DOFETILIDE ALGORITHM
DOFETILIDE IS CONTRAINDICATED IF:
(A) BASELINE QTc IS > 440 MSEC
(or > 500 msec in patients with ventricular
conduction abnormalities)
QTc Calculator
(B) CLCr < 20 mL/minCLCr Calculator
****ALGORITHM***1. Determine CLCr: *Male Creatinine Clearance =
(140-age) x actual body weight in kg
72 x serum creatinine (mg/dL)
*Female creatinine clearance =
(140 - age) x actual body weight in kg x 0.85
72 x serum creatinine
CLCr Calculator
2. First Dose CLCr > 60 mL/min: ----> 500 mcg BID
CLCr = 40-60 mL/min: -----> 250 mcg BID
CLCr = 20-40 mL/min: -----> 125 mcg BID
3. Get ECG 2-3 Hours after 1st Dose 4. Second Dose (give ONLY after calculating QTc)-
If QTc increases < 15% and QTc < 500 msec ---> Good to go!-If QTc increases > 15% or QTC > 500 msec (or 550 msec in ventricular conduction abnormality):
CLCr > 60 mL/min ----> 250 mcg po BID
CLCr = 40-60 mL/min: ----> 125 mcg po BID
CLCr = 20-40 mL/min: ----> 125 mcg po DAILY
5. Beyond 2nd Dose (3rd dose and everything after) -
If QTc still > 500 msec (or 550 msec in presence of ventricular conduction abnormality) --> DISCONTINUE!!! -OBTAIN ECG 2-3 HOURS AFTER EACH DOSE UNTIL THE PATIENT IS DISCHARGED- OTHER TIPS:*If Potassium (K+) < 4.0 mEq/L, replace prior to giving Dofetilide
*Get ECG and Renal Function q 3 months
*Hold Previous Antiarrhythmics for at least 3 plasma half lives
-Amiodarone should be withheld for at least 3 months or when amiodarone levels < 0.3 mcg/ml
DRUGS TO AVOID
-Verapamil
-Cimetidine
-HCTZ
-Ketoconazole
-Trimethoprim/Sulfamethoxazole
-Prochlorperazine
-Megestrol
-Dolutegravir
Patient Handout for Dofetilide Information