Appropriate dosing of antiarrhythmic drugs in Japan requires therapeutic drug monitoring*

Abstract

It is concluded that, with the exception of digoxin, the appropriate dosing regimen for antiarrhythmic drugs is not yet established. The establishment of appropriate dosing regimens for antiarrhythmic drugs requires the more widespread adoption of TDM.

Simultaneous determination of ten antiarrhythic drugs and a metabolite in human plasma by liquid chromatography—tandem mass spectrometry

“…Optimal therapy with antiarrhythic drugs requires therapeutic drug monitoring (TDM) in order to avoid adverse effects and obtain the desired clinical benefit [9,10]. Many literatures have reported bioanalytical methods for antiarrhythic drugs determination, but the majority of these methods only focused on individual drugs mainly detected with HPLC-UV or LC-MS [11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

CYP2D6 genotype affects age-related decline in flecainide clearance

“…CYP2D6*10 with low or unstable enzymatic activity is more prevalent in Japanese (38.8%) than in Caucasians (3.0%) [21]. This difference may be the reason behind the difference in the maintenance dose for Japanese (100 mg/day [22]) and Caucasians (200 mg/day [23]). Our findings also support a dose reduction for elderly patients according to the information found on the package inserts of flecainide acetate in Japan.…”

Frequency of Clinical Monitoring of Serum Concentrations of Digoxin, Potassium, and Creatinine, and Recording of Electrocardiograms in Digoxin-Treated Patients: A Japanese Claims Database Analysis

“…frequency at four hospitals in Japan in 2005 was 17−35%. 11) Despite the difference across the study populations, the low frequency of SDC monitoring in Japan has not changed. However, although TDM of digoxin was found to be low in this study, the frequency of measurement of serum creatinine level at baseline among new digoxin users was high approximately 61%.…”

“…3,4,10) Studies from Japan and the United States (US) indicated that TDM was performed in 17−50% of patients receiving digoxin. 7,11,12) However, there is not much information in the literature regarding the frequency of TDM for digoxin. In addition, the guideline 10) recommends to simultaneously measure the serum creatinine and serum potassium levels as for SDC; while the monitoring frequency for these laboratory tests remains unknown.…”