NORPACE

Dose: 0.4 mg/kg/hr
Single Dose: 0.4 (0.4)
Frequency: As recommended.
Route: IV Inf
Instructions: Maintenance,.

Dose: 2.5 to 7.5 mg/kg
Single Dose: 5 (5)
Frequency: 6 hourly
Route: oral
Instructions:

Dose: 2.5 to 7.5 mg/kg
Single Dose: 5 (5)
Frequency: 6 hourly
Route: Oral
Instructions: -

. It is of Synthetic origin and belongs to Pyridineacetamide. It belongs to Na-Channel Antiarrhythmic antagonist pharmacological group on the basis of mechanism of action. The Molecular Weight of Disopyramide is 339.50. Its pKa is 8.4.

Disopyramide is contraindicated in conditions like Cardiogenic shock,Hypotension,Left ventricular failure,Digitalis toxicity,Second or third degree A-V block.

The severe or irreversible adverse effects of Disopyramide, which give rise to further complications include Glaucoma, Jaundice, Jaundice, Urinary retention, Myasthenia gravis, Urinary retention.Disopyramide produces potentially life-threatening effects which include Hypoglycemia, Hypoglycemia, Negative ionotropic effects, QRS widening, QT prolongation, Hypoglycemia, Torsades de pointes. which are responsible for the discontinuation of Disopyramide therapy.The signs and symptoms that are produced after the acute overdosage of Disopyramide include Bradycardia, Cardiac arrhythmias, Apnea, ECG alterations, Unconsciousness, Ventricular fibrillation.The symptomatic adverse reactions produced by Disopyramide are more or less tolerable and if they become severe, they can be treated symptomatically, these include Headache, Fatigue, Constipation, Abdominal pain, Sweating, Dry mouth, Blurred vision, Skin rash, Weight gain, Xerostomia, Xerosis, Dry mouth.

'Disopyramide is primarily indicated in conditions like Arrhythmias following surgical procedures, Conversion of atrial fibrillation, Digitalis induced arrythmias, Duodenal ulceration, Hypertrophic cardiomyopathy, Premature systoles, Supraventricular tachycardia, Tobacco amblyopia and leber''s optic atrophy, Ventricular tachycardia, Wolf-parkinson-white syndrome.'

Disopyramide is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAmiodarone (HCl)Disopyramide may enhance the QTc-prolonging effect of Amiodarone. Amiodarone may increase the metabolism, via CYP isoenzymes, of Disopyramide. MajorRapidIncreased risk of ventricular arrhythmias when amiodarone given with disopyramide: avoid combined administration of these two drugs (or only undertaken with caution and appropriate monitoring).Amitriptyline (HCl)ArtemisininAtenololBoth drugs produce additive effect on heart results in reduced cardiac output, hypotension and bradycardia. Atenolol also decreases the clearence of disopyramide.Intravenous administration of these agents may exacerbate the risk of adverse effects.ModerateClosely monitor for cardiac output, blood pressure, heart rate and ECG.ClarithromycinClarithromycin increases the plasma concentration of disopyramide result in life-threatning malignant arrhythmia and prolong QT interval.MajorCoadministration should be avoided. Monitor the level of disopyramide.DigoxinDiltiazem (HCl)Diltiazem inhibit CYP450 3A4 result in decrease clearance and increases plasma concentration of Disopyramide. ModerateUse this combination with caution or dose adjustments are required.ErythromycinErythromycin increases the plasma level of Disopyramide.Erythromycin causes life threatening malignant arrhythmias and QT interval prolongation.MajorCoadministration should be avoided with disopyramide and level of Disopyramide must be monitored.Flecainide (Acetate)Halofantrine (HCl)Homatropine (HBr)Human InsulinInsulin GlulisineDisopyramide, oral antidiabetic products, pramlintide, ACE inhibitors, fibrates, monoamine oxidase inhibitors, salicylates, and somatostatin analogs, may increase the blood glucose-lowering effect of insulins and therefore increase the risk of hypoglycemia. Insulin LisproIsoetharineIsoetharine and Disopyramide when given together may increase risk of heart problems.Isophane insulinIsosorbide (Dinitrate)MetipranololInfrequent reports of METIPRANOLOL [EYE] increasing the NEGATIVE CHRONOTROPIC effect of DISOPYRAMIDE. ModerateMay need to avoid combinationMexiletinePhenobarbital SodiumPhenobarbitonePhenytoin (Na)Phenytoin decreases plasma level and therapeutic effects of disopyramide by induction of disopyramide metabolism.Disopyramide AUC decreases by 52% and half life upto 51%.ModerateClose observation of Disopyramide effectsi.e.dry mouth, blurry vision, urinary retention or worsening of irregular heart beat must be done.Pimozide Pimozide prolongs QT interval results in ventricular arrhythmias, ventricular tachycardia and torsade de pointes.ModerateCoadministration is considered contraindicated.PindololPindololPindolol decreases the clearance of disopyramide.Both agents have additive cardiac effecti.e.reduced cardiac output,hypotension and bradycardia.Coadministration may also prolong QT interval and QRS complexing widening. ModerateClose monitoring of cardiac output,blood pressure,heart rate and ECG is recommended.PractololPractololPropantheline (Br)Propiverine HydrochlorideTaking two or more antimuscarinic drugs together can increase their side effects.Propranolol (HCl)Pyridostigmine (Br)Quinagolide (HCl)QuinidineReserpineRifampicinRifampicinSotalol (HCl)Sotalol (HCl)Thioridazine (HCl)prolongs QT interval results in ventricular arrhythmias, ventricular tachycardia and torsade de pointes. prolongs QT interval results in ventricular arrhythmias, ventricular tachycardia and torsade de pointes. prolongs QT interval results in ventricular arrhythmias, ventricular tachycardia and torsade de pointes. Thioridazine prolongs QT interval results in ventricular arrhythmias, ventricular tachycardia and torsade de pointes. MajorCoadministration is considered contraindicatedVerapamil (HCl)Verapamil (HCl)Both work additively producing negative inotropic effects,hypotension and collapse especially in conduction defects.ModerateDisopyramide must not be administered less than 48 hours before or 24 hours after verapamil.VORICONAZOLEVoriconazole may also increase the serum concentration of disopyramide by decreasing its metabolism. Consider alternate therapy or monitor for QTc prolongation and changes Warfarin (Na)Disopyramide enhances the anticoagulant effect of warfarinMajorDelayedMonitor prothrombin time and INR of patientwhenever disopyramide added or discontinued. These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Drug should not be given to Paediatrics, Pregnant Mothers, Cardiac / Hypertensive Patients, patients suffering from Kidney dysfunction, and Neonates.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Caps Store in a well closed container, Below 40°C. Protect from Sunlight and Moisture.

Reduce doses of disopyramide in case of kidney or liver impairment, carefully monitor ECG. Correct any potassium deficit before initiating therapy because disopyramide may be ineffective in hypokalemia or its toxicity is enhanced in hyperkalemia. It should be used with caution in patient with diabetes mellitus. It is classified as pregnancy category C and use of disopyramide should be avoided during pregnancy unless the potential benefit justifies the risk to the fetus.