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Bretylol Side Effects

Generic Name: bretylium

Note: This page contains information about the side effects of bretylium. Some of the dosage forms included on this document may not apply to the brand name Bretylol.

Applies to bretylium: injectable solution, intravenous solution

Cardiovascular

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 (the active ingredient contained in Bretylol) [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]

Gastrointestinal

Gastrointestinal side effects of nausea and vomiting have occurred with rapid intravenous infusion. Diarrhea has been reported during intravenous and intramuscular administration.[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

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]

Nervous system

At least two cases of extreme hyperthermia to 108 degrees Fahrenheit have been reported. In both cases, the temperature fell rapidly after bretylium (the active ingredient contained in Bretylol) was discontinued and normalized in less than 16 hours. The mechanism for this effect is unknown.[Ref]

Nervous system side effects of headache, sweating, and hyperthermia have occurred.[Ref]

Respiratory

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 (the active ingredient contained in Bretylol) has not been clearly established.[Ref]

Psychiatric

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 (the active ingredient contained in Bretylol) has not been clearly established.[Ref]

Dermatologic

Dermatologic side effects including erythematous macular rash have been reported rarely. A causal relationship between the side effect and the use of bretylium (the active ingredient contained in Bretylol) has not been clearly established.[Ref]

References

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. Anderson JL "Bretylium tosylate: profile of the only available class III antiarrhythmic agent." Clin Ther 7 (1985): 205-24

3. Bernstein JG, Koch-Weser J "Effectiveness of bretylium tosylate against refractory ventricular arrhythmias." Circulation 45 (1972): 1024-34

4. Bryan CK, Darby MH "Bretylium tosylate: a review." Am J Hosp Pharm 36 (1979): 1189-92

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. Anderson JL, Popat KD "Paradoxical ventricular tachycardia and fibrillation after intravenous bretylium therapy." Arch Intern Med 141 (1981): 801-2

8. 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

9. Perlman PE, Adams WG, Ridgeway NA "Extreme pyrexia during bretylium administration." Postgrad Med 85 (1989): 111, 114

10. Chatterjee K, Mandel WJ, Vyden JK, et al "Cardiovascular effects of bretylium tosylate in acute myocardial infarction." JAMA 223 (1973): 757-60

11. "Product Information. Bretylol (bretylium)." DuPont Pharmaceuticals, Wilmington, DE.

12. 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

13. Heissenbuttel RH, Bigger JT Jr "Bretylium tosylate: a newly available antiarrhythmic drug for ventricular arrhythmias." Ann Intern Med 91 (1979): 229-38

14. Rapeport WG "Clinical pharmacokinetics of bretylium." Clin Pharmacokinet 10 (1985): 248-56

15. 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

16. Bexton RS, Camm AJ "Drugs with a class III antiarrhythmic action." Pharmacol Ther 17 (1982): 315-55

17. Kellog DL, Johnson JM, Kosiba WA "Baroflex control of the cutaneous active vasodilator system in humans." Circ Res 66 (1990): 1420-6

18. Koch-Weser J "Bretylium." N Engl J Med 300 (1979): 473-7

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

Not all side effects for Bretylol may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

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