Summary
The efficacy of oral disopyramide and mexiletine used alone or in combination was studied in 75 patients with frequent ventricular premature beats (VPBs). The efficacy was evaluated with 24-hour ambulatory ECG and ≥ 75% reduction in the number of VPBs was defined as effective. When disopyramide or mexiletine were ineffective or not tolerated, the alternative drug was administered and the efficacy was again evaluated. If the single administration of neither drug was effective, the combination of disopyramide and mexiletine was then given. Either disopyramide or mexiletine was effective in 48 patients, and neither drug was effective in 19 patients. In 19 patients unresponsive to both drugs, combination therapy was effective in six patients (32%). Both drugs caused side effects or one drug caused side effects and another drug was ineffective in eight patients. In five out of those patients, we attempted combined therapy with a reduced dosage of those drugs that caused side effects. This therapy was effective in two patients without intolerable side effects. Thus, when the single use of neither disopyramide nor mexiletine single-drug therapy is effective, it is worth-while to try combination therapy. Also, combination therapy with a reduced dosage of the drugs that caused side effects might be the therapy of choice in patients who have developed dose-dependent side effects.
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References
Greenspan, AM, Spielman, SR, Horowitz, LN. Combination antiarrhythmic drug therapy for ventricular tachyarrhythmias. PACE 1986;9:565–576.
Levy, S. Combination therapy for cardiac arrhythmias. Am J Cardiol 1988;61:95A-101A.
Krichbaum, DW. Combination drug therapy for ventricular arrhythmias. Clin Pharm 1988;7:808–819.
Duff, HG, Roden, D, Primm, K, et al. Mexiletine in the treatment of resistant ventricular arrhythmias: Enhancement of efficacy and reduction of dose-related side effects by combination with quinidine. Circulation 1983;67:1124–1128.
Kim, SG, Felder, SD, Waspe, LE, et al. Electrophysiologic effects and clinical efficacy of mexiletine used alone or in combination with class IA agents for refractory recurrent ventricular tachycardias or ventricular fibrillation. Am J Cardiol 1985;58:485–490.
Stern, H, Scheininger, M, Theisen, F, et al. Antiarrhythmic therapy with flecainide in combination and comparison with propranolol. Drugs 1985;29:77–85.
Kim, SG, Seiden, SW, Matos, JA, et al. Combination of procainamide and quinidine for better tolerance and additive effects for ventricular arrhythmias. Am J Cardiol 1985; 56:84–88.
Kim, SG, Mercando, AD, Fisher, JD. Combination of tocainide and quinidine for better tolerance and additive effects in patients with coronary artery disease. J Am Coll Cardiol 1987;9:1369–1374.
Barbey, JT, Thompson, KA, Echt, DS, et al. Tocainide plus quinidine for treatment of ventricular arrhythmias. Am J Cardiol 1988;61:570–573.
Kim, SG, Mercando, AD, Tam, S. combination of disopyramide and mexiletine for better tolerance and additive effects for treatment of ventricular arrhythmias. J Am Coll cardiol 1989;13:659–664.
Roden, DM. Use of mexiletine in combination with other antiarrhythmic drugs. Clin Prog Electrophysiol Pacing 1986;4:561–567.
Clarkson, CW, Hondeghem, LM. Electrophysiological evidence that local anesthetics and antiarrhythmic drugs bind to a specific receptor site in cardiac sodium channels: Displacement of bupivacaine by lidocaine. Prog West Pharmacol Soc 1984;27:23–25.
Pratt, CM, Slymen, DJ, Wierman, AM, et al. Analysis of the spontaneous variability of ventricular arrhythmias: Consecutive ambulatory electrocardiographic recordings of ventricular tachycardia. Am J Cardiol 1985;56:67–72.
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Sakurada, H., Motomiya, T. & Hiraoka, M. Efficacy of disopyramide and mexiletine used alone or in combination in the treatment of ventricular premature beats. Cardiovasc Drug Ther 5 (Suppl 4), 835–841 (1991). https://doi.org/10.1007/BF00120832
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DOI: https://doi.org/10.1007/BF00120832