Table 126135.

Recommended Doses of Drugs Proven Effective for Pharmacological Cardioversion of Atrial Fibrillation

Drug*Route of AdministrationDosage**Potential Adverse EffectsReferences
GI indicates gastrointestinal; IV, intravenous; BID, twice a day.
*Drugs are listed alphabetically.
**Dosages given in the table may differ from those recommended by the manufacturers.
†Insufficient data are available on which to base specific recommendations for the use of one loading regimen over another for patients with ischemic heart disease or impaired left ventricular function, and these drugs should be used cautiously or not at all in such patients.
‡The use of quinidine loading to achieve pharmacological conversion of atrial fibrillation is controversial, and safer methods are available with the alternative agents listed in the table. Quinidine should be used with caution.
AmiodaroneOralInpatient: 1.2–1.8 g per day in divided dose until 10 g total, then 200–400 mg per day maintenance or 30 mg/kg as single doseHypotension, bradycardia, QT prolongation, torsade de pointes (rare), GI upset, constipation, phlebitis (IV)92, 96, 124, 234, 251, 253–260
Outpatient: 600–800 mg per day divided dose until 10 g total, then 200–400 mg per day maintenance
Intravenous/oral5–7 mg/kg over 30–60 min, then 1.2–1.8 g per day continuous IV or in divided oral doses until 10 g total, then 200–400 mg per day maintenance
DofetilideOralCreatinine clearance (mL/min) Dose (mcg BID)QT prolongation, torsade de pointes; adjust dose for renal function, body size, and age133, 225–229
greater than 60 500
40–60 250
20–40 125
less than 20 Contraindicated
FlecainideOral200–300 mgHypotension, rapidly conducting atrial flutter88–90, 92, 230–235
Intravenous1.5–3.0 mg per kg over 10–20 min
IbutilideIntravenous1 mg over 10 min; repeat 1 mg when necessaryQT prolongation, torsade de pointes236–241
PropafenoneOral450–600 mgHypotension, rapidly conducting atrial flutter90, 93, 94, 230, 233, 235, 242–252
Intravenous1.5–2.0 mg per kg over 10–20 min
QuinidineOral0.75–1.5 g in divided doses over 6–12 h, usually with a rate-slowing drugQT prolongation, torsade de pointes, GI upset, hypotension88, 90, 91, 93, 242, 256, 257, 261, 262