1. Understanding Rate and Rhythm Control Drugs
A Program for Patients & Caregivers
Prepared by Kristen Campbell, PharmD, AACC
Last reviewed: September 2017

2. Today’s Program Rate control strategies for AFib
Rhythm control strategies for AFib
Common side effects and things to remember
Resources for support

3. Rate Control Medications

4. Rate Control Goal: Regulate your heart rate (pulse) to reduce symptoms
Beta Blockers
Calcium Channel Blockers
Metoprolol (Lopressor/Toprol XL)
Carvedilol (Coreg)
Propranolol (Inderal)
Atenolol (Tenormin)
Bisoprolol (Zebeta)
Nebivolol (Bystolic)
Nadolol (Corgard)
Diltiazem (Cardizem & others)
Verapamil (Calan, Verelan)

5. Beta Blockers Beta-adrenergic blocking agents
Block the effects of epinephrine (adrenaline)
Cause the heart to beat more slowly and with less force
Controls irregular rhythm
Reduces blood pressure

6. Beta Blockers Side Effects Things to Remember Slow heart rate
Feeling tired
Cold hands or feet
Weight gain
Shortness of breath
Do not stop taking unless instructed by provider

7. Calcium Channel Blockers
Prevent calcium from entering cells in the heart and blood vessel walls
Reduces blood pressure
Some cause the heart to beat more slowly
Controls irregular rhythm

8. Calcium Channel Blockers
Side Effects
Things to Remember
Slow heart rate
Feeling tired
Constipation
Dizziness
Do not stop taking unless instructed by provider

9. Rhythm Control Medications

10. Rhythm Control Goal: Achieve and maintain regular rhythm
These drugs work directly on heart tissue and slow impulses throughout the heart
Require close monitoring by providers
Talk about whether to use rhythm control with your health care professional
Considerations: type of AFib, symptoms, other health conditions, anticoagulation

11. Rhythm Control Drug-Drug Interactions Drug-Food Interactions
Many potential & many serious
Can occur with short-term medications (antibiotics)
Can occur with over-the-counter medications
Report ALL medications to ALL providers
Use the same pharmacy for all prescriptions
If you can’t, report all medications to each pharmacy
Drug-Food Interactions
Grapefruit
Juice cocktails, sodas

12. Flecainide (Tambocor)
Dosing: Taken twice a day
Side Effects:
Headache
Dizziness
Things to Remember:
Do not use if you have a history of heart attack or heart failure
Call your doctor if you have:
Chest pain
Fainting
New or worse heartbeat that does not feel normal
Change in eyesight

13. Propafenone (Rythmol)
Dosing: Taken 2-3 times a day
Side Effects:
Upset stomach
Nausea
Dizziness
Change in taste
Things to Remember:
Do not use if you have a history of heart attack or heart failure
Call your doctor if you have:
Chest pain
Fainting
New or worse heartbeat that does not feel normal

14. Amiodarone (Pacerone, Cordarone)
Dosing: Taken once a day
Side Effects:
Nausea
Dizziness
Amiodarone affects multiple organ systems in the body – liver, lungs, eyes, thyroid, nerves, brain and skin
Things to Remember:
You will need to have regular bloodwork and eye exams
You may get sunburned more easily

15. Things to look for while you are on Amiodarone
Wear a hat while in sun
Need to follow up with your primary care and cardiovascular physician regarding regular surveillance
Interacts with a lot of medications. Please make sure to check with your doc

16. Dofetilide (Tikosyn) Dosing: Taken two times a day Side Effects:
Headache
Dizziness
This drug can be started only in the hospital. ECG should be monitored to make sure that you don’t develop bad ventricular arrhythmias
Things to Remember:
You will need bloodwork and ECG testing every 3-4 months
Avoid grapefruit juice
Make sure your potassium (K) and magnesium (Mg) levels are OK
Has many drug-to-drug interactions. Check with your doctors and pharmacy when a new medication is given to you

17. Sotalol (Betapace) Dosing: Taken two times a day Side Effects:
Slow heart rate
Dizziness, fatigue, shortness of breath
This drug may be started in the hospital. ECG should be monitored to make sure that you don’t develop bad ventricular arrhythmias
Counseling Points:
You may be admitted to the hospital to begin sotalol
You will need bloodwork and ECG testing every 3-4 months
Make sure to have adequate K and Mg replacements

18. Dronedarone (Multaq) Dosing: Taken two times a day Side Effects:
Upset stomach
Dizziness
Diarrhea
Counseling Points:
Should not be taken if you have heart failure

19. Resources for Support and Information
CardioSmart is an ongoing patient education and empowerment initiative offered by the American College of Cardiology. Our mission is to help individuals prevent, treat and manage cardiovascular disease.

20. Q&A Session