroth J, Horowitz LN "Incidence of proarrhythmic effects from quinidine in the outpatient treatment of benign or potentially lethal ventricular arrhythmias." Am J Cardiol 56 (1985): 585-7
  9. Ben-Sorek ES, Wiesel J "Ventricular fibrillation following adenosine administration. A case report." Arch Intern Med 153 (1993): 2701-2
  10. Raehl CL, Patel AK, LeRoy M "Drug-induced torsade de pointes." Clin Pharm 4 (1985): 675-90
  11. Boriani G, Biffi M, Frabetti L, Azzolini U, Sabbatani P, Bronzetti G, Capucci A, Magnani B "Ventricular fibrillation after intravenous amiodarone in wolff-parkinson-white syndrome with atrial fibrillation." Am Heart J 131 (1996): 1214-6
  12. Reed R, Falk JL, O'Brien J "Untoward reaction to adenosine therapy for supraventricular tachycardia." Am J Emerg Med 9 (1991): 566-70
  13. Meurer MK "A 21-year-old woman with rapid atrial fibrillation after adenosine administration." J Emerg Nurs 17 (1991): 135-6
  14. Anderson JL, Popat KD "Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy." Arch Intern Med 141 (1981): 801-2
  15. Makkar RR, Fromm BS, Steinman RT, Meissner MD, Lehmann MH "Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs." JAMA 270 (1993): 2590-7
  16. Hii JT, Wyse DG, Gillis AM, et al "Propafenone-induced torsade de pointes: cross-reactivity with quinidine." Pacing Clin Electrophysiol 14 (1991): 1568-70
  17. Exner DV, Muzyka T, Gillis AM "Proarrhythmia in patients with the Wolff-Parkinson-White Syndrome after standard doses of intravenous adenosine." Ann Intern Med 122 (1995): 351-2
  18. Cheesman M, Ward DE "Exacerbation of ventricular tachycardia by tocainide." Clin Cardiol 8 (1985): 47-50
  19. "Product Information. Cordarone Intravenous (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  20. Strickberger SA, Man KC, Daoud EG, et al. "Adenosine-induced atrial arrhythmia: a prospective analysis." Ann Intern Med 127 (1997): 417-22
  21. Riccioni N, Castiglioni M, Bartolomei C "Disopyramide-induced QT prolongation and ventricular tachyarrhythmias." Am Heart J 105 (1983): 870-1
  22. "Product Information. Cordarone (amiodarone)." Wyeth-Ayerst Laboratories, Philadelphia, PA.
  23. Celiker A, Tokel K, Cil E, Ozkutlu S, Ozme S "Adenosine induced torsades de pointes in a child with congenital long QT syndrome." Pacing Clin Electrophysiol 17 (1994): 1814-7
  24. Silverman AJ, Machado C, Baga JJ, Meissner MD, Lehmann MH, Steinman RT "Adenosine-induced atrial fibrillation." Am J Emerg Med 14 (1996): 300-1
  25. "Product Information. Norpace (disopyramide)." Searle, Skokie, IL.
  26. Stavens CS, McGovern B, Garan H, Ruskin JN "Aggravation of electrically provoked ventricular tachycardia during treatment with propafenone." Am Heart J 110 (1985): 24-9
  27. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  28. "Product Information. Tonocard (tocainide)." Merck & Co, Inc, West Point, PA.
  29. Stratmann H, Walter K, Kennedy H "Torsade de pointes associated with elevated N-acetylprocainamide levels." Am Heart J 109 (1985): 375-6
  30. Wesley RC Jr, Turnquest P "Torsades de pointe after intravenous adenosine in the presence of prolonged QT syndrome." Am Heart J 123 (1992): 794-6
  31. Buss J, Neuss H, Bilgin Y, Schlepper M "Malignant ventricular tachyarrhythmias in association with propafenone treatment." Eur Heart J 6 (1985): 424-8
  32. Nathan AW, Hellestrand KJ, Bexton RS, Camm AJ "Fatal ventricular tachycardia in association with propafenone, a new class IC antiarrhythmic agent." Postgrad Med J 60 (1984): 155-6
  33. Morganroth J, Pratt CM "Prevalence and characteristics of proarrhythmia from moricizine (themozine)." Am J Cardiol 63 (1989): 172-6
  34. Kinney EL, Field EH, Salmon MP, Zelis R "Cardiac arrhythmias associated with disopyramide." N Engl J Med May (1990): 1146
  35. Bauman JL, Bauernfeind RA, Hoff JV, et al "Torsade de pointes due to quinidine: observations in 31 patients." Am Heart J 107 (1984): 425-30
  36. Dhein S, Schott M, Gottwald E, Klaus W "Electrocardiological profile and proarrhythmic effects of quinidine, verapamil and their combination: a mapping study." Naunyn Schmiedebergs Arch Pharmacol 352 (1995): 94-101
  37. Hohnloser SH, Klingenheben T, Singh BN "Amiodarone-associated proarrhythmic effects - a review with special reference to torsade de pointes tachycardia." Ann Intern Med 121 (1994): 529-35
  38. Chia BL "Disopyramide induced atypical ventricular tachycardia." Aust N Z J Med 10 (1980): 665-8
  39. Koenig W, Schinz AM "Spontaneous ventricular flutter and fibrillation during quinidine medication." Am Heart J 105 (1983): 863-5
  40. Heisler BE, Ferrier GR "Proarrhythmic actions of flecainide in an isolated tissue model of ischemia and reperfusion." J Pharmacol Exp Ther 279 (1996): 317-24
  41. Strasberg B, Sclarovsky S, Erdberg A, et al "Procainamide-induced polymorphous ventricular tachycardia." Am J Cardiol 47 (1981): 1309-14
  42. Dougherty AH, Gilman JK, Wiggins S, Jalal S, Naccarelli GV "Provocation of atrioventricular reentry tachycardia: a paradoxical effect of adenosine." Pacing Clin Electrophysiol 16 (1993): 8-12
  43. Lo KS, Gantz KB, Stetson PL, et al "Disopyramide-induced ventricular tachycardia." Arch Intern Med 140 (1980): 413-4
  44. Oberg KC, Otoole MF, Gallastegui JL, Bauman JL "''late'' proarrhythmia due to quinidine." Am J Cardiol 74 (1994): 192-4
  45. "Product Information. Rhythmol (propafenone)." Knoll Pharmaceutical Company, Whippany, NJ.
  46. Tzivoni D, Keren A, Stern S, Gottlieb S "Disopyramide-induced Torsade de pointes." Arch Intern Med 141 (1981): 946-7
  47. Sulke AN, Holt P, Sowton GE "Acceleration of conduction within an accessory pathway with propafenone." Int J Cardiol 28 (1990): 105-7
  48. Romer M, Candinas R "Adenosine-induced non-sustained polymorphic ventricular tachycardia." Eur Heart J 15 (1994): 281-2
  49. Damle R, Levine J, Matos J, et al "Efficacy and risks of moricizine in inducible sustained ventricular tachycardia." Ann Intern Med 116 (1992): 375-81
  50. Cocco G, Strozzi C, Chu D, Pansini R "Torsades de pointes as a manifestation of mexiletine toxicity." Am Heart J 100 (1980): 878-80
  51. "Product Information. Pronestyl (procainamide)." Apothecon Inc, Plainsboro, NJ.
  52. Faggiano P, Gardini A, Daloia A, Benedini G, Giordano A "Torsade de pointes occurring early during oral amiodarone treatment." Int J Cardiol 55 (1996): 205-8
  53. Hohnloser SH, Vandeloo A, Baedeker F "Efficacy and proarrhythmic hazards of pharmacologic cardioversion of atrial fibrillation: prospective comparison of sotalol versus quinidine." J Am Coll Cardiol 26 (1995): 852-8
  54. Au PK, Bhandari AK, Bream R, et al "Proarrhythmic effects of antiarrhythmic drugs during programmed ventricular stimulation in patients without ventricular tachycardia." J Am Coll Cardiol 9 (1987): 389-97
  55. "Product Information. Corvert (ibutilide)." Pharmacia and Upjohn, Kalamazoo, MI.
  56. "Product Information. Xylocaine (lidocaine)." Astra USA, Westborough, MA.
  57. Sclarovsky S, Lewin RF, Kracoff O, Strasberg B, Arditti A, Agmon J "Amiodarone-induced polymorphous ventricular tachycardia." Am Heart J 105 (1983): 6-12
  58. Williamson BD, Hummel J, Niebauer M, Man C, Strickberger SA, Daoud E, Morady F "Bradycardia-facilitated polymorphic ventricular tachycardia caused by amiodarone after radiofrequency modification of atrioventricular conduction." Am Heart J 130 (1995): 399-401
  59. Engler RL, LeWinter M "Tocainide-induced ventricular fibrillation." Am Heart J 101 (1981): 494-6
  60. Orebaugh SL, Handy M "Intravenous adenosine therapy accelerating rate of paroxysmal supraventricular tachycardia." Am J Emerg Med 10 (1992): 326-30
  61. Schweitzer P, Mark H "Torsade de pointes caused by disopyramide and hypokalemia." Mt Sinai J Med 49 (1982): 110-4
  62. "Product Information. Ethmozine (moricizine)." DuPont Pharmaceuticals, Wilmington, DE.
View all 62 references
Major

Mexiletine (Includes mexiletine) ↔ sinus (Includes mexiletine) ↔ AV node dysfunction

Major Potential Hazard, High plausibility. Applies to: Heart Block

The use of mexiletine is contraindicated in patients with cardiogenic shock, second- or third-degree AV block in the absence of a functional artificial pacemaker.

References

  1. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
Moderate

Mexiletine (Includes mexiletine) ↔ liver disease

Moderate Potential Hazard, High plausibility. Applies to: Liver Disease

Mexiletine is extensively metabolized by the liver to minimally active and inactive forms. The serum concentration of mexiletine is increased and the half-life prolonged in patients with liver impairment. Elevation of liver enzymes have been reported during the first few weeks of therapy, primarily in patients with congestive heart failure (CHF) or ischemia. Hepatic necrosis, resulting in death, has occurred. Therapy with mexiletine should be administered cautiously in patients with compromised liver function, CHF or ischemia. Clinical monitoring of cardiac function (ECG) and liver function is recommended.

References

  1. Pentikainen PJ, Hietakorpi S, Halinen MO, Lampinen LM "Cirrhosis of the liver markedly impairs the elimination of mexiletine." Eur J Clin Pharmacol 30 (1986): 83-8
  2. Nitsch J, Steinbeck G, Luderitz B "Increase of mexiletine plasma levels due to delayed hepatic metabolism in patients with chronic liver disease." Eur Heart J 4 (1983): 810-4
  3. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
Moderate

Mexiletine (Includes mexiletine) ↔ renal dysfunction

Moderate Potential Hazard, Moderate plausibility. Applies to: Renal Dysfunction

Mexiletine is primarily eliminated by the kidney. Approximately 10% of mexiletine is excreted in the urine unchanged. Marked changes in urinary pH alter the rate of mexiletine excretion. Elimination is accelerated with an acidic urinary pH and slowed with an alkaline urinary pH. Therapy with mexiletine should be administered cautiously in patients with significant renal impairment. Clinical monitoring of cardiac function (ECG) and renal function is recommended.

References

  1. Guay DR, Meatherall RC, Ferguson I, Smith H, Light B "Mexiletine clearance during peritoneal dialysis ." Br J Clin Pharmacol 19 (1985): 857-8
  2. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.
  3. El Allaf D, Henrard L, Crochelet L, Delapierre D, Carlier J, Dresse A "Pharmacokinetics of mexiletine in renal insufficiency." Br J Clin Pharmacol 14 (1982): 431-5
  4. Jones TE, Reece PA, Fisher GC "Mexiletine removal by peritoneal dialysis." Eur J Clin Pharmacol 25 (1983): 839-40
  5. Wang T, Wuellner D, Woosley RL, Stone WJ "Pharmacokinetics and nondialyzability of mexiletine in renal failure." Clin Pharmacol Ther 37 (1985): 649-53
View all 5 references
Moderate

Mexiletine (Includes mexiletine) ↔ seizures

Moderate Potential Hazard, Low plausibility. Applies to: Seizures

Seizures have been reported rarely during mexiletine therapy in patients with and without a history of seizures. Therapy with mexiletine should be administered cautiously in patients with or predisposition to seizure disorders.

References

  1. "Product Information. Mexitil (mexiletine)." Boehringer-Ingelheim, Ridgefield, CT.

Mexiletine drug interactions

There are 117 drug interactions with mexiletine

Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.