Drug Interactions in Arrhythmia Pharmacotherapy: A Literature Review on Clinical Effectiveness and Safety

Annisa Dwi Rohmatiwi, Lukman Heryawan, Soni Siswanto

Abstract

Background: Drug-drug interactions (DDIs) are a major concern in arrhythmia pharmacotherapy since antiarrhythmic drugs are often used in combinations with a narrow therapeutic index. This condition raises the risk of side effects and treatment failure. In this review, we summarise the most recent data on drug interactions in the pharmacotherapy of arrhythmias, updating and expanding previous findings, with a special focus on publications from 2016 to 2025. Objective: This study aimed to thoroughly investigate drug interactions in pharmacotherapy for arrhythmias using empirical evidence. Methods: This narrative review is based on a literature search of the PubMed, ScienceDirect, and Google Scholar databases. Inclusion criteria included original research articles, and the publication year range was limited to 2016-2025. Outcome: Most pharmacokinetic interactions were due to modulation of cytochrome P450 enzymes and P-glycoprotein transporters and resulted in changes in drug concentrations. The pharmacodynamic drug interactions were mostly additive with respect to cardiac conduction and QT interval prolongation. These interactions were associated with increased risk of bleeding, cardiac rhythm disorders, toxicity, and reduced therapeutic effect. Preventive actions included medication review, dose adjustment, clinical monitoring, patient education, and interdisciplinary collaboration. Conclusion: Arrhythmia interaction monitoring and pharmacotherapy require dose adjustments for individual cases and interdisciplinary cooperation, which play important roles in the safety and efficacy of drugs.

Keywords

Antiarrhythmic drugs; Arrhythmia pharmacotherapy; Drug-drug interactions; Medication safety; Narrative review

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DOI: https://doi.org/10.20961/jpscr.v11i2.114246

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