II. Indications
- Ventricular Arrhythmia
- Other Antiarrhythmics are preferred
III. Contraindications
- Structural heart disease (prior Myocardial Infarction, Systolic Dysfunction)
IV. Mechanism
- Class Ib Antiarrhythmic Drug
- Decreases automaticity at AV Node and ectopic focil
- Increases refractory period in His Bundle, Purkinje Fibers, ventricle and accessory pathways
V. Precautions
- Other Antiarrhythmics are preferred (consult cardiology)
- Consider dose adjustment in severe liver disease
- Proarrhythmic
- Higher mortality in non-life threatening ventricular Arrhythmia and structural heart disease
VI. Dosing
- Start: 200 mg every 8 hours with food
- Titrate dose to effect
- May convert to twice daily dosing when effective dose identified
- Maximum
- Three times daily: 1200 mg/day (400 mg/dose)
- Twice daily: 900 mg/day (450 mg/dose)
-
Renal Dosing for eGFR <10 ml/min
- Decrease to 50 to 75% of typical dose
VII. Safety
- Avoid in Lactation
- Pregnancy Category C
VIII. Adverse Effects
- Proarrhythmic
- Hepatotoxicity
- Neurotoxicity
- Seizures
IX. Drug Interactions
- Mexiletine may increase levels of other medications
- Other medications may effect drug levels of Mexiletine
X. Resources
XI. References
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 74-5
- van der Ree (2022) Europace 24(11):1809-23 +PMID: 36036670 [PubMed]
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Related Studies
| mexiletine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| MEXILETINE 150 MG CAPSULE | Generic | $0.43 each |
| MEXILETINE 200 MG CAPSULE | Generic | $0.70 each |
| MEXILETINE 250 MG CAPSULE | Generic | $0.92 each |