{"id":53091,"date":"2022-08-12T09:30:14","date_gmt":"2022-08-12T13:30:14","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=53091"},"modified":"2022-08-11T14:49:44","modified_gmt":"2022-08-11T18:49:44","slug":"multaq-alternatives","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/multaq-alternatives\/","title":{"rendered":"Multaq alternatives: What can I take instead of Multaq?"},"content":{"rendered":"

Compare Multaq alternatives<\/a> | Pacerone<\/a> | Tikosyn<\/a> | <\/span>Flecainide<\/span><\/a> | Rythmol SR<\/a> | Betapace AF<\/a> | Natural alternatives<\/a> | How to switch meds<\/a><\/span><\/p>\n

Have you ever felt your heart skip a beat or flutter? We sometimes joke this happens while around a new love interest, but in reality, an <\/span>atrial flutter<\/span> can be indicative of an <\/span>abnormal heart rhythm<\/span>, like <\/span>atrial fibrillation<\/span><\/a> \u2013 or \u201c<\/span>afib<\/span>\u201d for short. A diagnosis of <\/span>atrial fibrillation<\/span> is serious, and while management with electrical <\/span>cardioversion<\/span> is a possibility, the condition will likely require medications for treatment of the <\/span>abnormal heart rhythm<\/span> and prevent some common effects associated with the diagnosis\u2014such as blood thinners like <\/span>warfarin<\/span> to prevent stroke. Medications targeting the actual <\/span>heart rhythm<\/span> take two broad routes: rate control or <\/span>rhythm control<\/span>. Rate control medications slow the <\/span>heart rate<\/span> down, while <\/span>antiarrhythmic drugs<\/span>, like <\/span>Multaq<\/span> (<\/span>dronedarone<\/span>)<\/span>, aim to restore a normal <\/span>heart rhythm<\/span>.\u00a0<\/span><\/p>\n

RELATED: <\/b>Here\u2019s what actually happens when your heart skips a beat<\/b><\/a><\/p>\n

What can I take in place of <\/span>Multaq<\/span>?<\/span><\/h2>\n

Alternative Multaq prescription medications include other types of <\/span>antiarrhythmic drugs<\/span>, as well as those that aim to control the heart rate. These options may be more suitable for certain individuals based on other underlying health conditions, or due to their different uses, <\/span>side effect<\/span> profiles, and dosages.<\/span> Rate control may be preferred over <\/span>rhythm control<\/span> in very elderly patients (e.g., greater than 80 years of age) or patients with asymptomatic and long-standing or recurrent <\/span>afib<\/span>, whereas <\/span>rhythm control<\/span> might be preferred in patients at high risk for <\/span>cardiovascular<\/span> complications (e.g., older age, history of a stroke, among other factors), in those who have failed rate control, in those with <\/span>heart failure<\/span>, and finally in younger patients (less than 65 years of age). Either way, a <\/span>rhythm-control<\/span> strategy is not superior to rate-control<\/span><\/a> in mortality and may increase <\/span>hospitalization<\/span> given their <\/span>proarrhythmia<\/span> potential. If <\/span>afib<\/span> is unable to be converted to a normal rhythm, antiarrhythmics should not be continued. The decision to manage this <\/span>cardiac arrhythmia<\/span> with rate control versus <\/span>rhythm control<\/span> will be made by a <\/span>healthcare<\/span> professional specializing in <\/span>cardiology<\/span> after a detailed discussion weighing the risks and benefits of each approach for each patient.<\/span><\/p>\n

RELATED: <\/b>Antiarrhythmics: Uses, common brands, and safety info<\/b>
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Compare Multaq alternatives<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n

Drug name<\/b><\/td>\nUses<\/b><\/td>\nDosage<\/b><\/td>\nCoupons<\/b><\/td>\n<\/tr>\n
Multaq<\/span><\/a> (dronaderone)\u00a0<\/span><\/td>\nRhythm control<\/span> \u2013 <\/span>paroxysmal<\/span> or <\/span>persistent atrial fibrillation<\/span><\/td>\n400 mg twice daily<\/span><\/td>\nMultaq<\/span> coupons<\/span><\/a><\/td>\n<\/tr>\n
Pacerone<\/span><\/a> (<\/span>amiodarone<\/span>)<\/span><\/td>\nRhythm control<\/span> \u2013 <\/span>atrial fibrillation<\/span><\/td>\n200 mg to 400 mg twice daily for 2 to 4 weeks, then 100 mg to 200 mg once daily<\/span><\/td>\nPacerone coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Tikosyn<\/span><\/a>
\n(<\/span>dofetilide<\/span>)<\/span><\/td>\n		Cardioversion<\/span>, <\/span>Rhythm control<\/span> \u2013 <\/span>atrial fibrillation<\/span><\/td>\n500 mcg twice daily<\/span><\/td>\nTikosyn coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Flecainide<\/span><\/a>\u00a0<\/span><\/td>\nCardioversion<\/span>, <\/span>Rhythm control<\/span> \u2013 <\/span>paroxysmal<\/span> atrial fibrillation<\/span><\/td>\nLess than 70 kg: 200 mg once<\/span>
\nGreater than or equal to 70 kg: 300 mg once<\/span><\/td>\n		Flecainide<\/span> coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Rythmol SR <\/span><\/a>(<\/span>propafenone<\/span> ER)<\/span><\/td>\nCardioversion<\/span>, <\/span>Rhythm control<\/span> \u2013 <\/span>paroxysmal<\/span> atrial fibrillation<\/span>; prevention of <\/span>atrial fibrillation<\/span> recurrence\u00a0<\/span><\/td>\nCardioversion<\/b>:<\/b> Less than 70 kg: 450 mg once<\/span>
\nGreater than or equal to 70 kg: 600 mg once<\/span>
\nPrevention of recurrence:\u00a0<\/b>
\nImmediate-release: 150 mg to 300 mg every 8 hours<\/span>
\nExtended-release: 225 mg to 425 mg every 12 hours<\/span><\/td>\n		Rythmol SR coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Betapace AF<\/span><\/a> (<\/span>sotalol<\/span>)<\/span><\/td>\nRhythm control<\/span> \u2013 symptomatic <\/span>atrial fibrillation<\/span><\/td>\n40 mg to 160 mg every 12 hours<\/span><\/td>\nBetapace AF coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Tenormin<\/span><\/a>
\n\u00a0(atenolol)<\/span><\/td>\n		Rate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\n25 mg to 100 mg once daily<\/span><\/td>\nTenormin coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Corgard<\/span><\/a>
\n(nadolol)<\/span>\u00a0<\/span><\/td>\n		Rate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\n10 mg to 240 mg once daily<\/span><\/td>\nCorgard coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Lopressor<\/span><\/a> (metoprolol tartrate)<\/span>\u00a0<\/span><\/td>\nRate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\n25 mg to 100 mg twice daily<\/span><\/td>\nLopressor coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Inderal LA<\/span><\/a> (propranolol ER)<\/span>\u00a0<\/span><\/td>\nRate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\n30 mg to 160 mg\/day in 3 to 4 divided doses<\/span><\/td>\nInderal LA coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Bisoprolol<\/span><\/a><\/td>\nRate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\n2.5 mg to 10 mg once daily<\/span><\/td>\nBisoprolol coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Coreg<\/span><\/a>
\n(carvedilol)<\/span><\/td>\n		Rate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\n3.125 mg to 25 mg twice daily<\/span><\/td>\nCoreg coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Calan SR<\/span><\/a> (verapamil ER)<\/span><\/td>\nRate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\n40 mg to 120 mg 3 to 4 times daily (maximum 480 mg\/day)<\/span><\/td>\nCalan SR coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Cardizem<\/span><\/a> (diltiazem)<\/span>\u00a0<\/span><\/td>\nRate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\n120 mg to 480 mg\/day in 3 to 4 divided doses<\/span><\/td>\nCardizem coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n
Lanoxin<\/span><\/a>
\n(<\/span>digoxin<\/span>)<\/span><\/td>\n		Rate control \u2013 <\/span>atrial fibrillation<\/span><\/td>\nIndividualized based on patient weight and renal function<\/span>
\nMaintenance dose: 0.125 mg to 0.25 mg once daily<\/span><\/td>\n		Lanoxin coupons<\/span><\/a>\u00a0<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Top 5 <\/span>Multaq<\/span> alternatives<\/span><\/h2>\n

The following are some of the most common alternatives to <\/span>Multaq<\/span> (dronedarone).<\/span><\/p>\n

1. Pacerone (<\/span>amiodarone<\/span>)<\/span><\/h3>\n

Pacerone (<\/span>amiodarone<\/span>) is an alternative to <\/span>Multaq<\/span> for <\/span>rhythm control<\/span> in patients with concomitant <\/span>congestive heart failure<\/span> or left ventricular systolic dysfunction. This medication may also provide some rate control, but alternative rate control medications may be preferred given the <\/span>drug interaction<\/span> potential and <\/span>toxicities<\/span> associated with its use.\u00a0<\/span><\/p>\n

Monitoring is required with use of Pacerone to evaluate for <\/span>hepatic<\/span> injury, pulmonary <\/span>toxicity<\/span>, <\/span>thyroid<\/span> function, eye exams, and other <\/span>adverse effects<\/span>. Up to <\/span>50% of patients<\/span><\/a> taking Pacerone may experience some type of <\/span>side effect<\/span>, which resolves slowly with discontinuation of the medication since it has a very long half-life\u2014taking the body a long time to be rid of the medication. Pacerone should be avoided in patients with concomitant conditions of cardiogenic shock, <\/span>bradycardia<\/span> (slow <\/span>heart rate<\/span>), and second- or third-degree AV block.\u00a0<\/span><\/p>\n

2. Tikosyn (<\/span>dofetilide<\/span>)<\/span><\/h3>\n

Tikosyn comes with some of the best evidence for <\/span>cardioversion<\/span> (restoration of a regular <\/span>heart rhythm<\/span>) and is an excellent option for maintenance of <\/span>sinus rhythm<\/span> in patients at low risk of serious rhythm abnormalities (e.g., QT prolongation and\/or torsades de pointes). Tikosyn therapy must be initiated in a controlled, inpatient setting, because of the risk of serious <\/span>heart rhythm<\/span> abnormalities, and doses are individualized based on the patient’s renal function and ECG findings and monitoring.\u00a0<\/span><\/p>\n

This medication requires dose adjustments in patients with decreased renal function and is <\/span>contraindicated<\/span> entirely in those whose renal function is seriously compromised. Tikosyn must also be avoided in conjunction with medications known to prevent its elimination or medications which deplete certain electrolytes like <\/span>potassium,<\/span> as this will increase the risk of <\/span>ventricular arrhythmias<\/span>.\u00a0<\/span><\/p>\n

3. <\/span>Flecainide<\/span><\/h3>\n

Flecainide<\/span> is another excellent option with strong evidence for <\/span>cardioversion<\/span> and maintenance of <\/span>sinus rhythm<\/span>. <\/span>Flecainide<\/span> may be used on an outpatient basis a<\/span>s a <\/span>“pill-in-the-pocket”<\/span><\/a> approach to intermittent <\/span>atrial fibrillation<\/span> after a successful inpatient <\/span>cardioversion<\/span> trial. Patients must also be on an AV nodal-blocking medication, such as certain <\/span>beta blockers<\/span><\/a> or specific <\/span>calcium channel blockers<\/span><\/a>, and take a dose of one of these medications 30 minutes prior to taking <\/span>flecainide<\/span> to minimize the risk of developing a <\/span>ventricular arrhythmia<\/span>. <\/span>Flecainide<\/span> should be <\/span>avoided in patients with known coronary artery disease<\/span><\/a> as it has demonstrated an increase in mortality in patients with a prior heart attack.<\/span><\/p>\n

4. Rythmol SR (<\/span>propafenone<\/span>)<\/span><\/h3>\n

Rythmol SR (<\/span>propafenone<\/span>) is an older medication that comes with strong evidence for its <\/span>cardioversion<\/span> capabilities and is yet another option for the maintenance of <\/span>sinus rhythm<\/span>. Similar to <\/span>flecainide<\/span>, <\/span>propafenone<\/span> can be used at home to terminate an episode of <\/span>afib<\/span> after an inpatient trial; it also should be taken 30 minutes after an AV nodal-blocking medication. It shouldn\u2019t be used in patients with <\/span>heart disease<\/span> or in patients with <\/span>heart failure<\/span>, asthma, severe COPD, and severe liver impairment. <\/span>Propafenone<\/span> also can cause significant <\/span>drug interactions<\/span>, such as increasing <\/span>warfarin<\/span><\/a> levels.\u00a0<\/span><\/p>\n

5. Betapace AF (<\/span>sotalol<\/span>)<\/span><\/h3>\n

Betapace AF (<\/span>sotalol<\/span>) is a <\/span>rhythm control<\/span> option for patients with or without a history of <\/span>heart failure<\/span> or mild to moderate left ventricular dysfunction but is not indicated for actual <\/span>cardioversion<\/span>. Betapace AF is <\/span>contraindicated<\/span> in patients with certain pulmonary disorders, and in patients with <\/span>bradycardia<\/span>, <\/span>sick sinus syndrome<\/span><\/a>, or second- or third-degree AV block. Initiation of this medication should occur as an inpatient to monitor for the development of proarrhythmic effects.\u00a0<\/span><\/p>\n

Natural alternatives to <\/span>Multaq<\/span><\/h2>\n

Lifestyle modifications<\/span><\/a> for reduction of <\/span>atrial fibrillation<\/span> is an ongoing area of clinical research. The American Heart Association (AHA) identifies the relationship between lifestyle and <\/span>afib<\/span>, and identifies the following contributing factors:<\/span><\/p>\n

There are other <\/span>drug therapy<\/span> options available for the <\/span>management of atrial fibrillation<\/span> that do not respond to <\/span>Multaq<\/span> (<\/span>dronedarone<\/span>), for those who suffer from <\/span>adverse effects<\/span>, or for those that are simply not good candidates for this medication. Patients with <\/span>severe heart failure<\/span>, historically classified as NYHA <\/span>class III<\/span> or IV <\/span>heart failure<\/span>, or with decompensated <\/span>heart failure<\/span> within the prior four weeks should not be initiated on <\/span>Multaq<\/span> (<\/span>dronedarone<\/span>). A groundbreaking study published in the <\/span>New England Journal of Medicine<\/span><\/a> demonstrated the use of <\/span>Multaq<\/span> in these patients increases the risk of mortality. <\/span>Multaq<\/span> is also <\/span>contraindicated<\/span> in patients with <\/span>liver failure<\/span>, and with medications and\/or supplements that prolong the QT interval. Finally, <\/span>Multaq<\/span> is only indicated for patients with <\/span>intermittent <\/span>afib<\/span><\/a>, as use in patients with <\/span>permanent atrial fibrillation<\/span> has been demonstrated to <\/span>increase mortality<\/span><\/a> in another landmark <\/span>clinical trial<\/span>.\u00a0<\/span><\/p>\n