Brugada syndrome drugs to preferably avoid

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Drugs which are not contraindicated in Brugada syndrome, but which should be avoided, are amiodarone, cibenzoline, disopyramide, lidocaine, propanolol, and verapamil. These agents are all antiarrhythmics. Topical lidocaine used for anesthesia is thought to be safe when used in persons with Brugada syndrome.

Drugs to Preferably Avoid

The following drugs are not absolutely contraindicated but should be avoided in patients with Brugada syndrome.

(Alphabetical order generic name)

Generic Name	Brand Name®	Class / Clinical Use	References	Recommendation
Amiodarone	e.g. Cordarone® - more brand names here -	Antiarrhythmic Agent (3 – also 1A, 2, and 4 effects) / Arrhythmias	Chalvidan 2000 Paul 2006 D’Aloia 2012 Wu 2008	Class IIb
Cibenzoline	e.g. Cipralan® - more brand names here -	Antiarrhythmic Agent (1A: Na-blocker) / Arrhythmias	Tada 2000 Sarkozy 2005 Niwa 1998	Class IIb
Disopyramide†	e.g. Dicorantil® Norpace® Ritmoforine® - more brand names here -	Antiarrhythmic Agent (1A: Na-blocker) / Arrhythmias	Miyazaki 1996 Chinushi 1997 Shimizu 2000 Sugao 2005 Sumi 2010 Grant 2000	Class IIb
Lidocaine*	e.g. Xylocaine® - more brand names here -	Antiarrhythmic Agent (1A: Na-blocker) / Arrhythmias	Miyazaki 1996 Barajas 2008	Class IIb
Propranolol	e.g. Inderal® - more brand names here -	Antiarrhythmic Agent (2: B-blocker) / Arrhythmias	Miyazaki 1996 Shimada 1996 Kasanuki 1997 Nademanee 2003 Aouate 2005 Shimada 1999	Class IIb
Verapamil	e.g. Covera® Isoptin® - more brand names here -	Antiarrhythmic Agent (4: Ca-blocker) / Arrhythmias	Miyazaki 1996 Chinushi 2006 Fish 2008	Class IIb

Recommendation: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.

† Disopyramide has been either suggested to be pro-arrhythmic or anti-arrhythmic in Brugada syndrome patients. The reason for these contradictory results is currently uncertain but could possibly include disparate underlying genetic defects. The Brugadadrugs.org Advisory Board advices caution and rigorous monitoring when using this drug to be able to react promptly to possible untoward effects.

• Lidocaine use for local anesthesia (e.g. by dentists) does seem to be safe when combined with adrenaline/epinephrine (e.g. xylocaine dental/epinephrine or articaïne/epinefrine (Ultracain® or Septanest®) 1:100,000) and the amount administrated is low as it results in a local effect only (Theodotou 2009). When applied on the skin it is also unlikely that there will be systemic effects, and will most probably be safe.