Drug interactions
Dofetilide + Epinephrine
Severity: Major
Dofetilide and Epinephrine: major interaction.
Last updated Sources: Health Canada product monograph
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Dofetilide markedly prolongs repolarization and carries a high risk of torsades de pointes. Epinephrine adds proarrhythmic stimulation and can lower serum potassium, increasing this risk.
What this interaction means in plain words
Dofetilide and Epinephrine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Dofetilide belongs to Cardiovascular; Epinephrine belongs to Endocrine.
Why it happens
Additive proarrhythmic effects: dofetilide blocks IKr while catecholamine stimulation and hypokalemia increase torsades susceptibility.
What to do
Avoid non-essential epinephrine and use continuous ECG monitoring when it is required. Keep potassium and magnesium in the normal range.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Epinephrine
- Epinephrine + Isocarboxazid Contraindicated
- Epinephrine + Phenelzine Contraindicated
- Epinephrine + Tranylcypromine Contraindicated
- Acebutolol + Epinephrine Major
- Amitriptyline + Epinephrine Major
- Amoxapine + Epinephrine Major
Other interactions of Dofetilide
- Amiodarone + Dofetilide Contraindicated
- Amisulpride + Dofetilide Contraindicated
- Amlodipine-hydrochlorothiazide-valsartan + Dofetilide Contraindicated
- Amlodipine-olmesartan-hydrochlorothiazide + Dofetilide Contraindicated
- Candesartan-hydrochlorothiazide + Dofetilide Contraindicated
- Captopril-hydrochlorothiazide + Dofetilide Contraindicated
Frequently asked questions
Can I take Dofetilide with Epinephrine?
MediHelp rates the interaction as major. Dofetilide and Epinephrine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Dofetilide markedly prolongs repolarization and carries a high risk of torsades de pointes. Epinephrine adds proarrhythmic stimulation and can lower serum potassium, increasing this risk.
How serious is the interaction between Dofetilide and Epinephrine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid non-essential epinephrine and use continuous ECG monitoring when it is required. Keep potassium and magnesium in the normal range.
What other medicines interact with Epinephrine?
MediHelp also lists interactions of Epinephrine with, for example, Isocarboxazid, Phenelzine, Tranylcypromine. The full list is on the Epinephrine page.
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