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bretylium (medicine)


bretylium
<drug> An antihypertensive which on chronic oral dosing diminishes the release of norepinephrine from noradrenergic nerve endings.

Pharmacologic action: Suppress ventricular fibrillation and ventricular tachycardia, initially releases norepinephrine, then prevents synaptic release of norepinephrine; transiently increases myocardial contractilityUses: Treatment of refractory ventricular fibrillation and pulseless ventricular tachycardia after defibrillation, epinephrine, and lidocaine. Treatment of ventricular tachycardia with a pulse after lidocaine and procainamide. Treatment of wide complex tachycardia of uncertain type after lidocaine and adenosine.

Dose: 5 mg/kg IV initially, then 10 mg/kg every 5-10 minutes to a maximum of 30 mg/kg In persistently recurring ventricular tachycardia, load with 5-10 mg/kg diluted in 50 mL and infuse over 8-10 min. Follow with continuous infusion at 1-2 mg/min

Onset: Transient hypertension and tachycardia lasts about 20 min. Postural hypotension begins about 20 min after injection and peaks about 60 min later.

Potential complications: 1. May cause initial hypertension followed by a decrease in systemic vascular resistance and hypotension. 2. May exacerbate digitalis toxicityNote: Lidocaine is considered the first line drug for ventricular arrhythmias. Bretylium causes more hemodynamic instability than lidocaine and has not been shown to increase survival more than lidocaine.