Ibutilide

CORVERT

Open Ibutilide in the interactive console ↗

Ibutilide ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Ibutilide ballicule

What it isClass III hERG potassium-channel blocker; acute conversion of atrial flutter and fibrillation.

Why this oneConverts atrial flutter more reliably than atrial fibrillation and acts rapidly by infusion.

What limits itPotentially fatal torsades requires continuous ECG observation after dosing with magnesium and resuscitation capability available.

Ibutilide molecular structure (skeletal formula) — Molecular structure: Ibutilide

FDA-approved for

atrial fibrillation (IV) (1995)

Sulfonamide

Sulfonamide-derived drug — label silent

A sulfonamide by structure, without the N4 aromatic amine or N1 heterocycle; the label carries no sulfonamide warning, and Khan lists it among drugs with no or weak evidence of cross-reactivity.

Open the sulfonamide hypersensitivity presentation → · sources [n] are on its References slide.

Classes and tags

Clinical profile

Therapeutic safety burden4 / 4

Overdose danger3 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades4 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Defining liabilityAcute torsades and other life-threatening ventricular arrhythmias

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Potentially fatal arrhythmias (polymorphic VT, usually torsades); give only with continuous ECG monitoring by personnel trained to treat acute ventricular arrhythmias

FDA dosing	Population	Start	Target	Max
Atrial fibrillation/flutter (conversion to sinus rhythm)	≥60 kg	1 mg (one vial) IV over 10 min	1 mg IV over 10 min
Atrial fibrillation/flutter	<60 kg	0.01 mg/kg (0.1 mL/kg) IV over 10 min	0.01 mg/kg IV over 10 min

Renal Undefined

Hepatic Undefined

May repeat same dose once, 10 min after completion of first infusion, if arrhythmia persists

Instructions

May give undiluted or diluted in 50 mL (0.9% NaCl or 5% dextrose)
Continuous ECG monitoring during and ≥4 h after infusion (or until QTc returns to baseline)
Have cardioverter/defibrillator and treatment for sustained/polymorphic VT available
Stop infusion when arrhythmia terminates or if sustained/nonsustained VT or marked QT/QTc prolongation

Available strengths

inj 0.1 mg/mL

Cautions

Proarrhythmia — potentially fatal polymorphic ventricular tachycardia (Torsades)
QT/QTc prolongation
Requires continuous ECG monitoring and resuscitation equipment

Adverse reactions

Sustained/nonsustained polymorphic VT
Monomorphic VT
Ventricular/supraventricular extrasystoles
AV block, bundle branch block
Hypotension
Bradycardia/tachycardia
QT prolongation
Nausea
Headache

Pregnancy Teratogenic and embryocidal in rats; give only if benefit outweighs fetal risk

Lactation Undefined

Cost

Ibutilide (CORVERT)

Strength		#/mo	generic $/unit	CostPlus
0.1 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Ibutilide is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

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Self-check

Which rhythm does ibutilide convert more reliably: flutter or fibrillation?
Atrial flutter.
Which potentially fatal arrhythmia requires post-dose ECG observation?
Torsades.