Potential antiarrhythmic drugs in Brugada syndrome patients

The following drugs have been described in case reports or relatively small series as potential antiarrhythmic drugs in Brugada syndrome patients. Although promising, the BrugadaDrugs.org Advisory Board stresses that the utmost care should be taken when using these drugs in the acute or chronic setting in Brugada syndrome patients. None of these drugs have proofed to completely prevent arrhythmias, some drugs have not been tested to an appreciable extent in Brugada syndrome patients and some drugs may have unacceptable side-effects. Preferably only (severely) symptomatic or otherwise high-risk patients in the absence of provoking drugs may be candidates for chronic therapeutic treatment in an experienced medical center. Currently, quinidine seems to be the treatment of choice for chronic therapy. Recently a prospective registry has started investigating the use of empiric quinidine therapy for asymptomatic Brugada syndrome patients: Viskin 2009 (to admit patients to this registry, please go to www.BrugadaSyndrome.info). Further, a study evaluating the number of appropriate ICD shocks in Brugada syndrome patients using quinidine vs. placebo has recently started (QUIDAM study).

As mentioned earlier, avoidance of provocative drugs/substances and timely treatment of fever is probably the most effective and safe treatment in many Brugada syndrome patients. However, some Brugada syndrome patients may (only) be appropriately treated with an implantable cardioverter defibrillator.

Also see the page on emergencies (arrhythmias and anesthesia).

Notes about the lists:

  • On this list we summarized the drugs for which there is literature available on a possible antiarrhythmic effect in Brugada syndrome
  • Drugs are listed with up to 3 common brand names. There are several brand names for many of the drugs, which are not all listed. It is also important to look at the active drugs in medicines that contain a combination of drugs.
  • Lists contain links to DrugBank or PubChem (click on the drug name) and also (several) PubMed links to articles on the association between the drug and Brugada syndrome (click on the reference).
  • Lists contain a classifying column ‘Recommendation’ in which the available evidence from the literature and the expert opinion of the BrugadaDrugs.org Advisory Boardis described. Please note that there are no randomized clinical studies in Brugada syndrome patients, therefore the level of evidence is mostly C (only consensus opinion of experts, case studies, or standard-of-care) and for some B (non-randomized studies).
    • Class I: There is evidence and/or general agreement that a given drug is potentially antiarrhythmic in Brugada syndrome patients.
    • Class IIa:There is conflicting evidence and/or divergence of opinion about thedrug, but the weight of evidence/opinion is in favor of a potentially antiarrhythmic effect in Brugada syndrome patients.
    • Class IIb: There is conflicting evidence and/or divergence of opinion about thedrug, and the potential antiarrhythmic effect in Brugada syndrome patients is less well established by evidence/opinion.
    • Class III: There is no or very little evidence and/or general agreement that a drug is potentially antiarrhythmic in Brugada syndrome patients

Please also read our Disclaimer.

Drugs with potential antiarrhythmic effect

Generic nameBrand name®Clinical useReferencesClass
Bepridile.g.
Angopril®,
Bepadin®,
Cordium®,
Vascor®
Anti-arrhythmicSugao 2005
Ohgo 2007
Murakami 2010
Chinushi 2011
Kaneko 2014
IIa
Cilostazole.g.
Pletal®
Phosphodiesterase
inhibitor
Tsuchiya 2002
Abud 2006
Matsui 1999
IIb
Isoproterenol*
Isoprenaline*
e.g.
Isuprel®
Beta-adrenergic
receptor stimulation
Miyazaki 1996
Suzuki 2000
Watanabe 2006
Ohgo 2007
Ganesan 2006
I
Orciprenaline*e.g.
Alotec®
Metaprel®
Novasmasol®
Beta-adrenergic
receptor stimulation
Kyriazis 2009IIa
Quinidine**e.g.
Quinalan®
Chinidin®
Anti-arrhythmicSuzuki 2000
Alings 2001
Belhassen 2004
Mizusawa 2006
Probst 2007
Ohgo 2007
Marquez 2012
Belhassen 2015
Anguera 2016
Yan 1999
Hoogendijk 2014
I

Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
* Please read the statement of caution indicated for patients with a loss-of-function SCN5A mutation who have a conduction phenotype instead of a Brugada phenotype (www.brugadadrugs.org/emergencies/). These patients may react unfavorably on Quinidine and careful consideration and monitoring is advised.
** Please note that quinidine can also be used to treat supra ventricular arrhythmias (e.g. Giustetto et al. 2014)

Reports have postulated an antiarrhythmic effect of other drugs in Brugada syndrome. However, the BrugadaDrugs.org Advisory Board, considers the evidence on use of these drugs as antiarrhythmic treatment in Brugada syndrome patients to be too low (class III recommendation). These drugs are: amrinone (Marquez 2007), clarithromycin (Marquez 2007), denopamine (Ohgo 2007), dimethyl lithospermate B (Fish 2006), disopyramide (Sumi 2010), mexiletine (Miyazaki 1996, Kasanuki 1997), milrinone (Marquez 2007), phentolamine (Miyazaki 1996), prazosin (Miyazaki 1996), sotalol (Bertaglia 1998, Glatter 2005), tedisamil (Marquez 2007, Perez Riera 2007 and 4-aminopyridine (Marquez 2007)

Disclaimer and Waiver

The information presented is intended solely for the purpose of providing general information about health related matters. We do our best to ascertain that all information on this site is correct and up-to-date. However, we cannot guarantee that it is. The information provided here is for educational and informational purposes only and designed primarily for use by qualified physicians and other medical professionals. It is not intended for any other purpose, including, but not limited to, medical or pharmaceutical advice and/or treatment, nor is it intended to substitute for the users’ relationships with their own health care/pharmaceutical providers. To that extent, by continued use of this program, the user affirms the understanding of the purpose and releases the Academic Medical Center, the BrugadaDrugs.org Advisory Board and Cardionetworks from any claims arising out of his/her use of the website.

Principal limitation

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 conflicting results and there may be 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.