Ibutilide (Corvert) is a class III antiarrhythmic drug that is used to convert recent-onset atrial flutter or atrial fibrillation to sinus rhythm.

Ibutilide (Corvert) Uses:

• Atrial fibrillation and atrial flutter:

  • It is indicated for the rapid conversion of recent-onset atrial fibrillation or atrial flutter to sinus rhythm
  • The effectiveness of the drug has not been determined in patients with arrhythmias of more than 90 days in duration.

Note:

• As per the American Heart Association/American College of Cardiology/Heart Rhythm Society guidelines for the management of atrial fibrillation, in thermodynamically stable patients with pre-excited atrial fibrillation and rapid ventricular response, the use of ibutilide to restore sinus rhythm or slow the ventricular rate is recommended.

• Off Label Use of Ibutilide in Adults:

  • To facilitate transthoracic electrical cardioversion for atrial fibrillation
  • Postoperative atrial fibrillation

Ibutilide (Corvert) Dose in Adults:

Ibutilide (Corvert) Dose in the treatment of Atrial fibrillation and atrial flutter:

• <60 kg:

  • 0.01 mg/kg over 10 minutes

• ≥60 kg:

  • 1 mg over 10 minutes

Note:

• Treatment must be immediately discontinued in the following situations:
  • When the arrhythmia terminates,
  • Ventricular tachycardia occurs (sustained or ill-sustained), or
  • if marked QT/QTc prolongation occurs.
• If the patient continues to have arrhythmias after 10 minutes of the initial infusion, a second infusion may be administered of equal strength.

Use in Children:

Not indicated.

Pregnancy risk category: C

• Although it may be used in pregnancy, there are not many data.

Ibutilide use during breastfeeding:

• It is unknown if the drug will be excreted into breastmilk.
• The manufacturer suggests that you avoid breastfeeding during treatment.

Dose in Kidney Disease:

Adjustment in the dose is not necessary.

Dose in Liver disease:

Adjustment in the dose is not necessary.

Side Effects of Ibutilide (Corvert):

• Cardiovascular:

  • Nonsustained Monomorphic Ventricular Tachycardia
  • Ventricular Premature Contractions
  • Unsustained Polymorphic Ventricular Tachycardia
  • Supraventricular Tachycardia
  • Tachycardia
  • Atrioventricular Block
  • Bundle Branch Block
  • Hypotension
  • Sustained Polymorphic Ventricular Tachycardia
  • Bradycardia
  • Hypertension
  • Palpitations
  • Prolonged Q-T Interval On ECG

• Central Nervous System:

  • Headache

• Gastrointestinal:

  • Nausea

Contraindications to Ibutilide (Corvert):

• Allergy to ibutilide and any component of the formulation

Warnings and precautions

• Proarrhythmic effects: [US Boxed Warning]

  • It is possible to experience arrhythmias that can be life-threatening.
  • Fatal arrhythmias can include prolonged polymorphic ventricular rhythmia, which is usually associated with a prolongedQT/QTc (torsades des pointses) or QT prolongation.
  • However, it may also occur without a documented prolongation.
  • Incidence arrhythmias has a risk of 1.7%. Arrhythmias can quickly be reversed if you seek prompt treatment.
  • Arrhythmias can be dangerous so it is important that the drug is administered by qualified personnel who are trained in continuous ECG monitoring and can diagnose and manage acute ventricular arrhythmias.
  • Individuals with atrial fibrillation lasting more than 2 to 3 days should receive anticoagulation for at least 2 weeks.
  • To reduce QT-interval prolongation, intravenous magnesium (2gms) can be given before and after infusion. It may also increase the effectiveness of the drug.
  • Clinical trials have not evaluated a reduction in the incidence torsade des pointes (Tdp), but it is believed to decrease the incidence of Tdp.
  • Patients with QTc intervals greater than 440 msec should avoid ibutilide.
  • Patients who have had a history polymorphic ventricular arrhythmia (eg, Torsades de Pointes) should not receive the drug.

• Chronic atrial fibrillation (US Boxed Warning):

  • Patients suffering from chronic atrial fibrillation (CAF) should only be treated if they are more likely to benefit than the risk of thromboembolism.
  • It is important to carefully select the patients. If the alternative treatment is more effective and justifiable, it may be possible to have the treatment differ.

• Electrolyte imbalance:

  • It is important to correct electrolytes, especially hypomagnesemia, before administering the drug or during treatment.

Monitoring parameters:

• Serum electrolytes
• Observe the patient for at least four hours with continuous ECG monitoring after the infusion or until the QTc has returned to normal (Monitoring may be extended to greater than 4 hours in patients with abnormal liver function or if an arrhythmic activity is noted)
• It should be administered by trained personnel.
• Proper equipment should be available when administering the drug and during the monitoring.

How to administer Ibutilide (Corvert)?

It is administered as an intravenous infusion diluted or undiluted over 10 minutes.

Mechanism of action of Ibutilide (Corvert):

• It is a Vaughan Williams antiarrhythmic drug of class III.
• It also blocks the rapid component in the delayed rectifier potassium current, resulting in a delay of repolarization.

The onset of action:

• It takes about 90 minutes after the initiation of the infusion to convert the rhythm into sinus rhythm.

Protein binding:

• About 40%

Metabolism:

• Extensively metabolized in the liver via oxidation into 8 metabolites (only 1 active metabolite)

Half-life elimination:

• About 6 hours (ranging from 2 to 12 hours)

Excretion:

• Urine (~82%; ~7% unchanged);
• feces (~19%)

International Brands of Ibutilide:

• Corvert

Ibutilide Brand Names in Pakistan:

No Brands Available in Pakistan.