Drugs to be avoided by Brugada syndrome patients

The following drugs have been associated with arrhythmias and the typical (type-1) Brugada syndrome ECG. Therefore the BrugadaDrugs.org Advisory Board strongly advices to avoid these drugs in Brugada syndrome patients or to use these drugs only after extensive consideration and/or in controlled conditions.

Notes about the lists:

  • On this list we summarized those drugs for which there is literature available for an association between the drug and arrhythmias in Brugada syndrome
  • Drugs are listed with up to 3 common brand names. There may be over 100 different brand names for different drugs, an effort to list those we know of you can find here. 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).
  • We advice our Brugada syndrome patients to give this letter to all of their health care providers.
  • 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).
  • 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 arrhythmic in Brugada syndrome patients.
    • Class IIa:There is conflicting evidence and/or divergence of opinion about the
      drug, but the weight of evidence/opinion is in favor of a potentially arrhythmic effect in Brugada syndrome patients.
    • Class IIb: There is conflicting evidence and/or divergence of opinion about the
      drug, and the potential arrhythmic 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 arrhythmic in Brugada syndrome patients. You can find a list of these drugs on this page.

Please also read our Disclaimer.

Antiarrhythmic drugs

Generic name
Brand name®
Clinical use
References
Class
Ajmalinee.g.
Gilurytmal®
-other names-
Antiarrhythmic Agent
(1A: Na-blocker) /
Arrhythmias
Brugada 1997
Rolf 2003
Wolpert 2005
Bébarová 2005
I
Flecainidee.g.
Tambocor®
-other names-
Antiarrhythmic Agent
(1C: Na-blocker) /
Arrhythmias
Krishnan 1998
Brugada 2000
Gasparini 2003
Meregalli 2006
Stokoe 2007
I
Pilsicainidee.g.
Sunrhythm®
-other names-
Antiarrhythmic Agent
(1C: Na-blocker) /
Arrhythmias
Takenaka 1999
Fujiki 1999
Takagi 2002
Kimura 2004
I
Procainamidee.g.
Procan®
Pronestyl®
-other names-
Antiarrhythmic Agent
(1A: Na-blocker) /
Arrhythmias
Miyazaki 1996
Brugada 1997
Joshi 2007
Villemaire 1992
I
Propafenonee.g.
Rythmol®
-other names-
Antiarrhythmic Agent
(1C: Na-blocker) /
Arrhythmias
Matana 2000
Akdemir 2002
Hasdemir 2006
Shan 2008
Stark 1996
IIa

Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.

Psychotropic drugs

Generic name
Brand name®
Clinical use
References
Class
Amitriptylinee.g.
Elavil®
Sarotex®
Tryptizol®
-other names-
Antidepressive
(Tricyclic)
Bolognesi 1997
Rouleau 2001
Bebarta 2007
Nau 2000
IIa
Clomipraminee.g.
Anafranil®
Anafril®
-other names-
Antidepressive
(Tricyclic)
Goldgran 2002
Pacher 2000
IIa
Desipraminee.g.
Norpramin®
Pentofran®
-other names-
Antidepressive
(Tricyclic)
Babaliaros 2002
Chow 2005
Akhtar 2006
Sudoh 2003
IIa
Lithiume.g.
Eskalith®
-other names-
AntidepressiveBabalarios 2002
Darbar 2005
Wright 2010
IIb
Loxapinee.g.
Cloxazepine®
Loxitane®
-other names-
AntipsychoticRouleau 2001
Kinugawa 1988
IIa
Nortriptylinee.g.
Nortrilen®
Pamelor®
-other names-
Antidepressive
(Tricyclic)
Bardai 2013
Tada 2001
Muir 1982
Sudoh 2003
IIa
Oxcarbazepine*e.g.
Trileptal®
-other names-
Anti-epilepticEl-Menyar 2011
Huang 2008
IIa
Trifluoperazinee.g.
Fluoperazine®
Stelazine®
--other names-
Antipsychotic
(Phenothiazine)
Rouleau 2001
Klöckner 1987
IIa

Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.

*Oxcarbazepine is structurally a derivative of carbamazepine which is on the preferably avoid list.

Anesthetics / analgesics

Generic name
Brand name®
Clinical use
References
Class
Bupivacainee.g.
Marcaine®
Sensorcaine®
-other names-
Anesthetic /
analgesic
Phillips 2003
Vernooy 2006
Bramall 2011
De la Coussaye 1992
Berman 1994
IIa
Procainee.g.
Procaine-Penicillin
Novocain®
-other names-
AnalgesicArumugam 2012IIa
Propofol*e.g.
Diprivan®
-other names-
AnestheticInamura 2006
Vernooy 2006
Robinson 2008
Saint 1998
IIa

Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
* Prolonged propofol infusion has particularly been associated with adverse effects
For more information on anesthetic management of Brugada syndrome patients; a review article has been written by Kloesel & Ackerman, when appropriate precautions are taken (general) anesthesia can be performed safely.

Other substances

Generic name
Brand name®
Clinical use
References
Class
Acetylcholine-Not applicable-Cholinergic /
Vasospastic intracoronary
Miyazaki 1996
Noda 2002
Montgomery 1974
IIa
Alcohol
(toxicity)
-Not applicable-Other substances /
Beverage
Shimada 1996
Rouleau 2001
Ohkubo 2013
Habuchi 1995
IIb
Cannabis-Not applicable-Other substances /
illicit drugs
Romero-Puche 2012
Ghuran 2000
Turkanis 1991
IIb
Cocaine-Not applicable-Other substances /
Anesthetic
Littmann 2000
Ortega 2001
Bebarta 2007
Xu 1994
IIa
Ergonovinee.g.
Ergotrate®
-other names-
Vasospastic intracoronaryNoda 2002
Müller 1980
IIb

Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.

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.