Multaq (Dronedaron) 400mg Tablet

Multaq is the brand name for dronedarone, a medication used to manage certain heart rhythm disorders. Specifically, it is prescribed to help maintain normal sinus rhythm and reduce the risk of hospitalization in patients with atrial fibrillation (AF) or atrial flutter (AFL). It is available in an oral tablet form, with each tablet containing 400mg of dronedarone. Multaq is produced by Sanofi and represents a key option for patients requiring long-term management of atrial arrhythmias.

How It Works

Dronedarone, the active ingredient in Multaq, is a multi-channel blocker that works to stabilize cardiac electrical activity and maintain a normal heart rhythm. Here is a detailed explanation of how it works: 1. **Inhibition of Multiple Ion Channels**: Dronedarone blocks various cardiac ion channels, including potassium, sodium, and calcium channels. This affects the electrical signals in the heart and reduces abnormal impulses that cause irregular heartbeats. 2. **Potassium Channel Blockade**: By blocking potassium channels, dronedarone prolongs the repolarization phase of the cardiac action potential. This action helps prevent re-entrant circuits and irregular electrical activity that can lead to arrhythmias. 3. **Sodium Channel Blockade**: Dronedarone also blocks sodium channels, which slows down the conduction of electrical signals within the heart, further stabilizing the cardiac rhythm. 4. **Calcium Channel Blockade**: The drug inhibits calcium influx, reducing the force of contraction and slowing the heart rate, which can be beneficial in controlling the ventricular response to atrial fibrillation or flutter. 5. **Antiadrenergic Effects**: Dronedarone has antiadrenergic properties, meaning it can modulate the effects of adrenergic neurotransmitters, further contributing to its ability to maintain a steady heart rhythm.

Indications

Multaq is indicated for the treatment of:

• Atrial Fibrillation (AF): Used to reduce the risk of cardiovascular hospitalization and maintain sinus rhythm in patients with paroxysmal or persistent atrial fibrillation.
• Atrial Flutter (AFL): Helps prevent recurrent episodes of atrial flutter in patients with a history of AFL.

Side Effects

Common side effects of Multaq may include:

• Diarrhea
• Nausea
• Abdominal pain
• Vomiting
• Fatigue
• Bradycardia (slow heart rate)
• Skin rash
• Dyspepsia (indigestion)
• Peripheral edema (swelling of the legs or ankles)

Serious side effects that require immediate medical attention include:

• Liver injury: Symptoms may include jaundice, dark urine, and severe fatigue.
• Heart failure: Patients may experience symptoms such as shortness of breath, weight gain, and swelling of the legs or abdomen.
• Pulmonary toxicity: Difficulty breathing, cough, or chest pain should be promptly evaluated.
• QT prolongation: This can lead to Torsades de Pointes, a potentially life-threatening ventricular arrhythmia.
• Severe allergic reactions: These may present as difficulty breathing, swelling, or hives.

Contraindications

Multaq is contraindicated in the following situations:

• Severe heart failure: Dronedarone is contraindicated in patients with NYHA Class IV heart failure or symptomatic heart failure with recent decompensation.
• Liver or lung toxicity related to previous amiodarone use: Patients with a history of liver or lung toxicity from amiodarone should not use Multaq.
• Permanent atrial fibrillation: Patients with permanent AF should not be treated with dronedarone, as it may increase the risk of cardiovascular events.
• Concomitant use with strong CYP3A4 inhibitors: This includes drugs such as ketoconazole, itraconazole, and certain antivirals, which may lead to increased dronedarone levels.
• QT prolongation: Patients with QTc Bazett interval ≥ 500 ms should not use Multaq due to the risk of arrhythmias.
• Severe hepatic impairment: Dronedarone is contraindicated in patients with severe liver dysfunction.
• Concomitant use with other medications known to prolong the QT interval: Such drugs include certain antipsychotics and macrolide antibiotics.

Pricing Information

Here is a table detailing the price of Multaq in various countries:

Country	Price (per 400mg tablet)	Reference
United States	$10 – $15	GoodRx
Canada	CAD $8 – $12	DrugBank
United Kingdom	£7 – £10	NHS
Australia	AUD $13 – $18	PBS
Germany	€9 – €13	Apotheken Umschau

Top 5 Global Brands

In addition to Multaq, several pharmaceutical companies manufacture medications for the management of cardiac arrhythmias. Here are some of the top global brands:

• Amiodarone (Pacerone) – Wyeth Pharmaceuticals
• Sotalol (Betapace) – Mylan
• Flecainide (Tambocor) – 3M Pharmaceuticals
• Propafenone (Rythmol) – GlaxoSmithKline