The billion dollar question is this: when to use Multaq (dronedarone)? Safety is a key component in clinical decision-making process. --Torp-Pederson et al point out that rhythm control is the strategy often chosen by patients and physicians and conclude that dronedarone is an option for intermediate-risk patients and that for low-risk patients “dronedarone provides the only antiarrhythmic drug with a large safety database to prove reasonable safety. One should always know risks and side effects as most doctors do not tell you everything about their treatment plan and if you are uneducated and don’t ask the right questions or are surprise by effects…after the fact effect issues are a bad time to have that discussion. In the rapid‐switch group, switching from amiodarone to dronedarone within 48 hours was not associated with a higher incidence of treatment‐emergent AEs vs switching to placebo (Table 2). In general, the editorialist’s remarks regarding safety concerns with antiarrhythmic agents are on target. I’m sorry we live in an age of computers-stay off youor computer and trust your doctor, otherwise , find a new one–Don’t trust what you read-I was put on Multaq as well be my cardiologist several months ago and doing well on it however I lowered my intake to 1 tablet a day instead of 2 and my success is still great. (They then offer a detailed flow chart for treatment choices based on the clinical characteristics of the patient. The safety knowledge of dronedarone may result in patient and physician preference of dronedarone as first-line therapy, with a possible switch to amiodarone when sinus rhythm is no longer maintained.”

In general, with the most successful drugs the risk-benefit equation means that higher risk patients are the ones most likely to benefit. A study that investigated rapid switching from amiodarone to dronedarone (≤48 hours) in patients with AF showed nonsignificant higher incidence rates of bradyarrhythmia and heart failure in the “rapid-switching” group compared to the group of patients who had not received amiodarone within the last 2 months before taking dronaderone. The rate of serious adverse events associated with initiating dronedarone in the combined population of >1200 patients was low and varied little by whether patients had stopped taking amiodarone The finding that a switch can be made fairly safely and rapidly may help allay concerns over possibly severe increased risk if a patient starts dronedarone too soon after withdrawing from a drug with an unusually long half life and a notorious adverse-effect profile. This makes the drug costs unaffordable for many patients as out of pocket drug costs will cost you over $10k year. Having failed in high risk heart failure patients in its earlier trials, Sanofi was able to cherry pick a lower-risk subgroup and gather the low-hanging fruit. Post was not sent - check your email addresses! There’s another issue here that bothers me, relating to the partial paradox of deploying a low-efficacy drug for safety purposes in a low-risk population. Trusting doctors blindly is not good advice for anyone ask them and they will advise you to research and educate yourself too. In contrast, dronedarone, a synthetic derivative of amiodarone the structure of which lacks the iodine moiety, is … Incidence rates of serious AEs and events leading to hospitalization or death were similar across all groups. In such cases, he said, "it's probably a good idea to wait a bit longer [than 48 hours]. Steve Stiles. A new It all comes down to different ways of interpreting the safety and efficacy data. Share cases and questions with Physicians on Medscape Consult.