Dronedarone

MULTAQ

What it ishERG-blocking class III antiarrhythmic and noniodinated amiodarone analog; paroxysmal atrial fibrillation.

Why this oneIts noniodinated design greatly reduces thyroid toxicity but sacrifices rhythm-control efficacy versus amiodarone.

What limits itContraindicated in decompensated heart failure and permanent atrial fibrillation; it also raises digoxin exposure.

FDA-approved for

BOXED WARNING Doubles risk of death in NYHA Class IV/recently decompensated HF and in permanent AF; contraindicated in both.

FDA dosing	Population	Start	Target	Max
Paroxysmal/persistent atrial fibrillation (in sinus rhythm)	Adults	400 mg BID	400 mg BID	400 mg BID

Renal No adjustment needed

Hepatic No adjustment for moderate impairment; contraindicated in severe impairment

Permanent AF (sinus rhythm cannot be restored)
Symptomatic HF with recent decompensation requiring hospitalization or NYHA Class IV
Second/third-degree AV block or sick sinus syndrome (without functioning pacemaker)
Bradycardia <50 bpm
Concomitant strong CYP3A inhibitors
Concomitant erythromycin
Concomitant QT-prolonging drugs/herbals that may induce torsade de pointes
Liver or lung toxicity related to prior amiodarone use
QTc >500 ms or PR >280 ms
Severe hepatic impairment

Pregnancy May cause fetal harm (animal malformations); verify not pregnant and use effective contraception.

Lactation Do not breastfeed during treatment and for 5 days after last dose.

⚠ BOXED WARNING

Increased mortality in decompensated heart failure and in permanent atrial fibrillation

Cost, est. cash$300–$2,500/month

Generic entry2024

Therapeutic safety burden3 / 4

Overdose danger4 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades3 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilityProarrhythmia, conduction slowing and agent-specific organ toxicity; overdose may cause malignant dysrhythmia.