iv bag
Ibutilide (Corvert ®)
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents
D5W, NS

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]
[0 to 1 mg] [50 ml] [10 min]

See comments below.

Stability / Miscellaneous
EXP: 1 DAY (RT) / 2 DAYS (REF). Strict adherence to the use of aseptic technique during the preparation of the admixture is recommended in order to maintain sterility. May be administered undiluted as well.

Indications: rapid conversion of A-fib/flutter of recent onset.

LIFE-THREATENING ARRHYTHMIAS—APPROPRIATE TREATMENT ENVIRONMENT

CORVERT can cause potentially fatal arrhythmias, particularly sustained polymorphic ventricular tachycardia, usually in association with QT prolongation (torsades de pointes), but sometimes without documented QT prolongation. In registration studies, these arrhythmias, which require cardioversion, occurred in 1.7% of treated patients during, or within a number of hours of, use of CORVERT. These arrhythmias can be reversed if treated promptly (see package insert for WARNINGS, Proarrhythmia). It is essential that CORVERT be administered in a setting of continuous ECG monitoring and by personnel trained in identification and treatment of acute ventricular arrhythmias, particularly polymorphic ventricular tachycardia. Patients with atrial fibrillation of more than 2 to 3 days' duration must be adequately anticoagulated, generally for at least 2 weeks.


CHOICE OF PATIENTS
Patients with chronic atrial fibrillation have a strong tendency to revert after conversion to sinus rhythm (see package insert for CLINICAL STUDIES) and treatments to maintain sinus rhythm carry risks. Patients to be treated with CORVERT, therefore, should be carefully selected such that the expected benefits of maintaining sinus rhythm outweigh the immediate risks of CORVERT, and the risks of maintenance therapy, and are likely to offer an advantage compared with alternative management.


Dosing:
patient wt >60kg: 1 mg over 10min.
If < 60kg: 0.01 mg/kg over 10 min.

If the arrhythmia does not terminate within 10 minutes after the 1st dose, a 2nd dose may be given 10 minutes after the completion of the first infusion.

Mechanism of action : prolongs action potential duration and increases both atrial & ventricular refractoriness (class III agent).



DOSAGE AND ADMINISTRATION
The recommended dose based on controlled trials (see CLINICAL STUDIES) is outlined in the Table below. Ibutilide infusion should be stopped as soon as the presenting arrhythmia is terminated or in the event of sustained or nonsustained ventricular tachycardia, or marked prolongation of QT or QTc.

Recommended Dose of CORVERT Injection
Recommended Dose of CORVERT Injection
Patient Weight Initial Infusion (over 10 minutes) Second Infusion
60 kg (132 lb)
or more		 One vial
  (1 mg ibutilide fumarate)		 If the arrhythmia does not terminate within 10 minutes after the end of the initial infusion, a second 10-minute infusion of equal strength may be administered 10 minutes after completion of the first infusion.
Less than 60 kg
(132 lb)		 0.1 mL/kg
  (0.01 mg/kg ibutilide fumarate)

In a trial comparing ibutilide and sotalol (see package insert for CLINICAL STUDIES), 2 mg ibutilide fumarate administered as a single infusion to patients weighing more than 60 kg was also effective in terminating atrial fibrillation or atrial flutter.

In the post-cardiac surgery study (see package insert for CLINICAL STUDIES), one or two intravenous infusions of 0.5 mg (0.005 mg/kg per dose for patients weighing less than 60 kg) was effective in terminating atrial fibrillation or atrial flutter.

Patients should be observed with continuous ECG monitoring for at least 4 hours following infusion or until QTc has returned to baseline. Longer monitoring is required if any arrhythmic activity is noted. Skilled personnel and proper equipment (see package insert for WARNINGS, Proarrhythmia), such as a cardioverter/defibrillator, and medication for treatment of sustained ventricular tachycardia, including polymorphic ventricular tachycardia, must be available during administration of CORVERT and subsequent monitoring of the patient.


Dilution
CORVERT Injection may be administered undiluted or diluted in 50 mL of diluent. CORVERT may be added to 0.9% Sodium Chloride Injection or 5% Dextrose Injection before infusion. The contents of one 10 mL vial (0.1 mg/mL) may be added to a 50 mL infusion bag to form an admixture of approximately 0.017 mg/mL ibutilide fumarate. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit.


Compatibility and Stability
The following diluents are compatible with CORVERT Injection (0.1 mg/mL):

5% Dextrose Injection

0.9% Sodium Chloride Injection
The following intravenous solution containers are compatible with admixtures of CORVERT Injection (0.1 mg/mL):

polyvinyl chloride plastic bags

polyolefin bags
Admixtures of the product, with approved diluents, are chemically and physically stable for 24 hours at room temperature (15° to 30° C or 59° to 86° F) and for 48 hours at refrigerated temperatures (2° to 8°C or 36° to 46°F). Strict adherence to the use of aseptic technique during the preparation of the admixture is recommended in order to maintain sterility.


HOW SUPPLIED
CORVERT Injection (ibutilide fumarate injection) is supplied as an acetate-buffered isotonic solution at a concentration of 0.1 mg/mL that has been adjusted to approximately pH 4.6 in 10 mL clear glass, single-dose, flip-top vials.

Single-dose 10 mL vial, 1 mg /10 mL (0.1 mg/mL) NDC 0009-3794-22

Store at controlled room temperature 20° to 25°C (68° to 77°F) [see USP]. Store vial in carton until used.

NOVAPLUS is a registered trademark of Novation, LLC.
Source: [package insert]
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.