No

Antiarrhythmic Agent, Class I

For treatment of ventricular tachycardia and life-threatening ventricular arrhythmias

B

Hypersensitivity to moricizine or any component; pre-existing second- or third-degree AV block (except in patients with a functioning artificial pacemaker); right bundle branch block when associated with left hemiblock or bifascicular block (unless functional pacemaker in place); cardiogenic shock

Can be proarrhythmic; watch for new rhythm disturbances or existing arrhythmias that worsen. Use cautiously in CAD, previous history of MI, CHF, and cardiomegaly. The CAST II trial demonstrated a decreased trend in survival for patients receiving moricizine. Dose-related increases in PR and QRS intervals occur. Use cautiously in patients with pre-existing conduction abnormalities, and significant hepatic impairment. Safety and efficacy have not been established in pediatric patients.

>10%: Central nervous system: Dizziness

1% to 10%:

Cardiovascular: Proarrhythmia, palpitations, cardiac death, EKG abnormalities, congestive heart failure

Central nervous system: Headache, fatigue, insomnia

Endocrine & metabolic: Decreased libido

Gastrointestinal: Nausea, diarrhea, ileus

Ocular: Blurred vision, periorbital edema

Respiratory: Dyspnea

<1% (Limited to important or life-threatening symptoms): Ventricular tachycardia, cardiac chest pain, hypotension or hypertension, syncope, supraventricular arrhythmias, myocardial infarction, apnea

Has a narrow therapeutic index and severe toxicity may occur slightly above the therapeutic range, especially if combined with other antiarrhythmic drugs. (Acute single ingestion of twice the daily therapeutic dose is life-threatening). Symptoms of overdose include increases in P-R, QRS, Q-T intervals and amplitude of the T wave, A-V block, bradycardia, hypotension, ventricular arrhythmias (monomorphic or polymorphic ventricular tachycardia), and asystole; other symptoms include dizziness, blurred vision, headache, and GI upset.

Treatment is supportive, using conventional treatment (fluids, positioning, anticonvulsants, antiarrhythmics). Note: Type Ia antiarrhythmic agents should not be used to treat cardiotoxicity caused by type 1c drugs; sodium bicarbonate may reverse QRS prolongation, bradycardia and hypotension; ventricular pacing may be needed.

Cimetidine increases moricizine levels by 50%.

Digoxin may result in additive prolongation of the PR interval when combined with moricizine (but not rate of second- and third-degree A-V block).

Diltiazem increases moricizine levels resulting in an increased incidence of side effects. Moricizine decreases diltiazem plasma levels and decreases its half-life.

Drugs which may prolong QT interval (including cisapride, erythromycin, phenothiazines, cyclic antidepressants, and some quinolones) are contraindicated with Type Ia antiarrhythmics. Moricizine has some Type Ia activity, and caution should be used.

Theophylline levels are decreased by 50% with moricizine due to increased clearance.

Class I antiarrhythmic agent; reduces the fast inward current carried by sodium ions, shortens Phase I and Phase II repolarization, resulting in decreased action potential duration and effective refractory period

Protein binding, plasma: 95%

Metabolism: Undergoes significant first-pass metabolism absolute

Bioavailability: 38%

Half-life: Normal patients: 3-4 hours; Cardiac disease patients: 6-13 hours

Elimination: Some enterohepatic recycling occurs; 56% is excreted in feces and 39% in urine

Adults: Oral: 200-300 mg every 8 hours, adjust dosage at 150 mg/day at 3-day intervals.

When transferred from encainide, propafenone, tocainide, or mexiletine: Start Ethmozine® 8-12 hours after last dose

When transferred from flecainide: Start Ethmozine® 12-24 hours after last dose

When transferred from procainamide: Start Ethmozine® 3-6 hours after last dose

When transferred from quinidine or disopyramide: Start Ethmozine® 6-12 hours after last dose

Dosing interval in renal or hepatic impairment: Start at 600 mg/day or less.

Food delays absorption; best if taken on an empty stomach

This Class Ic antiarrhythmic agent was associated with a trend toward increased mortality in the CAST trial and therefore should not be used in patients with cardiovascular disease. Although moricizine was effective in suppressing asymptomatic ventricular arrhythmias in patients after myocardial infarction, it was accompanied by increased mortality. Cardiotoxic arrhythmic effects of moricizine and other Class Ic drugs should not be treated using Class Ia antiarrhythmics.

Dizziness is common; may cause sedation or insomnia; may rarely cause anxiety, confusion, amnesia

Use caution with TCAs may produce Q-T prolongation

No information available to require special precautions

No effects or complications reported

Take exactly as directed; do not take additional doses or discontinue without consulting prescriber. You will need regular cardiac checkups and blood tests while taking this medication. You may experience dizziness or visual changes (use caution when driving or engaging in tasks requiring alertness until response to drug is known); nausea or vomiting (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help); or headaches, sleep disturbances, or decreased libido (usually temporary, if persistent consult prescriber). Report chest pain, palpitation, or erratic heartbeat; increased weight or swelling of hands or feet; blurred vision or facial swelling; acute diarrhea; changes in bowel or bladder patterns; or difficulty breathing. Breast-feeding precautions: Breast-feeding is not recommended.

Administering 30 minutes after a meal delays the rate of absorption, resulting in lower peak plasma concentrations

Tablet, as hydrochloride: 200 mg, 250 mg, 300 mg