Etripamil

CARDAMYST

What it isIntranasal L-type calcium-channel blocker that slows AV-nodal conduction; acute symptomatic paroxysmal SVT.

Why this oneIt is the first patient-administered therapy designed to terminate an SVT episode without an IV or emergency visit.

What limits itNasal irritation is common; bradycardia, hypotension, and AV block are the key safety concerns.

FDA-approved for

FDA dosing	Population	Start	Target	Max
Paroxysmal supraventricular tachycardia (PSVT)	adults	70 mg intranasal (one spray each nostril) at symptom onset	70 mg intranasal PRN	140 mg intranasal / 24 h

Renal Undefined

Hepatic Undefined

Do not exceed 140 mg in 24 h; wait 10 min before repeat dose

Intranasal use only; administer as soon as possible after PSVT symptom onset, one spray into each nostril (70 mg total)
Administer in a sitting position where fall risk is minimal
If symptoms persist after 10 min, give a second 70 mg dose (one spray each nostril)
Seek emergency help if symptoms do not improve within 20 min after the second dose
If a full initial dose is not delivered (device malfunction/misuse), wait at least 10 min before a second dose

Heart failure — NYHA Class II to IV
Wolff-Parkinson-White (WPW), Lown-Ganong-Levine (LGL) syndromes, or manifest pre-excitation (delta wave) on 12-lead ECG
Sick sinus syndrome without a permanent pacemaker
Second degree AV Mobitz 2 block or higher degree of AV block

Syncope/dizziness from hemodynamic effects (BP, HR, cardiac conduction) — administer in a sitting position; monitor patients at risk for hemodynamic instability

Pregnancy No human data; animal (IV) studies showed no clear fetal harm at exposures near/above MRHD

Lactation No data on etripamil in milk; interrupt breastfeeding and pump and discard milk for 12 h after a dose

NO BOXED WARNINGS

Direct muscarinic antagonism0 / 4