Clinical evaluation of oral mexiletine therapy in the treatment of ventricular arrhythmias

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Abstract

The effect of oral mexiletine therapy on ventricular arrhythmias was evaluated in 58 patients in whom conventional drugs had been unsuccessful. Mean daily dose of mexiletine was 652 mg (range 250 to 1,500) and mean duration of therapy was 14.4 months (range 0.1 to 34.4). Mexiletine was associated with a decrease of 52% in total premature ventricular complexes in 24 hours compared with control (6,841 ± 1,053 [SEM] versus 3,248 ± 734, p < 0.005) and 19 patients (36.5%) had a greater than 83% decrease in ventricular ectopic rhythm. The drug was discontinued in 6 of these 19 patients because 5 of them (26%) experienced side effects after a mean period of 29.6 weeks (range 0.83 to 63.2) and sudden death occurred in 1 patient (5%); this indicates effective suppression of ventricular ectopic rhythm without significant side effects in 13 (25%) of 52 patients during long-term therapy. Adjustment of drug dosage to achieve therapeutic blood levels resulted in an efficacy on ventricular ectopic rhythm similar to that obtained with the maximal tolerated dose. There was no correlation between drug dose and therapeutic effectiveness. Mexiletine was associated with a 48% decrease in episodes of ventricular tachycardia (345.5 versus 179.3/24 h) and 5 of 10 patients with a history of cardiac arrest remained free of symptomatic ventricular tachyarrhythmias for 14.8 months (range 3.7 to 24.3). In 12 patients left ventricular ejection fraction, determined by radionuclide angiography before and during mexiletine therapy, demonstrated no significant change (32 versus 34%). Adverse effects requiring discontinuation of mexiletine occurred in 12 patients (21%) in the entire group and were primarily related to the central nervous system and gastrointestinal tract. Mexiletine was effective in a modest proportion of patients in whom conventional antiarrhythmic therapy had failed. Ventricular function appeared to be unaffected by the drug and the side effects, although relatively frequent, were not serious.

Original languageEnglish (US)
Pages (from-to)780-784
Number of pages5
JournalJournal of the American College of Cardiology
Volume6
Issue number4
StatePublished - 1985

ASJC Scopus subject areas

  • Nursing(all)

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