Considerations for dofetilide use in the elderly.
This case describes an 85-year-old African-American female with atrial arrhythmias on dofetilide maintenance therapy who presented to an ambulatory cardiology clinic with hypotension. The pharmacist identified a potential major drug-drug interaction between dofetilide and the thiazide diuretic, chlorthalidone. Because of the patient's hypotension, it was decided to discontinue chlorthalidone to avoid the potential drug interaction with dofetilide. A systolic BP goal of 140-145 mmHg was later achieved and maintained with the addition of low-dose amlodipine, in addition to her lisinopril. This case highlights important considerations for prescribing and monitoring dofetilide and reviews hypertension management in the elderly population.
Department of Clinical and Administrative Sciences, Notre Dame of Maryland University School of Pharmacy, Baltimore, Maryland.
Lindsey W
LW
Crist
Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond.
Dave L
DL
Dixon
D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy*; D002752:Chlorthalidone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007022:Hypotension / Q000139:chemically induced* / Q000175:diagnosis; D010627:Phenethylamines / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D000959:Antihypertensive Agents; D010627:Phenethylamines; D013449:Sulfonamides; D002752:Chlorthalidone; C063533:dofetilide
AF = Atrial fibrillation; BP = Blood pressure; CPC = Cardiopharmacotherapy clinic; Chlorthalidone; Diuretics; Dofetilide; Drug interactions; ECG = Electrocardiogram; HCTZ = Hydrochlorothiazide; HTN = Hypertension; IU = International units; PAC = Premature atrial contractions; TdP = Torsades de pointes; Thiazide