Dosing Guideline for Drugs commonly used to treat AFib

HEART RATE CONTROL
DRUG DOSING
Digoxin IV: 0.25mg q2hrs (up to 1.5mg), then 0.125-0.375mg daily; PO: 0.125-0.375mg daily
Beta Blockers
Atenolol PO: 25-100mg daily
Bisoprolol PO: 2.5mg daily; can be titrated to 20mg daily
Carvedilol PO: 3.125-25mg every 12 hrs (up to 50mg every 12 hrs for patients > 85kg), may use carvedilol sustained release 10-80mg daily
Esmolol IV: 500 mcg/kg over 1 min, then 50-200 mcg/kg/min
Metoprolol IV: 2.5-5mg bolus over 2 min (up to 3 doses); PO: 25-100mg bid, may use metoprolol succinate ER 25-200mg daily
Calcium Channel Blockers
Diltiazem IV: 0.25mg/kg (avg 20mg) over 2 min (2nd bolus can be given if HR >100bpm), then 5-15mg/hr; PO: 120-360mg daily (slow release preferred)
Verapamil IV: 0.075-0.15mg/kg over 2 min; PO: 120-360mg daily (slow release preferred)
HEART RHYTHM CONTROL
DRUG DOSING
Vaughan Williams Class I
Flecainide PO: 50-150mg every 12 hrs
Propafenone PO: 150-300mg every 8 hrs, or sustained release 225-425mg every 12 hrs
Vaughan Williams Class III
Amiodarone IV: 150mg over 10 min, then 0.5-1mg/min; PO: 200mg TID x 2 weeks, 200mg BID x 2wks, then 200mg daily. Take with meals.
Dofetilide PO: 125-500mcg every 12 hrs, based on renal function and QTc; must be initiated in the hospital
Dronedarone PO: 400mg twice daily with meals
Ibutilide IV: ≥ 60kg – 1 mg over 10 min; <60kg – 0.01mg/kg over 10 min, while observing for QTc prolongation and ventricular proarrhythmia. Dose can be repeated after 10 min but the risk of proarrhythmia increases. Pretreatment with MgSO4 1-2gm IV may reduce the risk of TdeP.
Sotalol PO: 80mg BID, to a maximum of 240-320mg/day, based on renal function and QTc

References

1. January CT, et al. AHA/ACC/HRS 2014 guideline for the management of patients with atrial fibrillation. Circulation, 2014. [Epub ahead of print]
2. Calkins, H, et al. 2012 HRS/EHRA/ECAS Expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm. 2012 Mar 1. [Epub ahead of print].
3. Connolly, S., et al. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med 2009 Sep 17; 361(12):1139-1151.
4. Patel, MR, et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011 Sep 8;365(10):883-91.
5. Granger, CB, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011 Sep 15;365(11):981-92.
6. The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) Investigators. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med. 2002;347: 1825-1833.
7. Van Gelder, IC, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med. 2010 Apr 15;362(15):1363-73.

This pocket guide was supported in part by SANOFI and Biosense Webster, a Johnson and Johnson Company