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 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).
- 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 Board is 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
Please also read our Disclaimer.
Antiarrhythmic drugs
(Alphabetical order generic name)
| Generic name | Brand name® | Class / Clinical use | References | Recommendation |
| Ajmaline | e.g. Gilurytmal® |
Antiarrhythmic Agent (1A: Na-blocker) / Arrhythmias | Brugada et al. 1997 Rolf et al. 2003 Wolpert et al. 2005 Bébarová et al. 2005 |
Class I |
| Flecainide | e.g. Tambocor® |
Antiarrhythmic Agent (1C: Na-blocker) / Arrhythmias | Krishnan et al. 1998 Brugada et al. 2000 Gasparini et al. 2003 Meregalli et al. 2006 Stokoe et al. 2007 |
Class I |
| Pilsicainide | e.g. Sunrhythm® |
Antiarrhythmic Agent (1C: Na-blocker) / Arrhythmias | Takenaka et al. 1999 Fujiki et al. 1999 Takagi et al. 2002 Kimura et al. 2004 |
Class I |
| Procainamide | e.g. Procan® Pronestyl® |
Antiarrhythmic Agent (1A: Na-blocker) / Arrhythmias | Miyazaki et al. 1996 Brugada et al. 1997 Joshi et al. 2007 Villemaire et al. 1992 |
Class I |
| Propafenone | e.g. Rythmol® |
Antiarrhythmic Agent (1C: Na-blocker) / Arrhythmias | Matana et al. 2000 Akdemir et al. 2002 Hasdemir et al. 2006 Shan et al. 2008 Stark et al. 1996 |
Class IIa |
Recommendation: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
Psychotropic drugs
(Alphabetical order generic name)
| Generic name | Brand name® | Class / Clinical use | References | Recommendation |
| Amitriptyline | e.g. Elavil® Sarotex® Tryptizol® |
Antidepressive Agent, Tricyclic | Bolognesi et al. 1997 Rouleau et al. 2001 Bebarta et al. 2007 Nau et al. 2000 |
Class IIa |
| Clomipramine | e.g. Anafranil® Anafril® |
Antidepressive Agent, Tricyclic | Goldgran et al. 2002 Pacher et al. 2000 |
Class IIa |
| Desipramine | e.g. Norpramin® Pentofran® |
Antidepressive Agent, Tricyclic | Babaliaros et al. 2002 Chow et al. 2005 Akhtar et al. 2006 Sudoh et al. 2003 |
Class IIa |
| Lithium | e.g. Eskalith® |
Antidepressive Agent | Babalarios et al 2002 Darbar et al. 2005 |
Class IIa |
| Loxapine | e.g. Cloxazepine® Loxitane® |
Antipsychotic Agent | Rouleau et al. 2001 Kinugawa et al. 1988 |
Class IIa |
| Nortriptyline | e.g. Nortrilen® Pamelor® |
Antidepressive Agent, Tricyclic | Tada et al. 2001 Muir et al. 1982 Sudoh et al. 2003 |
Class IIa |
| Trifluoperazine | e.g. Fluoperazine® Stelazine® |
Antipsychotic Agent, Phenothiazine | Rouleau et al. 2001 Klöckner et al. 1987 |
Class IIa |
Recommendation: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
Anesthetics
(Alphabetical order generic name)
| Generic name | Brand name® | Class / Clinical use | References | Recommendation |
| Bupivacaine | e.g. Marcaine® Sensorcaine® |
Anesthetic Agent | Phillips et al. 2003 Vernooy et al. 2006 Coussaye et al. 1992 Berman et al. 1994 |
Class IIa |
| Propofol | e.g. Diprivan® |
Anesthetic Agent | Inamura et al. 2006 Vernooy et al. 2006 Robinson et al. 2008 Saint 1998 |
Class IIb |
Recommendation: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
Other substances
(Alphabetical order generic name)
| Generic name | Brand name® | Class / Clinical use | References | Recommendation |
| Acetylcholine | - | Cholinergic Agent / Vasospastic intracoronary | Miyazaki et al. 1996 Noda et al. 2002 Montgomery et al. 1974 |
Class IIa |
| Alcohol (toxicity) | -Not applicable- | Other substances / Anesthetic Agent | Shimada et al. 1996 Rouleau et al. 2001 Habuchi et al. 1995 |
Class IIb |
| Cocaine | -Not applicable- | Other substances / Anesthetic Agent | Littmann et al. 2000 Ortega et al. 2001 Bebarta et al. 2007 Xu et al. 1994 |
Class IIa |
| Ergonovine | e.g. Ergotrate® |
Vasospastic intracoronary | Noda et al. 2002 Müller et al. 1980 |
Class IIb |
Recommendation: 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.