BrugadaDrugs.org is a non-profit initiative developed by physicians from the University of Amsterdam Academic Medical Center, department of Cardiology, in collaboration with a panel of world-renowned experts on Brugada syndrome as an aid to physicians who treat patients with Brugada syndrome and as an aid to patients with Brugada syndrome and their families with the goal to provide free, worldwide accessible and up-to-date information on safe drug use in Brugada syndrome.
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This website is up to date through July 6, 2014. The last drug update has been communicated on April 25, 2014, there are currently no new drugs under consideration.
Worldwide, the Brugada syndrome has been recognized as an important cause of sudden cardiac death at a relatively young age. However, many or most patients with Brugada syndrome are asymptomatic and will also not experience malignant arrhythmias. This knowledge base can result in a challenge for both physicians and patients. Brugada syndrome is diagnosed in the presence of specific electrocardiographic abnormalities (known as the type-1 Brugada syndrome ECG) combined with an absence of gross structural abnormalities and several other criteria. Furthermore, Brugada syndrome often shows familial aggregation. The presence of this type-1 ECG in particular has been linked to an increased risk for ventricular tachyarrhythmias, cardiac arrest and sudden death in Brugada syndrome patients. Importantly, many drugs have been reported to induce the type-1 ECG and/or (sometimes fatal) arrhythmias in Brugada syndrome patients. Therefore, it is necessary to advise patients with Brugada syndrome not to use these drugs, or to do so only in controlled conditions so that its potential pro-arrhythmic effect or the lack thereof can be documented and treated if necessary. This advice is also acknowledged in the latest (2013) guidelines for the treatment of inheritable arrhythmia syndromes (here).
In addition, we also advise to avoid these drugs in patients with a ‘loss-of-function’ sodium channel mutation who do not display a Brugada ECG pattern but who might also be at risk for untoward events when these drugs would be used.
You can find lists of the drugs that are (preferably) avoided by Brugada syndrome patients below. Just click on the bar and you will be taken to the appropriate page. Also you can choose to see potential anti-arrhythmic drugs, diagnostic drugs including ECG examples and a page with summary letters in many different languages which list all the drugs that need to be (preferably) avoided. A translation tool is also provided, and you can find frequently asked questions here.
Many drugs have been associated with the type-1 ECG and/or with arrhythmias in Brugada syndrome patients. We have divided these drugs into four lists (together with the available evidence in the literature and a recommendation from the BrugadaDrugs.org Advisory Board) :
- Red list: drugs that should be avoided by Brugada syndrome patients
- Orange list: drugs that preferably should be avoided by Brugada syndrome patients
- Green list: drugs that may have an antiarrhythmic effect in Brugada syndrome patients
- Blue list: drugs used to diagnose the Brugada syndrome ECG
- Purple list: contains a complete list of the above mentioned drugs to (preferably) avoid for patients to give to all their health care providers
It should be seriously considered to advise patients with Brugada syndrome to avoid drugs from the Red list (drugs to be avoided) because these drugs might result in arrhythmias, or to use these drugs only after extensive consideration and/or in controlled conditions. Drugs from the Orange list (drugs preferably avoided) have been associated with the appearance of the Brugada syndrome ECG and are therefore considered to be potentially proarrhythmic in patients with Brugada syndrome. However, this has not been documented clearly and some patients may benefit from these drugs for other reasons. Considering alternative drugs, administration in controlled conditions or close monitoring may be suitable. Please note that although the most appropriate treatment for Brugada syndrome patients is under discussion among experts, avoidance of (potential) proarrhythmic drugs and fever (a well known trigger of cardiac events in Brugada syndrome) is generally accepted to be an important part of (prophylactic) treatment. However, some patients may be appropriately treated with an implantable cardioverter defibrillator with or without ablation therapy. Furthermore, many Brugada syndrome patients seem to perform well on quinidine.
Please cite this site as:
Postema PG, Wolpert C, Amin AS, Probst V, Borggrefe M, Roden DM, Priori SG, Tan HL, Hiraoka M, Brugada J, Wilde AA. Drugs and Brugada syndrome patients: review of the literature, recommendations and an up-to-date website (www.brugadadrugs.org). Heart Rhythm 2009;6(9):1335-1341. (Free available from Heart Rhythm, PubMed link here).
Postema PG, Neville J, de Jong JS, Romero K, Wilde AA, Woosley RL. Safe drug use in long QT syndrome and Brugada syndrome: comparison of website statistics.Europace. 2013;15(7):1042-9. (PubMed link here)
For Long-QT syndrome a similar website can be found at www.qtdrugs.org. This website is initiated by the Critical Path Institute, University of Arizona, to aid physicians who treat patients with Long-QT syndrome and lists drugs to be avoided by patients with Long-QT syndrome.
Notes about the lists and site:
- On this site we summarized those drugs of which there are reports in the literature on an association between these drugs and the Brugada syndrome
- We advise our Brugada syndrome patients to give this letter to all of their health care providers.
- It should be clear to the users of this site that the principal limitation of the association between certain drugs, Brugada syndrome and arrhythmias, is that there are quite often only (a number of) case reports and experimental studies suggesting an effect in Brugada syndrome. Further, there may be conflicting results and large variability for Brugada syndrome patients in their response to certain drugs. This response may also differ in different conditions (e.g. with or without fever, drug in therapeutic range, overdosed or in combination with other drugs etc.). Clinical decision making should be based on more than the presence or absence of a (single) association in another patient.
- Drugs are listed with up to 4 common brand names. There are several brand names for many of the drugs, which are not all listed. It is always important to look at the active drugs in medicines that contain a combination of drugs.
- Lists contain links to DrugBank or PubChem and also (several) PubMed links to articles on the association between the drug and Brugada syndrome.
- The BrugadaDrugs.org Advisory Board provides consultation and aids in making decisions regarding these drug lists.
- This site has been developed in close analogy to www.QTdrugs.org, a website initiated by the Critical Path Institute, associated with the University of Arizona, and currently known as CredibleMeds to aid physicians who treat patients with Long QT syndrome.
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