Nursing Central: Antiarrhythmic Drugs: Amiodarone Digoxin, Disopyramide, Flecainide, Lidocaine, Procainamide, Quinidine

Antiarrhythmic Drugs: Amiodarone Digoxin, Disopyramide, Flecainide, Lidocaine, Procainamide, Quinidine

General

Synonym/Acronym:
Amiodarone (Cordarone); Digoxin (Digitek, Lanoxicaps, Lanoxin); disopyramide (Norpace, Norpace CR); flecainide (flecainide acetate, Tambocor); lidocaine (Xylocaine); procainamide (Procanbid, Pronestyl, Pronestyl SR); quinidine (Quinidex Extentabs, quinidine sulface SR, quinidine gluconate SR).

Common Use:
To evaluate specific drugs for subtherapeutic, therapeutic, or toxic levels in treatment of heart failure and cardiac arrhythmias.

Specimen:
Serum (1 mL) collected in a red-top tube.

Drug	Route of Administration	Recommended Collection Time
Amiodarone	Oral	Trough: immediately before next dose
Digoxin	Oral	Trough: 12–24 hr after dose
		Never draw peak samples
Disopyramide	Oral	Trough: immediately before next dose
		Peak: 2–5 hr after dose
Flecainide	Oral	Trough: immediately before next dose
		Peak: 3 hr after dose
Lidocaine	IV	15 min, 1 hr, then every 24 hr
Procainamide	IV	15 min; 2, 6, 12 hr; then every 24 hr
Procainamide	Oral	Trough: immediately before next dose
		Peak: 75 min after dose
Quinidine sulfate	Oral	Trough: immediately before next dose
		Peak: 1 hr after dose
Quinidine gluconate	Oral	Trough: immediately before next dose
		Peak: 5 hr after dose
Quinidine polygalacturonate	Oral	Trough: immediately before next dose
		Peak: 2 hr after dose

Normal Findings:
(Method: Immunoassay)

Drug (Indication)	Therapeutic Range*	SI Units	Half-Life (hr)	Volume of Distribution (L/kg)	Protein Binding (%)	Excretion
(SI = Conventional Units × 1.60)
Amiodarone	1.0–2.5 mcg/mL	1.6–4.0 micromol/L	250–1200	20–100	95–97	1° hepatic
(SI = Conventional Units × 1.28)
Digoxin	0.5–2.0 ng/mL	0.6–2.6 nmol/L	20–60	7	20–30	1° renal
(SI = Conventional Units × 2.95)
Disopyramide (atrial arrhythmias)	2.8–3.2 mcg/mL	8.3–9.4 micromol/L	4–10	0.7–0.9	20–60	1° renal
Disopyramide (ventricular arrhythmias)	3.3–5.0 mcg/mL	9.7–14.8 micromol/L				1° renal
(SI = Conventional Units × 2.41)
Flecainide	0.2–1.0 mcg/mL	0.5–2.4 micromol/L	7–19	5–13	40–50	1° renal
(SI = Conventional Units × 4.27)
Lidocaine	1.5–5.0 mcg/mL	6.4–21.4 micromol/L	1.5–2	1–1.5	60–80	1° hepatic
(SI = Conventional Units × 4.23)
Procainamide	4–10 mcg/mL	17–42 micromol/L	2–6	2–4	10–20	1° renal
N-acetyl procainamide	10–20 mcg/mL	42–85 micromol/L	8			1° renal
(SI = Conventional Units × 3.08)
Quinidine	2–5 mcg/mL	6–15 micromol/L	6–8	2–3	70–90	Renal and hepatic
*Conventional units.

Antiarrhythmic Drugs: Amiodarone Digoxin, Disopyramide, Flecainide, Lidocaine, Procainamide, Quinidine has been found in Davis's Lab & Diagnostic Tests

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