Tikosyn

The intensive monitoring required for tikosyn induction as actually due to earlier generation antiarrhythmics such as sotalol which turned out to be extremely dangerous, which is why today they are only recommended to be used in very rare situations (although you'll still find 'old-school' cardiologists who use them more regularly than they should). The FDA doesn't typically change requirements for drugs post-approval, typically they just apply the requirements they should have applied to previously approved drugs to drugs from that point forward.

The requirement for tikosyn is that the first 6 doses be given while on continuous cardiac monitoring and that QTc's be monitoring by 12 lead after each dose which must be reviewed by a physician qualified for tikosyn induction (typically an EP doc) prior to the next dose being ordered and dosage adjustments made as indicated.

The main concern is QT prolongation which can lead to ventricular arryhthmias, although the risk is much less compared to sodium channel blockers such as sotalol.

Typically, these are going to be easiest patients on a tele floor and adverse events are relatively rare. Day 3 can get a little busier since it's not unusual for an elective cardioversion to be attempted on day 3 if the patient has not already converted.

Very similar to sotalol, except check the pts insurance before they go, many do not cover tikosyn or it's quite expensive...

Sotalol isn't a sodium channel blocker.

Yes, that was bad editing on my part, it was supposed to be 'sodium channel blockers and sotalol.'

The Pfzier web site has a wealth of information on Tikosyn.

Thanks everyone!! I will check out their website and see what I can find!

I despise tikosyn... This drug is very risky and has a tendency to prolong the QT which is why the doc requires an EKG 2 hours after administration. We keep our patients for 3 days and monitor them VERY closely. I did have an incident once where my patient went into Torsades after her 2nd dose and and it kept happening every half hour after that and she ended up needing a pacer. We use it quite often but it freaks me out every time.