Dronedarone: A New Treatment for Atrial Fibrillation

Abstract

Dronedarone. Dronedarone is a benzofuran derivative pharmacologically related to amiodarone but without the iodine moiety. It is designed for the treatment of atrial fibrillation and atrial flutter. Historically, amiodarone has proved most effective in maintaining sinus rhythm and has been used safely in patients with advanced heart failure. However, its use has been limited by cumulative and often irreversible organ toxicity, especially in younger patients. Dronedarone was developed in an effort to provide equivalent efficacy and safety with less toxicity. Dronedarone has proved efficacious without toxic or proarrhythmic effects and has minimal side effects, but remaining concerns exist regarding its use in patients with advanced heart failure.

Pharmacologic Management of Atrial Fibrillation: Established and Emerging Options

“…The lack of iodine also could make dronedarone less lipophilic and limit its distribution and potential for extracardiac toxicities. 40 Dronedarone has a considerably shorter half-life than amiodarone (1-2 days vs. 30-55 days), which could make dosing more reliable and facilitate the use of loading doses. 40 Like amiodarone, dronedarone is a CYP3A4 substrate and inhibits CYP2D6; therefore, interactions with drugs metabolized by these isoenyzmes could occur.…”

“…40 Dronedarone has a considerably shorter half-life than amiodarone (1-2 days vs. 30-55 days), which could make dosing more reliable and facilitate the use of loading doses. 40 Like amiodarone, dronedarone is a CYP3A4 substrate and inhibits CYP2D6; therefore, interactions with drugs metabolized by these isoenyzmes could occur. 41,42 Dronedarone has been extensively studied in several phase III randomized, double-blind, placebo-controlled studies.…”

“…39,40 The chemical structure of dronedarone differs from that of amiodarone in its lack of iodine, which could minimize the impact of dronedarone on thyroid function. The lack of iodine also could make dronedarone less lipophilic and limit its distribution and potential for extracardiac toxicities.…”

Antiarrhythmic Drugs Use in Elderly Patients. Vaughan Williams Class III and IV Drugs

“…В клинических исследованиях частота развития фиброза легких, нарушения функции печени и щито-видной железы при применении дронедарона была ана-логична таковой у плацебо [31,32], а риск удлинения интервала QT был ниже, чем при применении амио-дарона [33]. Однако применение препарата в широкой медицинской практике показало, что 5-10% пациен-тов не переносят его из-за желудочно-кишечных по-бочных эффектов, а в редких случаях он может вызы-вать поражения легких [34].…”

Rhythm Control for Management of Patients With Atrial Fibrillation: Balancing the Use of Antiarrhythmic Drugs and Catheter Ablation

“…18 Patients with New York Heart Association class III or IV heart failure should not use dronedarone, based on the findings of the Antiarrhythmic Trial With Dronedarone in Moderate to Severe Chronic Heart Failure Evaluating Morbidity Decrease (ANDROMEDA) study. 19,20 The 22 compared dronedarone with amiodarone. The primary composite endpoint was time to first recurrence of AF or premature discontinuation of the study drug treatment for intolerance or lack of efficacy.…”