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Brugada Drug Avoidance — EECC MCQ

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EasyGeneral CardiologyBrugada Drug AvoidanceEECC

A 40-year-old man is diagnosed with Brugada syndrome. He asks which medications and substances he must avoid. What is the primary resource for drug safety in Brugada syndrome?

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Correct answer: C — The Brugada drugs website (www.brugadadrugs.org) maintains a comprehensive list of drugs to avoid; key categories include class IC antiarrhythmics (flecainide, propafenone), certain antidepressants, anaesthetic agents, and cocaine

Patients with Brugada syndrome must avoid drugs that block cardiac sodium channels, as these can unmask or worsen the Brugada ECG pattern and precipitate arrhythmias. The www.brugadadrugs.org website (endorsed by the ESC) categorises drugs into: 'definitely to avoid', 'preferably to avoid', and 'potentially to avoid'. Key drug categories to avoid include: (1) Class IC antiarrhythmics (flecainide, propafenone, ajmaline — used diagnostically for Brugada provocation but dangerous therapeutically); (2) Certain psychotropic drugs (lithium, tricyclic antidepressants in overdose); (3) Anaesthetic agents (bupivacaine, propofol in high doses); (4) Recreational drugs (cocaine — potent sodium channel blocker); (5) Certain anti-emetics, antihistamines. Fever must be treated promptly with antipyretics.

Reference: ESC (2022): VA/SCD Guidelines; www.brugadadrugs.org