19. “My doctor told me about the Tikosyn [generic name dofetilide] drug option that I want to consider in getting rid of my 5-month-old persistent A-Fib. That seems like something that should be discussed on your web site.”
Tikosyn made by Pfizer (generic name dofetilide) is a class III antiarrhythmic agent and certainly deserves its own discussion on A-Fib.com. (See also the first question in this section “Which medications are best to control my Atrial Fibrillation?” )
In Hospital for Three Days
Tikosyn is a newer antiarrhythmic med that works really well in some people. It’s approved for use in cases of persistent A-Fib. When starting Tikosyn, you have to be hospitalized for at least three days for observation. This is so that doctors can monitor you for bad effects (such as Torsades de Pointes, a special type of rapid heart rate which can be dangerous) due to its pro-arrhythmic potential (can cause arrhythmias instead of stopping them). Doctors also use this three-day hospitalization to determine the best dosage of Tikosyn for you. Importantly, short-term response does not necessarily predict long-term effectiveness.
How Tikosyn Works
For you technical types, Tikosyn works by selectively blocking the rapid component of the delayed rectifier outward potassium current (Iĸг). It causes the refractory period of atrial tissue to increase making your heart less susceptible to A-Fib signals. It’s 80% excluded by the kidneys, which means that anyone with kidney problems has to be carefully monitored or shouldn’t be taking it. Tikosyn has a half-life of roughly ten hours, which means it takes that long for your body to clear it from your system.
Tikosyn Somewhat Hard to Obtain
Not all doctors can prescribe Tikosyn. Only doctors who have gone through Tikosyn training from Pfizer can prescribe it. Depending on where you live, you may have a hard time finding a doctor who can prescribe Tikosyn. Call Pfizer for help in finding a doctor at 800-879-3477. Pfizer also has a special program if you are uninsured, call 866-706-2400.
Tikosyn and Persistent A-Fib
Persistent A-Fib is the hardest to cure. Catheter ablation success rates for Persistent A-Fib are usually lower than for Paroxysmal (occasional) A-Fib. This is because people in persistent A-Fib have probably been in A-Fib for a long time and have developed multiple areas of A-Fib producing spots in the heart other than in the Pulmonary Veins. These areas are harder to locate and ablate (isolate). Some people in persistent A-Fib who have had failed catheter ablations or surgeries are restored to normal sinus rhythm by taking Tikosyn. Tikosyn may work for you, though obviously it’s not guaranteed.
What Patient are Saying About Being on Tikosyn
In general, my non-scientific survey of these comments suggests that Tikosyn has more successes than failures, but that it’s a potentially dangerous drug. For some people, Tikosyn works when ablation has failed and when one has been in persistent A-Fib, even for a long time. It is expensive. And few people have been on Tikosyn for a lifetime. Since Tikosyn has potentially very bad side effects, so much so that one has to be hospitalized for three days when starting it, one wonders what a lifetime on Tikosyn will eventually do to one’s heart and body. But for people who’ve had failed ablations, surgeries, cardioversions and are in persistent symptomatic A-Fib, Tikosyn is a valid (welcome) option probably worth trying.
Thanks to Sam Matier for this question.
Banchs, Javier E., et al. Efficacy and safety of dofetilide in patients with atrial fibrillation and atrial flutter. Journal of Interventional Cardiac Electrophysiology November 2008, Volume 23, Issue 2, pp 111-115 Last accessed March 13, 2014 URL: http://link.springer.com/article/10.1007/s10840-008-9290-6
Roukoz H, Saliba W (January 2007).”Dofetilide: a new class III antiarrhythmic agent”. Expert Rev Cardiovasc Ther 5 (1): 9–19. doi:10.1586/14779072.5.1.9. PMID 17187453
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