Propafenone and carvedilol share a common hepatic metabolism involving the oxidative pathway (CYP2D6). Therefore, oral loading with propafenone (as "pill-in-the-pocket" treatment of recent-onset atrial fibrillation) in a patient on concurrent carvedilol treatment may lead to a pharmacokinetic interaction, with high plasma levels of propafenone and potential drug-related adverse effects. In clinical practice, in order to improve the safety of "pill-in-the-pocket" treatment, use of propafenone loading should, in our view, be discouraged in patients on concurrent treatment with carvedilol.
Atrial fibrillation: Adverse effects of "pill-in-the-pocket" treatment and propafenone-carvedilol interaction / Boriani, Giuseppe; Biffi, M; Diemberger, I; Domenichini, G; Marziali, A; Martignani, C.. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 140:2(2010), pp. 242-243. [10.1016/j.ijcard.2008.11.028]
Atrial fibrillation: Adverse effects of "pill-in-the-pocket" treatment and propafenone-carvedilol interaction.
BORIANI, Giuseppe;
2010
Abstract
Propafenone and carvedilol share a common hepatic metabolism involving the oxidative pathway (CYP2D6). Therefore, oral loading with propafenone (as "pill-in-the-pocket" treatment of recent-onset atrial fibrillation) in a patient on concurrent carvedilol treatment may lead to a pharmacokinetic interaction, with high plasma levels of propafenone and potential drug-related adverse effects. In clinical practice, in order to improve the safety of "pill-in-the-pocket" treatment, use of propafenone loading should, in our view, be discouraged in patients on concurrent treatment with carvedilol.
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