Dronedarone (Multaq) to Control Heart Rhythm

Unless otherwise noted, the following information about dronedarone (Multaq®) comes from the package insert.1

Purpose

Dronedarone is used for maintaining sinus rhythm after cardioversion or converting out of afib. It is the only antiarrhythmic shown to reduce the risk of hospitalization, heart-related death, and stroke in people with paroxysmal afib when started within a year of initial diagnosis.2,3,4

How to Use

Dronedarone is taken as 400 mg by mouth twice daily with meals. These meals should be more than a snack and include some fat, not just carbohydrates.

Warnings

Dronedarone should not be taken under the following circumstances:

  • If you have symptomatic heart failure requiring hospitalization or have a form of heart failure called left ventricular systolic dysfunction.
  • If you have liver disease, certain other heart rhythm conditions, or lung or liver damage from amiodarone.
  • If your doctor cannot get you into a normal sinus rhythm.
  • If you have permanent afib.

Common Side Effects

These are common side effects of dronedarone:

  • Diarrhea (typically for only a few days when starting dronedarone)
  • Heartburn
  • Weakness
  • Rash and redness on your skin

Serious Side Effects

Contact your doctor immediately if you experience any of the following serious side effects while taking dronedarone:

  • Shortness of breath
  • Wheezing, chest tightness, or coughing up frothy sputum at rest, nighttime, or after minor exercise
  • Trouble sleeping or waking up at night because of breathing problems
  • Needing additional pillows to prop yourself up at night so you can breathe more easily
  • Gaining more than 5 pounds quickly
  • Increasing swelling of feet or legs
  • Irregular pulse
  • Loss of appetite, nausea, or vomiting
  • Fever, feeling unwell, or unusual tiredness
  • Itching
  • Yellowing of the skin or the whites of the eyes (jaundice)
  • Unusual darkening of the urine
  • Right upper stomach area pain or discomfort

Drug Interactions

Talk with your doctor if you are using any of the following medications.

Medications that can affect the amount of dronedarone in your body include:

  • Nefazodone for depression
  • Ritonavir (Norvir®) for HIV infection
  • Certain antifungal medications
  • Clarithromycin, an antibiotic
  • Cyclosporine, an anti-rejection medication

Medications that could lead to a dangerous abnormal heart rhythm when taken with dronedarone include:

  • Phenothiazines (prescribed for mental health conditions)
  • Tricyclic antidepressants
  • Medications for abnormal heart rhythm or fast heartbeat
  • Certain antibacterials

Monitoring  

When taking dronedarone, you will need liver function tests every three months for the first year and every six months after that.

Guidelines

The various guidelines have specific recommendations related to dronedarone.

  • US guidelines (AHA/ACC/HRS) recommend dronedarone to maintain sinus rhythm, depending on underlying heart disease and other medical conditions.5
  • European guidelines (ESC) recommend dronedarone for long-term rhythm control in patients with afib, including those with heart failure, ischemic heart disease, or valvular heart disease.6
  • Canadian guidelines (CCS) leave the choice of which antiarrhythmic to use for maintaining rhythm control up to the physician based on patient characteristics.7

Resources