vernakalant hydrochloride: clinical use

Prescribing considerations

• Confirm recent-onset atrial fibrillation and assess haemodynamic stability and suitability for pharmacological cardioversion.
• Optimise hydration and haemodynamic status; correct uncorrected hypokalaemia before administration.
• Assess coagulation and anticoagulation requirements independently of rhythm conversion.
• Use caution with stable NYHA I–II heart failure, valvular disease, oral antiarrhythmics, hepatic impairment or a pacemaker.
• Vernakalant is not effective for typical primary atrial flutter and is not recommended for advanced hepatic impairment or previously documented severe left-ventricular systolic dysfunction.

Contraindications and cautions

• Hypersensitivity to vernakalant or an excipient.
• Severe aortic stenosis, systolic blood pressure below 100 mmHg, or NYHA III–IV heart failure.
• Baseline uncorrected QT prolongation, severe bradycardia, sinus-node dysfunction, or second- or third-degree heart block without a pacemaker.
• Recent intravenous class I or III antiarrhythmic use or planned use shortly after vernakalant.
• Acute coronary syndrome, including myocardial infarction, within the previous 30 days.

Monitoring

• Obtain baseline blood pressure, heart rate and ECG; consider potassium and coagulation assessment.
• Continuously monitor cardiac rhythm and observe vital signs throughout administration and afterwards until clinical and ECG parameters are stable.
• Stop administration for sudden hypotension or bradycardia, significant conduction or interval changes, ischaemic ECG changes, or ventricular arrhythmia.
• Monitor patients with heart failure or valvular disease particularly closely.

Clinical pharmacology

Vernakalant is an atrial-preferential multichannel antiarrhythmic. It slows atrial conduction and prolongs refractoriness, suppressing re-entry. Metabolism mainly involves CYP2D6 in extensive metabolisers; glucuronidation and renal excretion are more important in poor metabolisers. Systemic exposure is short-lived.

Formulation and product differences

• The licensed product is a clear, colourless to pale-yellow concentrate in single-use glass vials.
• It must be diluted with a compatible infusion fluid and visually inspected before administration.
• It must not be mixed with medicines other than the specified diluents.
• Vial size and chosen diluent affect the total sodium delivered.

Solution for infusion

Route: Intravenous

Strengths: 20 mg/mL