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ANNE ARUNDEL MEDICAL CENTER
CRITICAL CARE MEDICATION MANUAL
DEPARTMENT OF NURSING AND PHARMACY
Guidelines for Use of Intravenous Ibutilide (Corvert®)
Indication
For rapid conversion of atrial fibrillation or atrial flutter of recent onset to sinus rhythm when DC
cardioversion is not preferred.
Mechanism of Action
Ibutilide is an antiarrhythmic drug with predominantly class III properties. Ibutilide prolongs
atrial and ventricular action potential duration and refractoriness via delay of repolarization by
action of a slow inward current (predominantly sodium) in comparison to most other class III
antiarrhythmics.
Special Administration and Monitoring Techniques
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Ibutilide may be pro-arrhythmic and can cause fatal arrhythmias (see Comments).
Use of ibutilide on the A3 and IMU patient areas requires attachment of a “hands-off”
defibrillator prior to drug administration.
Anticoagulation should be considered prior to ibutilide in patients with atrial fibrillation of
greater than 2 days’ duration.
Electrolytes:
· Serum potassium should be measured prior to ibutilide administration; potassium
supplementation (to 4.0 mm/L) should be considered for all patients with baseline serum
potassium < 4.0 mm/L.
· Intravenous magnesium should be given (MgSO4 2 grams in 100 cc D5W IV over 30
minutes) prior to ibutilide infusion in all patients except when baseline magnesium may
be already elevated (e.g. serum creatinine > 2.0 mg/dl).
Ibutilide is administered intravenously. An initial infusion is given over 10 minutes
followed by a second 10-minute infusion if the arrhythmia is not terminated within 10
minutes after the end of the initial infusion. Ibutilide should be stopped if the arrhythmia
is terminated during the infusion / dose.
Monitoring EKG, blood pressure, and pulse is indicated for any patient receiving ibutilide.
Continuous EKG monitoring is indicated for at least 4 hours following infusion, or until the
QTc interval returns to baseline. EKG monitoring for longer periods is advised in patients
with liver dysfunction or if pro-arrhythmic activity is observed.
Dosage adjustment is not necessary with renal or hepatic disease.
Dosage adjustment is not indicated in older individuals.
Ibutilide reviewed 11/02
Dosage and Administration
Intravenous doses of ibutilide should be infused over a period of 10 minutes. The drug can be
given undiluted or diluted in 50 ml 5% dextrose or normal saline. If dilution preferred, the
contents of one 10 ml vial (1 mg / 10 ml) is added to a 50 ml infusion bag to form a final
concentration of approximately 0.017 mg/ml (1 mg / 60 ml).
The recommended dose is 1 mg IV for patients weighing > 60 kg (132 pounds). For patients
weighing less than 60 kg, a dose of 0.01 mg/kg should be administered. A second equal dose
may be given 10 minutes after the completion of the first infusion (20 minutes from the
beginning of the first infusion) if the arrhythmia is not terminated.
Recommended Dose of Ibutilide (CORVERT®) Injection
Patient Weight
60 kg (132 LB)
or more
<60 kg
(<132 LB)
Initial Infusion
(over 10 minutes)
One Vial – 10 ml
(1 mg ibutilide fumarate)
0.1ml/kg
(0.01 mg/kg ibutilide fumarate)
Second Infusion (over 10 minutes)
If the arrhythmia does not terminate within 10 minutes after
the end of the initial infusion, a second 10-minute infusion of
equal strength may be administered 10 minutes after the
completion of the first infusion.
Precautions
1. Ibutilide is not recommended in patients with a history of polymorphic v-tach.
2. Class IA antiarrhythmic drugs, such as disopyramide, quinidine, and procainamide, and
other class III drugs, such as amiodarone and sotalolol, may increase the risk of proarrhythmic effects. This risk should be considered by the ordering physician. Options
include monitoring closely for prolong refractoriness and/or holding the other antiarrhythmic
for 5 half-lives prior to ibutilide and within 4 hours post-infusion .
3. The potential for pro-arrhythmia may increase with the administration of ibutilide to patients
who are concomitantly receiving other drugs that can prolong the QT interval, such as
phenothiazines, tricyclic antidepressants, and certain antihistamine drugs (H1 receptor
antagonists), specifically terfenadine (Seldane) and astemizole (Hismanal).
4. Safety and efficacy in patients < 18 years old is unknown.
Adverse Effects
Cardiovascular – ventricular extrasystoles, non-sustained monomorphic VT, non-sustained
polymorphic VT, hypotension, bundle branch block, sustained polymorphic VT, AV block,
hypertension, QT segment prolongation, bradycardia, palpitations, and tachycardia.
Prolongation of the QTc interval has correlated directly with plasma levels. The greatest prolongation has been seen at the end of an
infusion and the QTc interval returns to baseline 2 to 4 hours after completion of the infusion. Polymorphic VT (PVT) has coincided with
maximal ibutilide levels (and maximum changes in the QTc interval), and the PVT is usually seen within 40 minutes of the start of an
infusion. However, plasma levels at the time of PVT occurrence in patients developing this arrhythmia have been similar to levels in
patients not developing PVT, and there is no threshold concentration at which the risk of its occurrence would be significantly higher.
Gastrointestinal – nausea
Central Nervous System - headache
Ibutilide reviewed 11/02
Comments
Ibutilide can cause potentially fatal arrhythmias, particularly sustained polymorphic ventricular
tachycardia, usually in association with QT prolongation (torsades de pointes), but
sometimes without documented QT prolongation. It is essential that ibutilide be
administered in the setting of continuous EKG monitoring and by personnel trained in the
identification and treatment of acute ventricular arrhythmias, particularly polymorphic VT.
Most cases of polymorphic VT respond to overdrive pacing and intravenous magnesium
infusion, however degeneration to VF requiring defibrillation may occur.
Ibutilide reviewed 11/02
Pharmacy Department/Clinical Services
IV Additive Service
DRUG
NAME
STORAGE
REQUIREMENTS
PREPARATION
Ibutilide
piggyback
Room temperature
Add 10 ml (one 1 mg / 10
ml vial) ibutilide to 50 ml of
D5W or NSS
RESULTING
CONCENTRATION
0.017 mg/ml
(1 mg / 60 ml)
Synonyms (Trade Names): Corvert®
Notes:
1.
2.
3.
Ibutilide may also be given undiluted IV push over 10 minutes.
Ibutilide should only be mixed with D5W or NSS.
Stable for 24 hours at room temperature and 48 hours at refrigerated temperatures.
Ibutilide reviewed 11/02
STABILITY
24 hrs