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Ajmaline Intravenous for adults

Who can administer

  Administration RESTRICTED - see Appendix 1

Important information

  • This drug may only be used under supervision of a cardiologist in the Coronary Care unit
  • Advanced cardio-pulmonary life-support systems must be immediately available (ref 1)
  • Ensure isoprenaline injection has been ordered and is ready for use if required- see separate monograph.
  • Unlicensed medicine - not routinely stocked in GUH
  • This monograph refers specifically to the use of the drug in the diagnosis of Brugada syndrome
  • There are numerous drug interactions (e.g. other antiarrythmic drugs, enzyme inducers, drugs which cause QTc interval prolongation)
  • If possible, all medications should be avoided on the day of the test.  Medications that impair conduction or prolong the QT interval should be avoided if at all possible.  The test can be performed if medications have been taken, but risk of arrhythmia is higher (ref 1)

Available preparations

Gilurytmal injection 50mg per 10ml ampoule

Reconstitution

Already in solution

Draw up using a 5 micron filter needle

Infusion fluids

Not required-product ready for use

Methods of intravenous administration

Slow intravenous injection (for the diagnosis of Brugada syndrome)

  • Administer each 10mg over one minute (see Dose below), followed by 5ml Sodium Chloride 0.9%  (ref 1)

Dose in adults

Ajmaline challenge in the diagnosis of Brugada syndrome (ref 1)

  • Perform pre-ajmaline ECG with high precordial leads
  • Administer 10mg over 60 seconds followed by Sodium chloride flush
  • Wait three minutes - then repeat ECG with high precordial leads
  • If no ECG changes, repeat above steps until the maximum dose has been administered (1mg/kg up to a maximum of 100mg) OR one termination criterion manifests
  • The patient may experience cutaneous flushing and eyelid twitching

Drug administration should be terminated if (ref 1)

  • Maximum dose reached, OR
  • Diagnostic Brugada pattern in at least one ECG lead
  • Occurence of ventricular ectopic beats or ventricular tachycardia
  • Sinus arrest
  • Bradycardia less than 50/min
  • 2nd or 3rd degree AV nodal block
  • Prolongation of QRS duration by more than 30%

Monitoring

  • If test is negative (no Brugada ECG changes and no complications) patient can be discharged two hours after last dose of ajmaline was injected
  • If test is positive, patient should remain on ECG monitor with hourly ECGs until changes resolve (this should take no more than three hours)
  • If the test is positive and ventricular arrhythmias are observed - isoprenaline infusion may be required- see separate isoprenaline monograph for details

Further information

  • Contains propylene glycol (ref 1)

Storage

  • Store below 25° C

References

SPC translated from German to English Feb 2010 - part of Salford reference

1: Ajmaline provocation for suspected Brugada syndrome Salford guide Version 2, expiry Feb 2019

Therapeutic classification

Class 1a antiarrythmic