Tikosyn

dofetilide

Tikosyn

Indications

Action

Pharmacokinetics

Time/action profile (blood levels)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• dizziness (most frequent)
• headache (most frequent)

Cardiovascular

• ventricular arrhythmias (including torsade de pointes) (life-threatening)
• chest pain (most frequent)
• QT interval prolongation

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Monitor ECG, pulse, and BP continuously during initiation of therapy and for at least 3 days, then periodically during therapy. Evaluate QTc prior to initiation of therapy and every 3 mo during therapy. If QTc exceeds 440 msec (500 msec in patients with ventricular conduction abnormalities), discontinue dofetilide and monitor patient until QTc returns to baseline.
• Assess the patient’s medication history including OTC, Rx, and natural/herbal products, with emphasis on those that interact with dofetilide (see Interactions).
• Lab Test Considerations: Creatinine clearance must be calculated for all patients prior to administration and every 3 mo during therapy.

Potential Nursing Diagnoses

Implementation

• Dolfetilide must be initiated or reinitiated in a setting that provides continuous ECG monitoring and has personnel trained in the management of serious ventricular arrhythmias and pharmacists trained to dispense dofetilide. Due to the potential for life-threatening ventricular arrhythmias, dofetilide is usually used for patients with highly symptomatic AF/AFl.
  • Patients with AF should be anticoagulated according to usual protocol prior to electrical or pharmacological cardioversion.
  • Make sure patient has an adequate supply of dofetilide prior to discharge to prevent interruption of therapy.
  • Patients should not be discharged from the hospital within 12 hr of electrical or pharmacological conversion to normal sinus rhythm.
• Oral: Administer at the same time each day without regard to food.

Patient/Family Teaching

• Instruct patient to take medication as directed, even if feeling well. If a dose is missed, do not double next dose. Take next dose at usual time.
• Patient should read the patient package insert prior to initiation of therapy and reread it each time therapy is renewed. Emphasize the need for compliance with therapy, the potential for drug interactions, and the need for periodic monitoring to minimize the risk of serious arrhythmias.
• Instruct patient or family member on how to take pulse. Advise patient to report changes in pulse rate or rhythm to health care professional.
• May cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Advise patient to inform health care professional of medication regimen prior to treatment or surgery.
• Instruct patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult health care professional before taking other Rx, OTC, or herbal products.
• Advise patient to consult health care professional immediately if they faint, become dizzy, or have fast heartbeats. If health care professional is unavailable, instruct patient to go to nearest hospital emergency department, take remaining dofetilide capsules, and show them to the doctor or nurse. If symptoms associated with altered electrolyte balance such as excessive or prolonged diarrhea, sweating, or vomiting or loss of appetite or thirst occur, health care professional should also be notified immediately.
• Emphasize the importance of routine follow-up exams to monitor progress.

Evaluation/Desired Outcomes

• Prevention of recurrent AF/AFl.
• Conversion of AF/AFl to normal sinus rhythm.
  • If patients do not convert to normal sinus rhythm within 24 hr of initiation of therapy, electrical conversion should be considered.