Table 76135.

Recommendations for Use of Orally Administered Pharmacological Agents for Heart Rate Control in Patients With Atrial Fibrillation

Drug*Loading DoseOnsetUsual Maintenance Dose**Major Side EffectsRecommendation
HF indicates heart failure; PO, by mouth; NA, not applicable; HF, heart failure; and BID, twice a day.
*Drugs are listed alphabetically within each class of recommendation.
**Recommended maintenance dosages are the usual ones necessary, but higher doses may be appropriate in some patients.
†The table includes representative members of the type of beta-blocker drugs, but other, similar agents could be used for this indication in appropriate doses.
Digoxin0.25 mg PO each 2 h; up to 1.5 mg2 h0.125–0.375 mg dailyDigitalis toxicity, heart block, bradycardiaI
DiltiazemNA2–4 h120–360 mg daily in divided doses; slow release availableHypotension, heart block, HFI
MetoprololNA4–6 h25–100 mg BIDHypotension, heart block, bradycardia, asthma, HFI
PropranololNA60–90 min80–240 mg daily in divided dosesHypotension, heart block, bradycardia, asthma, HFI
VerapamilNA1–2 h120–360 mg daily in divided doses; slow release availableHypotension, heart block, HF, digoxin interactionI
Amiodarone800 mg daily for 1 wk 600 mg daily for 1 wk 400 mg daily for 4–6 wk1–3 wk200 mg dailyPulmonary toxicity, skin discoloration, hypothyroidism, corneal deposits, optic neuropathy, warfarin interaction, proarrhythmiaIIb