Bretylium Side Effects
Applies to bretylium: injectable solution, intravenous solution
Postural hypotension has occurred in most patients and was usually reversible with volume expansion or catecholamine infusion such as dopamine or epinephrine. It is recommended that patients remain supine until blood pressure changes stabilize. Some degree of supine hypotension occurred in approximately 50% of patients. The degree of hypotension did not appear to be dose-related and discontinuation was usually not required.
Bretylium administration causes an initial release of norepinephrine which may result in increased blood pressure or aggravation of arrhythmias. These effects are usually transient and do not generally require discontinuation of bretylium.[Ref]
Cardiovascular side effects including hypotension have been commonly reported during bretylium therapy. Hypotension occurs most frequently during intravenous administration. Postural hypotension has also been reported even when administered in a supine position. Other cardiovascular side effects have included transient hypertension, induction of new arrhythmias, bradycardia, precipitation of angina, and substernal pressure sensation. Flushing has been reported.[Ref]
To minimize nausea and vomiting due to rapid intravenous infusion, it is recommended that bretylium be diluted in at least 50 cc of 5% dextrose or normal saline and infused over 10 to 15 minutes.[Ref]
Local pain at the site of intramuscular injections has occurred. Administration sites should be rotated to prevent atrophy, fibrosis, or necrosis of muscle tissue, or vascular degeneration and inflammatory changes.[Ref]
At least two cases of extreme hyperthermia to 108 degrees Fahrenheit have been reported. In both cases, the temperature fell rapidly after bretylium was discontinued and normalized in less than 16 hours. The mechanism for this effect is unknown.[Ref]
Respiratory side effects including shortness of breath and nasal congestion have been reported rarely. A causal relationship between the side effect and the use of bretylium has not been clearly established.[Ref]
Psychiatric side effects including confusion, anxiety, psychoses, and emotional lability have been reported rarely. A causal relationship between the side effect and the use of bretylium has not been clearly established.[Ref]
Dermatologic side effects including erythematous macular rash have been reported rarely. A causal relationship between the side effect and the use of bretylium has not been clearly established.[Ref]
1. Narang PK, Adir J, Josselson J, Yacobi A, Sadler J "Pharmacokinetics of bretylium in man after intravenous administration." J Pharmacokinet Biopharm 8 (1980): 363-72
2. Bernstein JG, Koch-Weser J "Effectiveness of bretylium tosylate against refractory ventricular arrhythmias." Circulation 45 (1972): 1024-34
3. Bryan CK, Darby MH "Bretylium tosylate: a review." Am J Hosp Pharm 36 (1979): 1189-92
4. Anderson JL "Bretylium tosylate: profile of the only available class III antiarrhythmic agent." Clin Ther 7 (1985): 205-24
5. Alfery DD, Denlinger JK "Profound hypotension following a "test dose" of bretylium tosylate." Anesth Analg 58 (1979): 516-8
6. Kron IL, Nolan SP "Severe hypotension due to the use of bretylium for postcardiotomy ventricular arrhythmias." Ann Thorac Surg 35 (1983): 271-3
7. Taylor SH, Saxton C, Davies PS, Stoker JB "Bretylium tosylate in prevention of cardiac dysrhythmias after myocardial infarction." Br Heart J 32 (1970): 326-9
8. Chatterjee K, Mandel WJ, Vyden JK, et al "Cardiovascular effects of bretylium tosylate in acute myocardial infarction." JAMA 223 (1973): 757-60
9. Duff HJ, Roden DM, Yacobi A, et al "Bretylium: relations between plasma concentrations and pharmacologic actions in high-frequency ventricular arrhythmias." Am J Cardiol 55 (1985): 395-401
10. Kellog DL, Johnson JM, Kosiba WA "Baroflex control of the cutaneous active vasodilator system in humans." Circ Res 66 (1990): 1420-6
11. Anderson JL, Popat KD "Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy." Arch Intern Med 141 (1981): 801-2
12. Koch-Weser J "Bretylium." N Engl J Med 300 (1979): 473-7
13. Perlman PE, Adams WG, Ridgeway NA "Extreme pyrexia during bretylium administration." Postgrad Med 85 (1989): 111, 114
14. Cohen HC, Gozo EG, Langendorf R, et al "Response of resistant ventricular tachycardia to bretylium: relation to site to ectopic focus and location of myocardial disease." Circulation 47 (1973): 331-40
15. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals, Wilmington, DE.
16. Bexton RS, Camm AJ "Drugs with a class III antiarrhythmic action." Pharmacol Ther 17 (1982): 315-55
17. Rapeport WG "Clinical pharmacokinetics of bretylium." Clin Pharmacokinet 10 (1985): 248-56
18. Heissenbuttel RH, Bigger JT Jr "Bretylium tosylate: a newly available antiarrhythmic drug for ventricular arrhythmias." Ann Intern Med 91 (1979): 229-38
19. Josselson J, Narang PK, Adir J, Yacobi A, Sadler JH "Bretylium kinetics in renal insufficiency." Clin Pharmacol Ther 33 (1983): 144-50
20. Day HW, Bacaner M "Use of bretylium tosylate in the management of acute myocardial infarction." Am J Cardiol 27 (1971): 177-89
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
Some side effects may not be reported. You may report them to the FDA.