ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -28 مورد

Propafenone: Drug information

Propafenone: Drug information
2025© UpToDate, Inc. and its affiliates and/or licensors. All Rights Reserved.
For additional information see "Propafenone: Patient drug information"

For abbreviations, symbols, and age group definitions show table
ALERT: US Boxed Warning
Mortality:

In the National Heart, Lung, and Blood Institute's Cardiac Arrhythmia Suppression Trial (CAST), a long-term, multicenter, randomized, double-blind study in patients with asymptomatic non–life-threatening ventricular arrhythmias who had a myocardial infarction (MI) more than 6 days but less than 2 years previously, an increased rate of death or reversed cardiac arrest rate (7.7%) was seen in patients treated with encainide or flecainide (class IC antiarrhythmics) compared with that seen in patients assigned to placebo (3%). The average duration of treatment with encainide or flecainide in this study was 10 months.

The applicability of the CAST results to other populations (eg, those without recent MI) or other antiarrhythmic drugs is uncertain, but at present, it is prudent to consider any IC antiarrhythmic to have a significant risk in patients with structural heart disease. Given the lack of any evidence that these drugs improve survival, generally avoid antiarrhythmic agents in patients with non–life-threatening ventricular arrhythmias, even if the patients are experiencing unpleasant, but not life-threatening, symptoms or signs.

Brand Names: US
  • Rythmol SR [DSC]
Brand Names: Canada
  • APO-Propafenone;
  • MYLAN-Propafenone;
  • Rythmol
Pharmacologic Category
  • Antiarrhythmic Agent, Class Ic
Dosing: Adult

Note: Consider for use only in patients without structural or ischemic heart disease. Patients who exhibit significant widening of QRS complex or second- or third-degree AV block may need dose reduction.

Atrial fibrillation/flutter, maintenance of sinus rhythm

Atrial fibrillation/flutter, maintenance of sinus rhythm:

IR tablet: Oral: Initial: 150 mg every 8 hours; dosage increase may be made at minimum of 3- to 4-day intervals; may increase to 225 mg every 8 hours; if further increase is necessary, may increase to 300 mg every 8 hours.

ER capsule: Oral: Initial: 225 mg every 12 hours; dosage increase may be made at a minimum of 5-day intervals; may increase to 325 mg every 12 hours; if further increase is necessary, may increase to 425 mg every 12 hours.

Atrial fibrillation/flutter, pharmacologic cardioversion

Atrial fibrillation/flutter, pharmacologic cardioversion (off-label use):

Note: May be used on an outpatient basis (“Pill-in-the-pocket”), however, an initial inpatient cardioversion trial should have been successful before sending patient home on this therapy. Patient must be taking an atrioventricular (AV) nodal-blocking agent (eg, beta-blocker, nondihydropyridine calcium channel blocker) prior to initiation of propafenone. AV nodal-blocking agent is generally administered ≥30 minutes before propafenone (Ref).

IR tablet: Oral: <70 kg: 450 mg; do not repeat dose within 24 hours (Ref).

IR tablet: Oral: ≥70 kg: 600 mg; do not repeat dose within 24 hours (Ref).

Supraventricular tachycardia, maintenance of sinus rhythm

Supraventricular tachycardia, maintenance of sinus rhythm:

IR tablet: Oral: Initial: 150 mg every 8 hours; dosage increase may be made at minimum of 3- to 4-day intervals; may increase to 225 mg every 8 hours; if further increase is necessary, may increase to 300 mg every 8 hours (Ref).

ER capsule: Oral: Initial: 225 mg every 12 hours; maximum maintenance dose: 425 mg every 12 hours (Ref).

Ventricular arrhythmia

Ventricular arrhythmia:

IR tablet: Oral: 150 mg every 8 hours; dosage increase may be made at minimum of 3- to 4-day intervals; may increase to 225 mg every 8 hours; if further increase is necessary, may increase to 300 mg every 8 hours (Ref).

ER capsule : Oral: 225 to 425 mg every 12 hours (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

Altered kidney function: No dosage adjustment necessary for any degree of kidney impairment (Ref).

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzable (Ref): No dosage adjustment necessary (Ref).

Peritoneal dialysis: Not significantly dialyzable (Ref): No dosage adjustment necessary (Ref).

CRRT: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Dosing: Liver Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling; however, dosage reduction should be considered as drug undergoes hepatic metabolism. Alternatively, in patients with mild to moderate impairment, the following dosing recommendations have been made: Initial: 150 mg once daily; if necessary, may increase dosage by 150 mg/day in divided doses (eg, twice daily, three times daily) at a minimum of 4-day intervals up to maximum of 300 mg every 12 hours (Ref).

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reported adverse reactions are for adults.

>10%:

Gastrointestinal: Nausea (≤11%), vomiting (≤11%)

Nervous system: Unusual taste (14%; dysgeusia: ≥2%)

1% to 10%:

Cardiovascular: Angina pectoris (≥2%), bradycardia (2%), bundle branch block (1%; including right bundle branch block and left bundle branch block), cardiac conduction disorder (≥2%; including atrioventricular conduction disturbance [slow]; cardiac conduction delay [1%]), chest pain (≥1%), edema (≥2%), heart block (including complete atrioventricular block [<1%]), first-degree atrioventricular block [3%], second-degree atrioventricular block [<1%]), heart failure (≤2%; including worsening of heart failure), heart murmur (≥2%), hypotension (≥2%), palpitations (2%), sinus bradycardia (≥2%), ventricular arrhythmia (new or worsened: ≤5%; including ventricular fibrillation, ventricular premature contractions, ventricular tachycardia)

Dermatologic: Ecchymosis (≥2%)

Gastrointestinal: Anorexia (2%), constipation (8%), diarrhea (2%), flatulence (≥2%), xerostomia (≥2%)

Genitourinary: Hematuria (≥2%)

Hepatic: Increased serum alkaline phosphatase (>1%)

Nervous system: Anxiety (≥2%), asthenia (3%), ataxia (2%), depression, dizziness (9%), drowsiness (≥2%), fatigue (6%), headache (6%), myasthenia (including exacerbation of myasthenia gravis), tremor (2%)

Ophthalmic: Blurred vision (3%)

Respiratory: Dyspnea (2%), rales (≥2%), upper respiratory tract infection (≥2%), wheezing (≥2%)

<1%:

Cardiovascular: Atrioventricular dissociation, flushing, sick sinus syndrome, sinoatrial arrest, sinus pause, supraventricular tachycardia

Dermatologic: Alopecia, pruritus

Endocrine & metabolic: Hot flash

Gastrointestinal: Cholestasis, gastroenteritis

Genitourinary: Impotence

Hematologic & oncologic: Agranulocytosis, anemia, bruise, granulocytopenia, leukopenia, positive ANA titer, purpuric disease, thrombocytopenia

Hepatic: Hepatitis

Nervous system: Abnormal dreams (including nightmares), altered sense of smell, amnesia, confusion, loss of balance, mania, numbness, pain, paresthesia, psychosis, seizure, speech disturbance, vertigo

Neuromuscular & skeletal: Muscle cramps

Ophthalmic: Eye irritation, visual disturbance

Otic: Tinnitus

Renal: Nephrotic syndrome

Frequency not defined:

Cardiovascular: Acute myocardial infarction, atrioventricular nodal arrhythmia, cold extremity, coronary artery disease (including carotid bruit), deep vein thrombosis, embolism of systemic artery, extrasystoles, hypertension, hypertensive crisis, pericarditis, peripheral vascular disease, prolongation P-R interval on ECG, sinoatrial block (including atrial hypertrophy), sinoatrial nodal rhythm disorder, supraventricular extrasystole, syncope, thrombosis, unstable angina pectoris, ventricular hypertrophy, widened QRS complex on ECG

Dermatologic: Dermatitis, diaphoresis, erythema of skin, pallor, skin rash, xeroderma

Endocrine & metabolic: Decreased libido, dehydration, diabetes mellitus, hyperglycemia, hypokalemia, increased lactate dehydrogenase, increased uric acid, ketonuria, weight gain, weight loss

Gastrointestinal: Abdominal distension, abdominal pain, duodenitis, dyspepsia, dysphagia, eructation, gastritis, gastroesophageal reflux disease, gingival hemorrhage, glossalgia, halitosis, intestinal obstruction, melena, oral mucosal ulcer, pancreatitis, peptic ulcer, rectal hemorrhage

Genitourinary: Dysuria, glycosuria, nocturia, oliguria, prostatism, proteinuria, pyuria, urinary frequency, urinary incontinence, urinary retention

Hematologic & oncologic: Decreased neutrophils, eosinophilia, hematoma, hemorrhage, hyperprothrombinemia, hypoprothrombinemia, leukocytosis, lymphadenopathy, monocytosis, petechia, spleen disease

Nervous system: Abnormal gait, cerebrovascular accident, emotional disturbance, hypertonia, hypoesthesia, insomnia, malaise, neurosis, numbness of tongue, sleep disorder

Neuromuscular & skeletal: Arthropathy, costochondritis, muscle spasm, myalgia, tendinopathy

Ophthalmic: Blepharoptosis, decreased visual acuity, miosis, ophthalmic inflammation, retinopathy, retrobulbar hemorrhage

Otic: Auditory impairment

Renal: Casts in urine, increased blood urea nitrogen, increased serum creatinine, renal failure syndrome

Respiratory: Abnormal breath sounds (decreased), atelectasis, cough, epistaxis, hemoptysis, pharyngeal edema, pleural effusion, pulmonary congestion, respiratory failure

Postmarketing:

Cardiovascular: Asystole, torsades de pointes

Dermatologic: Acute generalized exanthematous pustulosis (Huang 2005), psoriasis (Palleschi 2008), urticaria (Incorvaia 2006)

Endocrine & metabolic: Hyponatremia, SIADH

Hematologic & oncologic: Prolonged bleeding time

Hepatic: Hepatomegaly (Younan 2013), hepatotoxicity (Younan 2013), increased gamma-glutamyl transferase (Younan 2013), increased serum alanine aminotransferase (Younan 2013), increased serum aspartate aminotransferase (Younan 2013), increased serum bilirubin (Younan 2013), jaundice (Younan 2013)

Hypersensitivity: Angioedema (Incorvaia 2006)

Nervous system: Coma, myoclonus (Chua 1994), peripheral neuropathy (Galasso 1995)

Neuromuscular & skeletal: Lupus erythematosus

Respiratory: Apnea

Miscellaneous: Fever (O’Rourke 1997)

Contraindications

Hypersensitivity to propafenone or any component of the formulation; sinoatrial, atrioventricular, and intraventricular disorders of impulse generation or conduction (except in patients with a functioning artificial pacemaker); known Brugada syndrome; bradycardia; cardiogenic shock; heart failure; marked hypotension; bronchospastic disorders or severe obstructive pulmonary disease; marked electrolyte imbalance

Canadian labeling: Additional contraindications (not in US labeling): MI within past 3 months; severe hepatic impairment; myasthenia gravis; concurrent use with ritonavir.

Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Warnings/Precautions

Concerns related to adverse effects:

• Agranulocytosis: Agranulocytosis has been reported; generally occurring within the first 2 months of therapy. Upon therapy discontinuation, WBC usually normalized by 14 days.

• CNS effects: May cause dizziness, fatigue, blurred vision; caution patients about performing dangerous tasks (eg, driving, operating machinery).

• Conduction disturbances: Slows atrioventricular conduction, potentially leading to first degree AV block; degree of PR interval prolongation and increased QRS duration are dose and concentration related. Avoid in patients with conduction disturbances (unless functioning pacemaker present).

• Elevated antinuclear antibody titers: Positive antinuclear antibody (ANA) titers have been reported with use. Titers have decreased with and without therapy discontinuation. Positive titers have not usually been associated with clinical symptoms, although at least one case of drug-induced lupus erythematosus has been reported. Consider therapy discontinuation in symptomatic patients with positive ANA titers.

• Hepatotoxicity: Hepatic abnormalities (including fulminant hepatitis and fatalities) have been reported; toxicity appeared due to hepatocellular injury and/or cholestasis.

• Proarrhythmic effects: Can cause life-threatening drug-induced arrhythmias, including ventricular fibrillation, ventricular tachycardia, asystole, and torsade de pointes (Hii 1991). The manufacturer notes that propafenone may increase the QT interval; however, due to QRS prolongation, changes in the QT interval are difficult to interpret. In an evaluation of propafenone (450 mg/day) in healthy individuals compared to other selected antiarrhythmic agents, propafenone did not affect repolarization time (eg, QT, QTc, JT, JTc) only depolarization time (ie, QRS interval) (Sarubbi 1998). Monitor for proarrhythmic effects, and when necessary, adjust dose to prevent QTc prolongation.

Disease-related concerns:

• Brugada syndrome: Initiation of propafenone may unmask Brugada syndrome; obtain ECG after treatment initiation and discontinue if ECG indicative of Brugada syndrome.

• Electrolyte imbalance: Use is contraindicated in patients with uncorrected electrolyte abnormalities. Correct electrolyte disturbances, especially hypokalemia or hypomagnesemia, prior to use and throughout therapy.

• Heart failure (HF): Avoid use in patients with HF; similar agents have been shown to increase mortality in this population; may precipitate or exacerbate condition.

• Hepatic impairment: Use with caution in patients with hepatic impairment.

• Myasthenia gravis: Use with caution in patients with myasthenia gravis; may exacerbate condition.

• Renal impairment: Use with caution in patients with renal impairment.

• Structural or ischemic heart disease: Avoid use in patients with structural or ischemic heart disease as the risk of death and cardiac events may be increased (ACC/AHA/HRS [Page 2016]; ACC/AHA [Joglar 2024]).

Other warnings/precautions:

• Pacemakers: May alter pacing and sensing thresholds of artificial pacemakers.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule Extended Release 12 Hour, Oral, as hydrochloride:

Rythmol SR: 225 mg [DSC], 325 mg [DSC], 425 mg [DSC] [contains soybean lecithin]

Generic: 225 mg, 325 mg, 425 mg

Tablet, Oral, as hydrochloride:

Generic: 150 mg, 225 mg, 300 mg

Generic Equivalent Available: US

Yes

Pricing: US

Capsule, 12-hour (Propafenone HCl ER Oral)

225 mg (per each): $0.98 - $7.89

325 mg (per each): $1.18 - $10.00

425 mg (per each): $1.18 - $10.00

Tablets (Propafenone HCl Oral)

150 mg (per each): $1.64

225 mg (per each): $2.33

300 mg (per each): $2.97

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Tablet, Oral, as hydrochloride:

Rythmol: 150 mg, 300 mg

Generic: 150 mg, 300 mg

Administration: Adult

Oral: Capsules should be swallowed whole; do not crush or chew; may be taken without regard to meals.

The Canadian labeling recommends the tablet be swallowed whole with liquid and to be administered with food.

Bariatric surgery: Capsule, extended release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. IR tablet formulation is available. If safety and efficacy can be effectively monitored, no change in formulation or administration is required after bariatric surgery; however, selection of IR tablet should be strongly considered for propafenone after bariatric surgery.

Use: Labeled Indications

Immediate release: Treatment of life-threatening ventricular arrhythmias; to prolong the time to recurrence of paroxysmal atrial fibrillation/flutter (PAF) or paroxysmal supraventricular tachycardia (PSVT) in patients with disabling symptoms without structural heart disease.

ER capsule: Prolong the time to recurrence of symptomatic atrial fibrillation in patients without structural heart disease.

Use: Off-Label: Adult

Atrial fibrillation/flutter, pharmacologic cardioversion

Metabolism/Transport Effects

Substrate of CYP1A2 (Minor), CYP2D6 (Major), CYP3A4 (Major with inducers), CYP3A4 (Minor with inhibitors); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP1A2 (Weak), CYP2D6 (Weak), P-glycoprotein;

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Adagrasib: May increase QTc-prolonging effects of Propafenone. Adagrasib may increase serum concentration of Propafenone. Risk X: Avoid

Afatinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Afatinib. Management: If combined, administer the P-gp inhibitor simultaneously with, or after, the dose of afatinib. Monitor closely for signs and symptoms of afatinib toxicity and if the combination is not tolerated, reduce the afatinib dose by 10 mg. Risk D: Consider Therapy Modification

Aliskiren: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Aliskiren. Risk C: Monitor

Amiodarone: May increase QTc-prolonging effects of Propafenone. Risk X: Avoid

Amisulpride (Oral): May increase QTc-prolonging effects of QT-prolonging Agents (Moderate Risk). Risk C: Monitor

Artemether and Lumefantrine: May increase serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor

Atazanavir: May increase serum concentration of Propafenone. Management: Avoid using ritonavir-boosted atazanavir with propafenone. Use of unboosted atazanavir with propafenone should be done with caution and close monitoring for evidence increased propafenone concentrations and adverse effects. Risk D: Consider Therapy Modification

Bilastine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Bilastine. Risk X: Avoid

Bradycardia-Causing Agents: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Cardiac Glycosides: Propafenone may increase serum concentration of Cardiac Glycosides. Management: Measure cardiac glycoside serum concentrations before initiating treatment with propafenone. Reduce cardiac glycoside concentrations by either reducing the dose by 30% to 50% or by modifying the dosing frequency. Risk D: Consider Therapy Modification

Celiprolol: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Celiprolol. Risk C: Monitor

Colchicine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Colchicine. Colchicine distribution into certain tissues (e.g., brain) may also be increased. Management: This combination is often contraindicated, but combined use may be permitted with dose adjustment and monitoring. Recommendations vary based on brand, indication, use of CYP3A4 inhibitors, and hepatic/renal function. See interaction monograph for details. Risk D: Consider Therapy Modification

CycloSPORINE (Systemic): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of CycloSPORINE (Systemic). Risk C: Monitor

CYP2D6 Inhibitors (Moderate): May increase serum concentration of Propafenone. Risk C: Monitor

CYP2D6 Inhibitors (Strong): May increase serum concentration of Propafenone. Risk C: Monitor

CYP3A4 Inducers (Strong): May decrease serum concentration of Propafenone. Risk C: Monitor

CYP3A4 Inhibitors (Strong): May increase serum concentration of Propafenone. Risk C: Monitor

Dabigatran Etexilate: P-glycoprotein/ABCB1 Inhibitors may increase active metabolite exposure of Dabigatran Etexilate. Risk C: Monitor

Dabrafenib: May increase QTc-prolonging effects of QT-prolonging Class IC Antiarrhythmics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Domperidone: QT-prolonging Agents (Moderate Risk) may increase QTc-prolonging effects of Domperidone. Risk X: Avoid

DOXOrubicin (Conventional): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of DOXOrubicin (Conventional). Risk X: Avoid

DOXOrubicin (Liposomal): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of DOXOrubicin (Liposomal). Risk C: Monitor

Edoxaban: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Edoxaban. Risk C: Monitor

Encorafenib: May increase QTc-prolonging effects of Propafenone. Encorafenib may decrease serum concentration of Propafenone. Management: Monitor for QTc interval prolongation, ventricular arrhythmias, and reduced propafenone concentrations and efficacy when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Ensartinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Ensartinib. Risk X: Avoid

Etoposide Phosphate: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Etoposide Phosphate. Risk C: Monitor

Etoposide: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Etoposide. Risk C: Monitor

Etrasimod: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Everolimus: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Everolimus. Risk C: Monitor

Fezolinetant: CYP1A2 Inhibitors (Weak) may increase serum concentration of Fezolinetant. Risk X: Avoid

Fingolimod: Bradycardia-Causing Agents may increase bradycardic effects of Fingolimod. Management: Consult with the prescriber of any bradycardia-causing agent to see if the agent could be switched to an agent that does not cause bradycardia prior to initiating fingolimod. If combined, perform continuous ECG monitoring after the first fingolimod dose. Risk D: Consider Therapy Modification

Fluorouracil Products: QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of Fluorouracil Products. Management: Monitor for QTc interval prolongation and ventricular arrhythmias, including torsades de pointes when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Fosamprenavir: May increase serum concentration of Propafenone. Management: Concurrent use of ritonavir-boosted fosamprenavir with propafenone is contraindicated. The use of non-ritonavir-boosted fosamprenavir with propafenone is not specifically contraindicated but should only be undertaken with caution. Risk X: Avoid

Glecaprevir and Pibrentasvir: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Glecaprevir and Pibrentasvir. Risk C: Monitor

Grapefruit Juice: May increase serum concentration of Propafenone. Risk X: Avoid

Haloperidol: QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Ivabradine: Bradycardia-Causing Agents may increase bradycardic effects of Ivabradine. Risk C: Monitor

Lacosamide: Bradycardia-Causing Agents may increase AV-blocking effects of Lacosamide. Risk C: Monitor

Lacosamide: QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase adverse/toxic effects of Lacosamide. Specifically the risk for bradycardia, ventricular tachyarrhythmias, or a prolonged PR interval may be increased. Risk C: Monitor

Landiolol: Bradycardia-Causing Agents may increase bradycardic effects of Landiolol. Risk X: Avoid

Lapatinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Lapatinib. Risk C: Monitor

Larotrectinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Larotrectinib. Risk C: Monitor

Lefamulin: May increase QTc-prolonging effects of QT-prolonging CYP3A4 Substrates. Management: Do not use lefamulin tablets with QT-prolonging CYP3A4 substrates. Lefamulin prescribing information lists this combination as contraindicated. Risk X: Avoid

Levoketoconazole: QT-prolonging CYP3A4 Substrates may increase QTc-prolonging effects of Levoketoconazole. Levoketoconazole may increase serum concentration of QT-prolonging CYP3A4 Substrates. Risk X: Avoid

Mavorixafor: May increase serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk X: Avoid

Methadone: Propafenone may increase QTc-prolonging effects of Methadone. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

Mexiletine: Propafenone may increase serum concentration of Mexiletine. Risk C: Monitor

Midodrine: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

Morphine (Systemic): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Morphine (Systemic). Risk C: Monitor

Nadolol: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Nadolol. Risk C: Monitor

Naldemedine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Naldemedine. Risk C: Monitor

Naloxegol: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Naloxegol. Risk C: Monitor

Nirmatrelvir and Ritonavir: May increase serum concentration of Propafenone. Risk X: Avoid

Ondansetron: QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of Ondansetron. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Opipramol: May increase serum concentration of Propafenone. Propafenone may increase serum concentration of Opipramol. Risk C: Monitor

Orlistat: May decrease absorption of Propafenone. Risk C: Monitor

Ozanimod: May increase bradycardic effects of Bradycardia-Causing Agents. Risk C: Monitor

PAZOPanib: Propafenone may increase QTc-prolonging effects of PAZOPanib. Propafenone may increase serum concentration of PAZOPanib. Risk X: Avoid

Peginterferon Alfa-2b: May decrease serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Peginterferon Alfa-2b may increase serum concentration of CYP2D6 Substrates (High risk with Inhibitors). Risk C: Monitor

Pentamidine (Systemic): QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of Pentamidine (Systemic). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Pimozide: May increase QTc-prolonging effects of QT-prolonging Agents (Moderate Risk). Risk X: Avoid

Piperaquine: QT-prolonging Agents (Moderate Risk) may increase QTc-prolonging effects of Piperaquine. Risk X: Avoid

Ponesimod: Bradycardia-Causing Agents may increase bradycardic effects of Ponesimod. Management: Avoid coadministration of ponesimod with drugs that may cause bradycardia when possible. If combined, monitor heart rate closely and consider obtaining a cardiology consult. Do not initiate ponesimod in patients on beta-blockers if HR is less than 55 bpm. Risk D: Consider Therapy Modification

Posaconazole: May increase serum concentration of QT-prolonging CYP3A4 Substrates. Such increases may lead to a greater risk for proarrhythmic effects and other similar toxicities. Risk X: Avoid

Propranolol: Propafenone may increase serum concentration of Propranolol. Propranolol may increase serum concentration of Propafenone. Risk C: Monitor

QT-prolonging Antidepressants (Moderate Risk): QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Antidepressants (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Antipsychotics (Moderate Risk): QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Class IA Antiarrhythmics (Highest Risk): Propafenone may increase QTc-prolonging effects of QT-prolonging Class IA Antiarrhythmics (Highest Risk). Risk X: Avoid

QT-prolonging Class IC Antiarrhythmics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Class IC Antiarrhythmics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Class III Antiarrhythmics (Highest Risk): Propafenone may increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Risk X: Avoid

QT-Prolonging Inhalational Anesthetics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Class IC Antiarrhythmics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Kinase Inhibitors (Highest Risk): Propafenone may increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

QT-prolonging Kinase Inhibitors (Moderate Risk): QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Miscellaneous Agents (Highest Risk): Propafenone may increase QTc-prolonging effects of QT-prolonging Miscellaneous Agents (Highest Risk). Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification

QT-prolonging Miscellaneous Agents (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Class IC Antiarrhythmics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk): QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Quinolone Antibiotics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Class IC Antiarrhythmics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk): QT-prolonging Class IC Antiarrhythmics (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Quinidine (Non-Therapeutic): May increase QTc-prolonging effects of QT-prolonging CYP2D6 Substrates. Quinidine (Non-Therapeutic) may increase serum concentration of QT-prolonging CYP2D6 Substrates. Risk X: Avoid

QuiNIDine: Propafenone may increase QTc-prolonging effects of QuiNIDine. QuiNIDine may increase serum concentration of Propafenone. Risk X: Avoid

Ranolazine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Ranolazine. Risk C: Monitor

Relugolix, Estradiol, and Norethindrone: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Relugolix, Estradiol, and Norethindrone. Management: Avoid use of relugolix/estradiol/norethindrone with P-glycoprotein (P-gp) inhibitors. If concomitant use is unavoidable, relugolix/estradiol/norethindrone should be administered at least 6 hours before the P-gp inhibitor. Risk D: Consider Therapy Modification

Relugolix: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Relugolix. Management: Avoid coadministration of relugolix with oral P-gp inhibitors whenever possible. If combined, take relugolix at least 6 hours prior to the P-gp inhibitor and monitor patients more frequently for adverse reactions. Risk D: Consider Therapy Modification

Repotrectinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Repotrectinib. Risk X: Avoid

RifAXIMin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of RifAXIMin. Risk C: Monitor

Rimegepant: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Rimegepant. Management: Avoid administration of another dose of rimegepant within 48 hours if given concomitantly with a P-glycoprotein (P-gp) inhibitor. Risk D: Consider Therapy Modification

RisperiDONE: Propafenone may increase QTc-prolonging effects of RisperiDONE. Propafenone may increase serum concentration of RisperiDONE. Management: Monitor for increased risperidone toxicities, including QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor

Ritonavir: May increase serum concentration of Propafenone. Risk X: Avoid

RomiDEPsin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of RomiDEPsin. Risk C: Monitor

Saquinavir: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Saquinavir. Risk C: Monitor

Sertindole: May increase QTc-prolonging effects of QT-prolonging Agents (Moderate Risk). Risk X: Avoid

Silodosin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Silodosin. Risk C: Monitor

Simeprevir: May increase serum concentration of Propafenone. Risk C: Monitor

Siponimod: Bradycardia-Causing Agents may increase bradycardic effects of Siponimod. Management: Avoid coadministration of siponimod with drugs that may cause bradycardia. If combined, consider obtaining a cardiology consult regarding patient monitoring. Risk D: Consider Therapy Modification

Sirolimus (Conventional): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Sirolimus (Conventional). Management: Avoid concurrent use of sirolimus with P-glycoprotein (P-gp) inhibitors when possible and alternative agents with lesser interaction potential with sirolimus should be considered. Monitor for increased sirolimus concentrations/toxicity if combined. Risk D: Consider Therapy Modification

Sirolimus (Protein Bound): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Sirolimus (Protein Bound). Risk X: Avoid

Tacrolimus (Systemic): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor

Talazoparib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Talazoparib. Risk C: Monitor

Teniposide: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Teniposide. Risk C: Monitor

Tenofovir Disoproxil Fumarate: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Tenofovir Disoproxil Fumarate. Risk C: Monitor

Theophylline Derivatives: CYP1A2 Inhibitors (Weak) may increase serum concentration of Theophylline Derivatives. Risk C: Monitor

Thioridazine: QT-prolonging Agents (Moderate Risk) may increase QTc-prolonging effects of Thioridazine. Risk X: Avoid

Tipranavir: May increase serum concentration of Propafenone. Risk X: Avoid

TiZANidine: CYP1A2 Inhibitors (Weak) may increase serum concentration of TiZANidine. Management: Avoid the use of tizanidine with weak CYP1A2 inhibitors when possible. If combined, monitor closely for increased tizanidine toxicities (eg, hypotension, bradycardia, drowsiness). Tizanidine dose reduction or discontinuation may be necessary. Risk D: Consider Therapy Modification

Topotecan: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Topotecan. Risk X: Avoid

Ubrogepant: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Ubrogepant. Management: Use an initial ubrogepant dose of 50 mg and second dose (at least 2 hours later if needed) of 50 mg when used with a P-gp inhibitor. Risk D: Consider Therapy Modification

Venetoclax: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Venetoclax. Management: Reduce the venetoclax dose by at least 50% in patients requiring concomitant treatment with P-glycoprotein (P-gp) inhibitors. Resume the previous venetoclax dose 2 to 3 days after discontinuation of a P-gp inhibitor. Risk D: Consider Therapy Modification

Venlafaxine: Propafenone may increase serum concentration of Venlafaxine. Venlafaxine may increase serum concentration of Propafenone. Risk C: Monitor

VinCRIStine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of VinCRIStine. Risk X: Avoid

Vitamin K Antagonists: Propafenone may increase serum concentration of Vitamin K Antagonists. Risk C: Monitor

Food Interactions

Administration of food with single-dose propafenone increased propafenone serum concentrations and bioavailability; however, with multidose administration, propafenone bioavailability was not significantly different between fed and fasted states. Management: Administer without regard to meals.

Propafenone serum concentrations may be increased with concomitant use of grapefruit juice. Management: Monitor for increased effects/toxicity with concomitant use.

Reproductive Considerations

Propafenone may cause reversible impairment of spermatogenesis.

Pregnancy Considerations

Propafenone and the 5-hydroxypropafenone metabolite cross the placenta and can be detected in the newborn (Brunozzi 1988; Libardoni 1991).

Due to pregnancy-induced physiologic changes, some pharmacokinetic properties of propafenone may be altered (Libardoni 1991).

Untreated maternal arrhythmias may cause adverse events in the mother and fetus; guidelines are available for the management of arrhythmias during pregnancy (ESC [Regitz-Zagrosek 2018]). Propafenone may be used for the ongoing management of pregnant patients with highly symptomatic supraventricular tachycardia (SVT). The lowest effective dose is recommended; avoid use during the first trimester if possible (ACC/AHA/HRS [Page 2016]). Use is also recommended for the prevention of SVT in patients with Wolff-Parkinson-White (WPW) syndrome. Until more data are available, when prevention of SVT in patients without WPW syndrome, atrial tachycardia, or atrial fibrillation is needed in pregnant patients, propafenone is generally reserved for use when other agents are not effective (ESC [Regitz-Zagrosek 2018]).

Breastfeeding Considerations

Propafenone and the 5-hydroxypropafenone metabolite are present in breast milk.

Data related to the presence of propafenone are available from case reports.

• A report describes the use of propafenone administered orally to a mother during the last trimester of pregnancy (300 mg three times daily) and postpartum. Breast milk was sampled prior to the morning dose 3 days after delivery. Milk concentrations were 32 ng/mL (propafenone) and 47 ng/mL (5-hydroxypropafenone). Authors of the study calculated the relative infant dose (RID) of propafenone to the breastfed infant to be ~0.03% of the weight adjusted maternal dose. The infant was not breastfed (Libardoni 1991).

• A second case reports breast milk concentrations following a single dose of propafenone 150 mg orally. Sampling occurred at intervals between 1 and 12 hours after the dose (postpartum age not noted). The highest breast milk concentrations were observed at 2 hours (propafenone 37.4 ng/mL; 5-hydroxypropafenone 102 ng/mL), and concentrations were undetectable 12 hours after the maternal dose. Authors of this report calculated the RID to be 0.1%. The infant was not breastfed (Wakaumi 2005).

• In general, breastfeeding is considered acceptable when the RID of a medication is <10% (Anderson 2016; Ito 2000).

According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Monitoring Parameters

ECG, blood pressure, pulse (particularly at initiation of therapy)

Mechanism of Action

Propafenone is a class 1c antiarrhythmic agent which possesses local anesthetic properties, blocks the fast inward sodium current, and slows the rate of increase of the action potential. Prolongs conduction and refractoriness in all areas of the myocardium, with a slightly more pronounced effect on intraventricular conduction; it prolongs effective refractory period, reduces spontaneous automaticity and exhibits some beta-blockade activity.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Well absorbed

Distribution: Vd: Adults: 252 L

Protein binding: 95% to alpha1-acid glycoprotein

Metabolism: Hepatic via CYP2D6, CYP3A4 and CYP1A2 to two active metabolites (5-hydroxypropafenone and N-depropylpropafenone) then ultimately to glucuronide or sulfate conjugates. Two genetically determined metabolism groups exist (extensive and poor metabolizers); 10% of Caucasians are poor metabolizers. Exhibits nonlinear pharmacokinetics; when dose is increased from 300-900 mg/day, serum concentrations increase tenfold; this nonlinearity is thought to be due to saturable first-pass effect.

Bioavailability: Immediate release (IR): 150 mg: 3.4%; 300 mg: 10.6%; relative bioavailability of extended release (ER) capsule is less than IR tablet; the bioavailability of an ER capsule regimen of 325 mg twice-daily regimen approximates an IR tablet regimen of 150 mg 3 times/day.

Half-life elimination: Extensive metabolizers: 2-10 hours; Poor metabolizers: 10-32 hours

Time to peak, serum: IR: 3.5 hours; ER: 3-8 hours

Excretion: Urine (<1% unchanged; remainder as glucuronide or sulfate conjugates); feces

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Hepatic function impairment: Cl is reduced and elimination half-life is increased.

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AE) United Arab Emirates: Apo-propafenone | Rytmonorm;
  • (AR) Argentina: Normorytmin;
  • (AT) Austria: Propafenon accord | Propafenon genericon pharma | Rytmonorma;
  • (BD) Bangladesh: Rythmosin;
  • (BE) Belgium: Rytmonorm;
  • (BG) Bulgaria: Propafenon Alkaloi | Rytmocard | Rytmonorm;
  • (BR) Brazil: Cloridrato de propafenona | Ritmonorm | Tunta;
  • (CH) Switzerland: Rytmonorm;
  • (CL) Chile: Corecel | Ritmocor | Rytmonorm;
  • (CN) China: Propafenone | Rytmonorm | Xin lv ping;
  • (CO) Colombia: Propafen | Propafenona | Rytmonorm;
  • (CZ) Czech Republic: Profenorm | Prolekofen | Propafenon al | Propanorm | Rytmonorm;
  • (DE) Germany: Cuxafenon | Jutanorm | Pintoform | Propa-Oramon | Propafen biochemie | Propafenon | Propafenon Aliud | Propafenon Corax | Propafenon CT | Propafenon Eu Rho | Propafenon Lich | Propafenon Ratiopharm | Propafenon Sandoz | Propafenon Siga | Propafenon stada | Propafucon | Propamerck | Prorynorm | Rytmo Puren | Rytmogenat | Rytmonorm | Tachyfenon;
  • (DO) Dominican Republic: Rytmonorm;
  • (EC) Ecuador: Berezo | Rytmonorm | Tunta;
  • (EE) Estonia: Propafenone accord | Propanorm | Rytmonorm;
  • (EG) Egypt: Rytmonorm;
  • (ES) Spain: Propafenona hidrocloruro accord | Rytmonorm;
  • (FI) Finland: Propanorm | Rytmonorm;
  • (FR) France: Propafenone accord | Rythmol;
  • (GB) United Kingdom: Arythmol;
  • (GR) Greece: Rythmonorm;
  • (HK) Hong Kong: Apo-propafenone | Propafenone | Rytmonorm;
  • (HR) Croatia: Propafenon Alkaloid | Rytmonorm;
  • (HU) Hungary: Propafenon | Propafenon al | Propafenone Orion | Rytmonorm;
  • (ID) Indonesia: Rytmonorm;
  • (IE) Ireland: Arythmol | Propafenone;
  • (IL) Israel: Profex | Rythmex;
  • (IN) India: Pradil | Rhythmonorm | Rytmonorm;
  • (IT) Italy: Cardiofenone | Fenorit | Propafenone | Propafenone accord | Propafenone Doc | Propafenone eg | Rytmonorm;
  • (JO) Jordan: Rytmonorm;
  • (JP) Japan: Pronon | Ropaful | Ropaful choseido | Sobiral;
  • (KR) Korea, Republic of: Profenon | Ritmol | Rytmonorm | Rytmonorm sr;
  • (KW) Kuwait: Apo-propafenone | Rytmonorm;
  • (LB) Lebanon: Rytmonorm;
  • (LT) Lithuania: Prolekofen | Propafenone accord | Propanorm | Rytmonorm;
  • (LU) Luxembourg: Propafenon Hexal | Prorynorm | Rytmonorm;
  • (LV) Latvia: Prolekofen | Propafenone accord | Rytmonorm;
  • (MX) Mexico: Biopafen | Kenona | Nistaken | Norfenon | Propafenona;
  • (MY) Malaysia: Rytmonorm;
  • (NL) Netherlands: Propafenon | Propafenon Hcl PCH | Rytmonorm;
  • (NO) Norway: Rytmonorm;
  • (NZ) New Zealand: Rytmonorm;
  • (PE) Peru: Rytmonorm;
  • (PH) Philippines: Rytmocard;
  • (PL) Poland: Polfenon | Prolekofen | Tonicard;
  • (PR) Puerto Rico: Propafenone HCL | Rythmol;
  • (PT) Portugal: Propafenona accord;
  • (PY) Paraguay: Ritmonorm;
  • (QA) Qatar: Rytmonorm;
  • (RU) Russian Federation: Propafenon | Propafenone | Propanorm | Rytmonorm;
  • (SE) Sweden: Rytmonorm;
  • (SG) Singapore: Rytmonorm;
  • (SI) Slovenia: Prolekofen | Propafenon | Propafenon alkaloid int | Rytmonorm | Rytmonorma;
  • (SK) Slovakia: Prolekofen | Propanorm | Rytmonorm;
  • (TH) Thailand: Rytmonorm;
  • (TR) Turkey: Ritmoll | Rytmonorm;
  • (TW) Taiwan: Rhynorm | Rytmonorm;
  • (UA) Ukraine: Rythmocard | Rytmonorm;
  • (UY) Uruguay: Rytmonorm | Taqui;
  • (VE) Venezuela, Bolivarian Republic of: Rytmonorm;
  • (ZA) South Africa: Rythmol
  1. Alboni P, Botto GL, Baldi N, et al, "Outpatient Treatment of Recent-Onset Atrial Fibrillation With the "Pill-in-the-Pocket" Approach," N Engl J Med, 2004, 351(23):2384-91. [PubMed 15575054]
  2. Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published online October 30, 2017]. Circulation. doi: 10.1161/CIR.0000000000000549. [PubMed 29084731]
  3. Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. doi: 10.1002/cpt.377. [PubMed 27060684]
  4. “A Randomized, Placebo-Controlled Trial of Propafenone in the Prophylaxis of Paroxysmal Supraventricular Tachycardia and Paroxysmal Atrial Fibrillation. UK Propafenone PSVT Study Group,” Circulation, 1995, 92(9):2550-7. [PubMed 7586356]
  5. Boriani G, Capucci A, Lenzi T, et al, “Propafenone for Conversion of Recent-Onset Atrial Fibrillation. A Controlled Comparison Between Oral Loading Dose and Intravenous Administration,” Chest, 1995, 108(2):355-8. [PubMed 7634866]
  6. Boriani G, Biffi M, Capucci A, et al, “Oral Propafenone to Convert Recent-Onset Atrial Fibrillation in Patients With and Without Underlying Heart Disease. A Randomized, Controlled Trial,” Ann Intern Med, 1997, 126(8):621-5. [PubMed 9103129]
  7. Brunozzi LT, Meniconi L, Chiocchi P, Liberati R, Zuanetti G, Latini R. Propafenone in the treatment of chronic ventricular arrhythmias in a pregnant patient. Br J Clin Pharmacol. 1988;26(4):489-490. doi:10.1111/j.1365-2125.1988.tb03413.x [PubMed 3191001]
  8. Burgess E, Duff H, Wilkes P. Propafenone disposition in renal insufficiency and renal failure. J Clin Pharmacol. 1989a;29(2):112-113. [PubMed 2715367]
  9. Burgess ED, Duff HJ. Hemodialysis removal of propafenone. Pharmacotherapy. 1989b;9(5):331-333. [PubMed 2813154]
  10. Chua TP, Farrell T, Lipkin DP. Myoclonus associated with propafenone. BMJ. 1994;308(6921):113. doi:10.1136/bmj.308.6921.113b [PubMed 8298383]
  11. Echt DS, Liebson PR, Mitchell LB, et al, “Mortality and Morbidity in Patients Receiving Encainide, Flecainide, or Placebo: The Cardiac Arrhythmia Suppression Trial,” N Engl J Med, 1991, 324(12):781-8. [PubMed 1900101]
  12. Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
  13. Fromm MF, Botsch S, Heinkele G, et al. Influence of renal function on the steady-state pharmacokinetics of the antiarrhythmic propafenone and its phase I and phase II metabolites. Eur J Clin Pharmacol. 1995;48(3-4):279-283. [PubMed 7589055]
  14. Funck-Brentano C, Kroemer HK, Lee JT, et al, “Propafenone,” N Engl J Med, 1990, 322(8):518-25. [PubMed 2405273]
  15. Galasso PJ, Stanton MS, Vogel H. Propafenone-induced peripheral neuropathy. Mayo Clin Proc. 1995;70(5):469-472. doi:10.4065/70.5.469 [PubMed 7731257]
  16. Hii JT, Wyse DG, Gillis AM, et al, “Propafenone-Induced Torsade de Pointes: Cross-Reactivity With Quinidine,” Pacing Clin Electrophysiol, 1991,14(11 Pt 1):1568-70. [PubMed 1721143]
  17. Huang YM, Lee WR, Hu CH, Cheng KL. Propafenone-induced acute generalized exanthematous pustulosis. Int J Dermatol. 2005;44(3):256-257. doi:10.1111/j.1365-4632.2004.02311.x [PubMed 15807741]
  18. Incorvaia C, Pravettoni C, Riario-Sforza GG. Urticaria-angioedema reaction caused by propafenone. Allergy. 2006;61(2):269. doi:10.1111/j.1398-9995.2006.00981.x [PubMed 16409210]
  19. Ito S. Drug therapy for breast-feeding women [published correction appears in N Engl J Med. 2000;343(18):1348]. N Engl J Med. 2000;343(2):118-126. doi: 10.1056/NEJM200007133430208. [PubMed 10891521]
  20. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation. 2024;149(1):e1-e156. doi:10.1161/CIR.0000000000001193 [PubMed 38033089]
  21. Libardoni M, Piovan D, Busato E, Padrini R. Transfer of propafenone and 5-OH-propafenone to foetal plasma and maternal milk. Br J Clin Pharmacol. 1991;32(4):527-528. [PubMed 1958453]
  22. O'Rourke DJ, Palac RT, Holzberger PT, Gerling BR, Greenberg ML. Propafenone-induced drug fever in the absence of agranulocytosis. Clin Cardiol. 1997;20(7):662-664. doi:10.1002/clc.4960200715 [PubMed 9220185]
  23. Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2016;67(13):e27-e115. doi: 10.1016/j.jacc.2015.08.856. [PubMed 26409259]
  24. Palleschi GM, Bellandi S, Torchia D. Propafenone-induced psoriasis. Clin Exp Dermatol. 2008;33(2):209-210. doi:10.1111/j.1365-2230.2007.02671.x [PubMed 18257839]
  25. Poirier JM, Joannides R, Geffroy-Josse S, Fillastre JP, Etienne I. Propafenone pharmacokinetics in uremic patients treated by peritoneal dialysis. Clin Nephrol. 1992;38(4):231-232. [PubMed 1424311]
  26. Propafenone [prescribing information]. Baudette, MN: ANI Pharmaceuticals; November 2018.
  27. Propafenone [prescribing information]. Chestnut Ridge, NY: Par Pharmaceutical; February 2020.
  28. Refer to the manufacturer's labeling.
  29. Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, et al; ESC Scientific Document Group. 2018 ESC guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165-3241. doi: 10.1093/eurheartj/ehy340. [PubMed 30165544]
  30. Rythmol SR (propafenone) [prescribing information]. Research Triangle Park, NC: GlaxoSmithKline; November 2018.
  31. Rythmol (propafenone) [product monograph]. Etobicoke, Ontario, Canada: BGP Pharma ULC; August 2021.
  32. Sarubbi B, Ducceschi V, Briglia N, et al, “Compared Effects of Sotalol, Flecainide and Propafenone on Ventricular Repolarization in Patients Free of Underlying Structural Heart Disease,” Int J Cardiol, 1998, 66(2):157-64. [PubMed 9829329]
  33. Seto W, Trope AE, Gow RM. Propafenone disposition during continuous venovenous hemofiltration. Ann Pharmacother. 1999;33(9):957-959. [PubMed 10492500]
  34. Siddoway LA, Roden DM, and Woosley RL, “Clinical Pharmacology of Propafenone: Pharmacokinetics, Metabolism and Concentration-Response Relations,” Am J Cardiol, 1984, 54(9):9D-12D. [PubMed 6496371]
  35. Skanes AC, Healey JS, Cairns JA, et al, “Focused 2012 Update of the Canadian Cardiovascular Society Atrial Fibrillation Guidelines: Recommendations for Stroke Prevention and Rate/Rhythm Control,” Can J Cardiol, 2012, 28(2):125-36. [PubMed 22433576]
  36. Wakaumi M, Tsuruoka S, Sakamoto K, Shiga T, Fujimura A. Pilsicainide in breast milk from a mother: comparison with disopyramide and propafenone. Br J Clin Pharmacol. 2005;59(1):120-122. doi: 10.1111/j.1365-2125.2004.02219.x. [PubMed 15606453]
  37. Younan LB, Barada KA, Faraj WG, et al. Propafenone hepatotoxicity: report of a new case and review of the literature. Saudi J Gastroenterol. 2013;19(5):235-237. doi:10.4103/1319-3767.118137 [PubMed 24045598]
Topic 9821 Version 500.0