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Home > Formulary : Adult > Chapters > 2. Cardiovascular System >

BNSSG Adult Joint Formulary

2.1 Arrhythmias

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Last edited: 21-05-2025

First line drugs Second line drugs Specialist drugs Secondary care drugs
Recommended in both primary and secondary care Alternatives (often in specific conditions) in both primary and secondary care Where a specialist input is needed (see introduction for definition) Prescribing principally within secondary care only

 

Antiarrhythmics 

Recommended:

Adenosine (TLS Red)

Amiodarone (intravenous) (TLS Red)

Amiodarone (oral) (TLS Amber)

Digoxin (intravenous) (TLS Red)

Digoxin (oral) (TLS Green)

Please see MHRA Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions

Disopyramide (intravenous) (TLS Red)

Disopyramide (oral) (TLS Green) - please see the Stock Shortages page

Flecainide (intravenous) (TLS Red)

Flecainide (oral) (TLS Amber Specialist Recommended)

Lidocaine (TLS Red)

Magnesium sulphate - see 9.2.5 (TLS Red)

Mexiletine (TLS Red)

Propafenone (intravenous) (TLS Red)

Propafenone (oral) (TLS amber Specialist Recommended)

Sotalol (intravenous) (TLS Red)

Sotalol (oral) (TLS Green)

Please see MHRA Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions

Verapamil (intravenous) (TLS Red)

Verapamil (oral) (TLS Green)

Specific Indication:

Dronedarone (TLS Amber 3 months) (SCP click here)

  • For the treatment of non-permanent AF, in accordance with the recommendations in NICE TA197
  • Following cases of rare but serious liver injury in patients using dronedarone, please See MHRA guidance

Ajmaline (Unlicensed, TLS Red)

  • Approved for use in the diagnosis of Brugada syndrome by Consultant Cardiologists only.

Procainamide (intravenous) (Unlicensed, TLS Red)

  • Approved for severe or symptomatic ventricular arrhythmia, as a third-line option for specialist use only

Cardiac Glycosides

Recommended: (TLS Green)

Digoxin

Please see MHRA Prescribing medicines in renal impairment: using the appropriate estimate of renal function to avoid the risk of adverse drug reactions

 

Digoxin-specific antibody

Specific indication: (TLS Red)

Digoxin-specific antibody fragments - reversal of life-threatening Digoxin overdose

 

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