Dronedarone: the new kid on the block

Abstract

Dronedarone is a new anti-arrhythmic drug with similar properties to amiodarone. It is indicated in the maintenance of sinus rhythm following successful cardioversion of atrial fibrillation or flutter but is recommended to be prescribed only after alternative treatment options have been considered. The recommended dosage is 400 mg twice daily taken with food. Although efficacious in the treatment of atrial fibrillation or flutter, concern exists regarding its use in patients with poor left ventricular function owing to its potential to exacerbate heart failure symptoms and cause myocardial decompensation. Although it does not possess the same toxic adverse event profile as amiodarone, particularly in relation to the thyroid gland, gastric disturbance is commonly reported following start of treatment, which is usually self-limiting. Its efficacy and impact on the patient from a rhythm management perspective, and its impact on patients with heart failure, have been investigated in several randomized, controlled trials, the largest of which was ATHENA. From a nurse prescribing perspective, baseline assessment and follow-up is integral to the optimal care of patients receiving dronedarone, particularly in relation to its effect on the conduction system, the renal system, and the hepatic system. Patient education is the cornerstone in identifying early-onset heart failure and liver injury as well as potential for drug interactions.