dofetilide
Tikosyn (dofetilide) is an antiarrhythmic medication that's used to treat and prevent atrial fibrillation (AFib) and atrial flutter. It's available as a brand name and generic capsule. Tikosyn (dofetilide) isn't a first-choice treatment since it requires close monitoring, including a minimum 3-day stay in a healthcare facility when you first start treatment to make sure the dose is safe for you. This medication can cause side effects like headache, chest pain, and dizziness. Tikosyn (dofetilide) can interact with many medications, including certain diuretics (water pills) and other antiarrhythmics.
What is Tikosyn (dofetilide)?
What is Tikosyn (dofetilide) used for?
Prevention of recurrent atrial fibrillation (AFib) or atrial flutter
Treatment of atrial fibrillation or flutter
How Tikosyn (dofetilide) works
Tikosyn (dofetilide) is an antiarrhythmic medication. It works by blocking potassium channels, which play an important role in regulating your heart's electrical activity. Tikosyn (dofetilide) slows down the electrical activity to keep your heart rhythm normal.
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What are the side effects of Tikosyn (dofetilide)?
Common Side Effects
- Abnormal heart rhythms (up to 15%)
- Headache (11%)
- Chest pain (10%)
- Dizziness (8%)
- Respiratory tract infection (7%)
- Shortness of breath (6%)
- Nausea (5%)
Other Side Effects
- Diarrhea
- Stomach pain
- Back pain
- Rash
- Flu-like symptoms
- Difficulty sleeping
- Accidental injury
- Needing a procedure or healthcare provider visit
Serious Side Effects
- Arrhythmia or irregular heartbeat: chest discomfort, dizziness, fainting, fast heartbeat
Source: DailyMed
More on Tikosyn (dofetilide) side effects
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Dizziness
fainting
fast heartbeat
Less common
confusion
facial or flaccid paralysis
numbness or tingling of the hands, feet, or face
paralysis
pounding, slow heartbeat
slurred speech
swelling of the ankles, arms, face, feet, fingers, legs, lips, tongue, or throat
troubled breathing
unexplained shortness of breath
unusual tiredness or weakness
yellow eyes or skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Tikosyn (dofetilide)
Pros
A recommended medication for stabilizing and maintaining normal heart rhythm
Less likely to cause liver damage
Available as a lower-cost generic form
Cons
Must stay in a healthcare facility for 3 days when first starting
Requires close monitoring because it has many risks, including irregular heartbeat
Taken twice daily
Pharmacist tips for Tikosyn (dofetilide)
When you're starting or re-starting Tikosyn (dofetilide), you'll need to stay in a healthcare facility for at least 3 days. This is so your providers can determine the right dose for you and closely monitor you. After you go home, make sure to take the exact same dose that you were prescribed at the end of your stay.
You can take Tikosyn (dofetilide) with or without food. Food doesn't affect how well this medication works.
If you miss a dose, don't double up to make up for the missed dose. Skip the missed dose and take the next dose at the usual time.
Avoid drinking grapefruit juice, since it can raise levels of Tikosyn (dofetilide) in the body and lead to more side effects.
Make sure you tell your provider and pharmacist about all of the medications you take, including supplements. And while you're taking Tikosyn (dofetilide), always check with your provider before starting any new medications or supplements. Your providers can check and discuss with you about dangerous drug interactions that Tikosyn (dofetilide) might have with your other medications. Certain Tikosyn (dofetilide) drug interactions can be very dangerous because of the risk of severe side effects, including abnormal heart rhythms.
Frequently asked questions about Tikosyn (dofetilide)
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What are the risks and warnings for Tikosyn (dofetilide)?
Tikosyn (dofetilide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Arrhythmias (irregular heart rhythm)
Risk factors: Poor kidney function | Taking medications that raise levels of Tikosyn (dofetilide)
Tikosyn (dofetilide) can cause arrhythmias (irregular heart rhythms). Certain types of arrhythmias can be very serious and potentially life-threatening. For this reason, you must stay in a healthcare facility for at least 3 days when you start or re-start Tikosyn (dofetilide). This allows your providers to make sure the medication is safe for you by adjusting your dose based on your kidney function and closely monitoring your heart's electrical activity through electrocardiograms (EKGs). They'll also be able to treat serious arrhythmias quickly if they happen. Get medical help right away if you experience chest discomfort, dizziness, fainting, or fast heartbeat while you're taking Tikosyn (dofetilide).
Let your provider know if you have a heart condition called sick sinus syndrome or second or third-degree heart block and you don't have a pacemaker. It's not known whether it's safe for you to use Tikosyn (dofetilide) without a pacemaker.
Many drug interactions
Tikosyn (dofetilide) can interact with many medications. Some can raise levels of Tikosyn (dofetilide) in the blood by slowing its breakdown or preventing the kidneys from clearing it out of the body. When Tikosyn (dofetilide) levels are too high, there's a higher risk for side effects. While you're taking Tikosyn (dofetilide), don't take cimetidine (Tagamet HB) (an over-the-counter antacid), trimethoprim (an antibiotic that's often combined with sulfamethoxazole in a medication called Bactrim or Septra), or ketoconazole (an antifungal).
In addition to Tikosyn (dofetilide), other medications, such as amiodarone (Pacerone), can cause abnormal heart rhythms. Let your provider know if you've taken amiodarone (Pacerone) or other antirrhythmic medication before you start Tikosyn (dofetilide). To lower your risk for heart rhythm problems due to this drug interaction, your provider might wait until these medications have cleared from your system before starting Tikosyn (dofetilide) treatment.
Be sure to talk to your providers and your pharmacist about all the medications you're taking, including over-the-counter medications and supplements. They can help check for dangerous drug interactions and make sure your medications are safe for you to take.
Low potassium and magnesium levels when taken with water pills
Risk factors: Taking certain diuretics (water pills)
Taking Tikosyn (dofetilide) with certain diuretics (water pills) can lead to low potassium and low magnesium levels. This raises your risk for serious heart rhythm problems. Your provider will check your electrolyte levels before and while you're taking this medication.
Dose adjustments needed for people with kidney problems
Risk factors: History of kidney problems
Your kidneys are responsible for removing Tikosyn (dofetilide) from the body. If you have low kidney function, you might need a lower dose of Tikosyn (dofetilide) since the medication is more likely to build up in the body and raise your risk for side effects. Your provider will check your kidney function through blood work to prescribe you an appropriate dose. Let your provider know if you have kidney problems so they can make sure Tikosyn (dofetilide) is safe for you.
Tikosyn (dofetilide) dosage forms
Typical dosing for Tikosyn (dofetilide)
The typical dose is 125 micrograms (mcg), 250 mcg, or 500 mcg by mouth twice daily. Your provider will determine the right dose for you based on various factors, especially your kidney function and your heart rhythm.
Interactions between Tikosyn (dofetilide) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Bictegravir
- Cimetidine
- Cisapride
- Dolutegravir
- Dronedarone
- Fingolimod
- Fluconazole
- Hydrochlorothiazide
- Itraconazole
- Ketoconazole
- Lefamulin
- Levomethadyl
- Megestrol
- Mesoridazine
- Pimozide
- Piperaquine
- Posaconazole
- Prochlorperazine
- Saquinavir
- Sparfloxacin
- Sulfamethoxazole
- Terfenadine
- Thioridazine
- Trimethoprim
- Verapamil
- Vernakalant
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Acecainide
- Alfuzosin
- Amiloride
- Amiodarone
- Amisulpride
- Amitriptyline
- Amoxapine
- Anagrelide
- Apomorphine
- Aprindine
- Aripiprazole
- Aripiprazole Lauroxil
- Arsenic Trioxide
- Artemether
- Asenapine
- Astemizole
- Azimilide
- Azithromycin
- Azosemide
- Bedaquiline
- Bemetizide
- Bendroflumethiazide
- Benzthiazide
- Berotralstat
- Bretylium
- Bumetanide
- Buprenorphine
- Buserelin
- Buthiazide
- Capmatinib
- Ceritinib
- Chloral Hydrate
- Chloroquine
- Chlorothiazide
- Chlorpromazine
- Chlorthalidone
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clopamide
- Clozapine
- Crizotinib
- Cyclobenzaprine
- Cyclopenthiazide
- Cyclothiazide
- Dabrafenib
- Dasatinib
- Degarelix
- Delamanid
- Desipramine
- Deslorelin
- Deutetrabenazine
- Diazoxide
- Dibenzepin
- Digoxin
- Dirithromycin
- Disopyramide
- Dolasetron
- Domperidone
- Donepezil
- Doxepin
- Droperidol
- Efavirenz
- Eliglustat
- Encorafenib
- Enflurane
- Entrectinib
- Erdafitinib
- Erythromycin
- Escitalopram
- Ethacrynic Acid
- Etozolin
- Fenquizone
- Flecainide
- Fluoxetine
- Formoterol
- Foscarnet
- Fosnetupitant
- Fostemsavir
- Furosemide
- Gatifloxacin
- Gemifloxacin
- Glasdegib
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Halothane
- Histrelin
- Hydroflumethiazide
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Iloperidone
- Imipramine
- Indapamide
- Inotuzumab Ozogamicin
- Isoflurane
- Isradipine
- Ivabradine
- Ivosidenib
- Josamycin
- Lacosamide
- Lamotrigine
- Lanreotide
- Lapatinib
- Lenvatinib
- Levofloxacin
- Lidoflazine
- Lofexidine
- Lopinavir
- Lorcainide
- Lorlatinib
- Lumefantrine
- Macimorelin
- Mefloquine
- Metformin
- Methadone
- Methyclothiazide
- Metolazone
- Metronidazole
- Mifepristone
- Mirtazapine
- Moricizine
- Moxifloxacin
- Nafarelin
- Netupitant
- Nilotinib
- Norfloxacin
- Nortriptyline
- Octreotide
- Ofloxacin
- Ondansetron
- Osilodrostat
- Osimertinib
- Oxaliplatin
- Ozanimod
- Paliperidone
- Panobinostat
- Pasireotide
- Pazopanib
- Pentamidine
- Pimavanserin
- Piretanide
- Pitolisant
- Polythiazide
- Ponesimod
- Prilocaine
- Probucol
- Procainamide
- Promethazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinethazone
- Quinidine
- Ranolazine
- Ribociclib
- Risperidone
- Roxithromycin
- Selpercatinib
- Sematilide
- Sertindole
- Sertraline
- Sevoflurane
- Siponimod
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Solifenacin
- Sorafenib
- Sotalol
- Spiramycin
- Sulpiride
- Sultopride
- Sunitinib
- Tacrolimus
- Tafenoquine
- Tedisamil
- Telavancin
- Telithromycin
- Tetrabenazine
- Toremifene
- Torsemide
- Trazodone
- Triamterene
- Trichlormethiazide
- Triclabendazole
- Trifluoperazine
- Trilaciclib
- Trimipramine
- Triptorelin
- Troleandomycin
- Tucatinib
- Vandetanib
- Vardenafil
- Vemurafenib
- Vinflunine
- Voclosporin
- Voriconazole
- Voxelotor
- Xipamide
- Zolmitriptan
- Zotepine
- Zuclopenthixol
How much does Tikosyn (dofetilide) cost?
Tikosyn (dofetilide) contraindications
Severe kidney problems
Heart rhythm condition called long QT syndrome
Use with certain interacting medications (see Risk and Warnings, or ask your provider or pharmacist)
What are alternatives to Tikosyn (dofetilide)?
Prevention of recurrent atrial fibrillation (AFib) or atrial flutter
Treatment of atrial fibrillation or flutter
Life-threatening ventricular fibrillation that keeps coming back (when other antiarrhythmics haven't worked well)
Life-threatening tachycardia that keeps coming back (when other antiarrhythmics haven't worked)
To lower the risk of hospitalization from atrial fibrillation (AFib) in adults who have a history of paroxysmal or persistent AFib
Tikosyn (dofetilide) images
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References
Best studies we foundAmerican Heart Association. (2022). What is an arrhythmia?
American Heart Association. (2023). Atrial fibrillation medications.
Bionpharma Inc. (2023). Dofetilide capsule [package insert]. DailyMed.
Csengeri, D., et al. (2021). Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes. European Heart Journal.
Dakkak, W., et al. (2023). Sick sinus syndrome. StatPearls.
Ibrahim, M.A., et al. (2023). Dofetilide. StatPearls.
January, C. T., et al. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation.
National Heart, Lung, and Blood Institute. (2022). Arrhythmias: Types.
National Institute of Diabetes and Digestive and Kidney Diseases. (2016). Dofetilide. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury.
Pfizer, Inc. (2012). Material safety data sheet: Tikosyn (Dofetilide) capsules - 0.125 mg, 0.25 mg, 0.50 mg.
Wolbrette, D. L., et al. (2018). A quarter of a century later: What is dofetilide’s clinical role today? Journal of Cardiovascular Pharmacology and Therapeutics.
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