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FAQs A-Fib Drug Therapy: Medications

Drug Therapies for Atrial Fibrillation, A-Fib, Afib“Which antibiotics are less liable to cause an A-Fib attack? How is Clindamycin for dental work? In the past I reacted to Azithromycin and Advil.

To answer these questions, I turned to members of our world-wide Advisory Board. Several EPs shared their opinions, research data and insights from their practices.

Expert Opinions from Several Members of our A-Fib Advisory Board:

One EP’s response: “There is no particular association that I can think of or have seen with antibiotics, but likely more of a personal idiosyncratic reaction to the drug. Everybody is different and has a different trigger.”

Another EP wrote: Most antibiotics are well tolerated by patients with A-Fib.

A well-known authority on pharmaceuticals and A-Fib stated: “I know of NO data to prove a link between any antibiotic and A-Fib.”

”Most [antibiotics] do not change the way the heart’s electrical system functions other than prolonging the QT interval, which should have the opposite effect…act like antiarrhythmics.”

From another EP: “Most [antibiotics] do not change the way the heart’s electrical system functions other than prolonging the QT interval, which should have the opposite effect. In the quinolone family, (antibiotics) like Levofloxacin and Ciprofloxacin act like antiarrhythmics.

However, some antibiotics have worse gastric tolerance effects like Azithromycin and Erythromycin which can become a trigger for A-Fib by GI stimulation such as nausea or reflux. Medication to counter that side effect can be used, such as acid reducers.”

One EP called our attention to a study that focused on ventricular arrhythmia rather than on A-Fib. (Ventricular arrhythmias can kill you, while an attack of A-Fib usually isn’t life threatening):

“There have been reports of higher rates of ventricular arrhythmias with certain antibiotics (macrolides like Azithromycin and fluoroquinolones like Levofloxacin). It’s possible similar results could be found if looking for atrial arrhythmias, too. (The FDA warned of the risks of possibly lethal heart rhythm when taking Azithromycin or Levofloxacin. [Rao and colleagues.] But the absolute risks were relatively low.)

It’s much more likely that the underlying infection or illness causes A-Fib rather than the antibiotic used to treat it.

This EP further clarified:

A-Fib is more likely to start during times of physical stress, such as after surgery or when your body is fighting an infection. It’s much more likely that the underlying infection or illness causes A-Fib rather than the antibiotic used to treat the infection.”

The General Consensus on Antibiotics and A-Fib

At this time, we can’t identify antibiotics that cause or trigger A-Fib in most patients.

According to most authorities in the A-Fib field, an A-Fib patient’s negative reaction to a particular antibiotic is most likely an individual idiosyncratic response rather than a generalized, population-wide phenomenon.

Thanks to Our A-Fib Advisory Board

I am deeply indebted to these cardiac electrophysiologists and others who offer me their counsel in publishing When I have a tough question, I can button hole them at a medical conference, send an email, or telephone them.

While not always agreeing with all my positions, these doctors try to point me in the right direction. It is my honor to acknowledge and thank the world-wide members of the Advisory Board.

For a list of members, go to the Advisory Board.

Resources for this Article
• Neale, Todd. Can Antibiotics Trigger Arrhythmias? Medpage Today, March 10, 2014.

• Rao G et al. Azithromycin and levofloxacin use and increased risk of cardiac arrhythmias and death. Ann Fam Med 2014; 12: 121-127. doi:  10.1370/afm.1601

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Last updated: Wednesday, August 26, 2020

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