The following drugs have been associated with arrhythmias and the typical (type-1) Brugada syndrome ECG. Therefore the BrugadaDrugs.org Advisory Board strongly advices to avoid these drugs in Brugada syndrome patients or to use these drugs only after extensive consideration and/or in controlled conditions.
Notes about the lists:
- On this list we summarized those drugs for which there is literature available for an association between the drug and arrhythmias in Brugada syndrome
- Drugs are listed with up to 3 common brand names. There may be over 100 different brand names for different drugs, an effort to list those we know of you can find here. It is also important to look at the active drugs in medicines that contain a combination of drugs.
- Lists contain links to DrugBank or PubChem (click on the drug name) and also (several) PubMed links to articles on the association between the drug and Brugada syndrome (click on the reference).
- We advise our Brugada syndrome patients to give this letter to all of their health care providers.
- Lists contain a classifying column ‘Recommendation’ in which the available evidence from the literature and the expert opinion of the BrugadaDrugs.org Advisory Board is described. Please note that there are no randomized clinical studies in Brugada syndrome patients, therefore the level of evidence is mostly C (only consensus opinion of experts, case studies, or standard-of-care) and for some B (non-randomized studies).
- Class I: There is evidence and/or general agreement that a given drug is potentially arrhythmic in Brugada syndrome patients.
- Class IIa:There is conflicting evidence and/or divergence of opinion about the
drug, but the weight of evidence/opinion is in favor of a potentially arrhythmic effect in Brugada syndrome patients. - Class IIb: There is conflicting evidence and/or divergence of opinion about the
drug, and the potential arrhythmic effect in Brugada syndrome patients is less well established by evidence/opinion. - Class III: There is no or very little evidence and/or general agreement that a drug is potentially arrhythmic in Brugada syndrome patients. You can find a list of these drugs on this page.
- For information on the treatment of co-morbidities in Brugada syndrome patients several papers are available, e.g. Postema et al. 2013 (free PMC article).
Please also read our Disclaimer.
Antiarrhythmic drugs
| Generic name | Brand name® | Clinical use | References | Class |
|---|---|---|---|---|
| Ajmaline | e.g. Gilurytmal® -other names- | Antiarrhythmic Agent (1A: Na-blocker) / Arrhythmias | Brugada 1997 Rolf 2003 Wolpert 2005 Bébarová 2005 | I |
| Allapinin | e.g. Allapinine® Glialin® Lappaconite Hydrobromide® -other names- | Antiarrhythmic Agent (1C: Na-blocker) / Arrhythmias | Sokolov 2014 Khisamutdinova 2007 | IIb |
| Ethacizin | e.g. Ethacizine® Etacizin® Etmozin® -other names- | Antiarrhythmic Agent (1C: Na-blocker) / Arrhythmias | Makarov 2011 Bolotina 1992 | IIb |
| Flecainide | e.g. Tambocor® -other names- | Antiarrhythmic Agent (1C: Na-blocker) / Arrhythmias | Krishnan 1998 Brugada 2000 Gasparini 2003 Meregalli 2006 Stokoe 2007 | I |
| Pilsicainide | e.g. Sunrhythm® -other names- | Antiarrhythmic Agent (1C: Na-blocker) / Arrhythmias | Takenaka 1999 Fujiki 1999 Takagi 2002 Kimura 2004 | I |
| Procainamide | e.g. Procan® Pronestyl® -other names- | Antiarrhythmic Agent (1A: Na-blocker) / Arrhythmias | Miyazaki 1996 Brugada 1997 Joshi 2007 Villemaire 1992 | I |
| Propafenone | e.g. Rythmol® -other names- | Antiarrhythmic Agent (1C: Na-blocker) / Arrhythmias | Matana 2000 Akdemir 2002 Hasdemir 2006 Shan 2008 Stark 1996 | IIa |
Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
Psychotropic drugs
| Generic name | Brand name® | Clinical use | References | Class |
|---|---|---|---|---|
| Amitriptyline | e.g. Elavil® Sarotex® Tryptizol® -other names- | Antidepressive (Tricyclic) | Bolognesi 1997 Rouleau 2001 Bebarta 2007 Nau 2000 | IIa |
| Clomipramine | e.g. Anafranil® Anafril® -other names- | Antidepressive (Tricyclic) | Goldgran 2002 Pacher 2000 | IIa |
| Desipramine | e.g. Norpramin® Pentofran® -other names- | Antidepressive (Tricyclic) | Babaliaros 2002 Chow 2005 Akhtar 2006 Sudoh 2003 | IIa |
| Lithium | e.g. Eskalith® -other names- | Antidepressive | Babalarios 2002 Darbar 2005 Wright 2010 | IIb |
| Loxapine | e.g. Cloxazepine® Loxitane® -other names- | Antipsychotic | Rouleau 2001 Kinugawa 1988 | IIa |
| Nortriptyline | e.g. Nortrilen® Pamelor® -other names- | Antidepressive (Tricyclic) | Bardai 2013 Tada 2001 Muir 1982 Sudoh 2003 | IIa |
| Oxcarbazepine* | e.g. Trileptal® -other names- | Anti-epileptic | El-Menyar 2011 Huang 2008 | IIa |
| Trifluoperazine | e.g. Fluoperazine® Stelazine® --other names- | Antipsychotic (Phenothiazine) | Rouleau 2001 Klöckner 1987 | IIa |
Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
*Oxcarbazepine is structurally a derivative of carbamazepine which is on the preferably avoid list.
Anesthetics / analgesics
| Generic name | Brand name® | Clinical use | References | Class |
|---|---|---|---|---|
| Bupivacaine | e.g. Marcaine® Sensorcaine® -other names- | Anesthetic / analgesic | Phillips 2003 Vernooy 2006 Bramall 2011 De la Coussaye 1992 Berman 1994 | IIa |
| Procaine | e.g. Procaine-Penicillin Novocain® -other names- | Analgesic | Arumugam 2012 | IIa |
| Propofol* | e.g. Diprivan® -other names- | Anesthetic | Inamura 2006 Vernooy 2006 Robinson 2008 Flamee 2020 Saint 1998 | IIa |
Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
* Prolonged propofol infusion has particularly been associated with adverse effects
For more information on anesthetic management of Brugada syndrome patients; a review article has been written by Kloesel & Ackerman. When appropriate precautions (see the emergencies page) are taken (general) anesthesia with propofol can most often be performed safely.
Other substances
| Generic name | Brand name® | Clinical use | References | Class |
|---|---|---|---|---|
| Acetylcholine | -Not applicable- | Cholinergic / Vasospastic intracoronary | Miyazaki 1996 Noda 2002 Montgomery 1974 | IIa |
| Alcohol (overdose) | -Not applicable- | Other substances / Beverage | Shimada 1996 Rouleau 2001 Ohkubo 2013 Habuchi 1995 | IIb |
| Cannabis | -Not applicable- | Other substances / illicit drugs | Ghuran 2000 Romero-Puche 2012 Kariyanna 2018 Stockholm 2020 Turkanis 1991 | IIb |
| Cocaine | -Not applicable- | Other substances / illicit drugs / Anesthetic | Littmann 2000 Ortega 2001 Bebarta 2007 El Mazloum 2015 Xu 1994 | IIa |
| Ergonovine | e.g. Ergotrate® -other names- | Vasospastic intracoronary | Noda 2002 Müller 1980 | IIb |
Recommendation class: Class I: convincing evidence/opinion; Class IIa: evidence/opinion less clear; Class IIb: conflicting evidence/opinion; Class III: very little evidence.
Disclaimer and Waiver
The information presented is intended solely for the purpose of providing general information about health related matters. We do our best to ascertain that all information on this site is correct and up-to-date. However, we cannot guarantee that it is. The information provided here is for educational and informational purposes only and designed primarily for use by qualified physicians and other medical professionals. It is not intended for any other purpose, including, but not limited to, medical or pharmaceutical advice and/or treatment, nor is it intended to substitute for the users’ relationships with their own health care/pharmaceutical providers. To that extent, by continued use of this program, the user affirms the understanding of the purpose and releases the Academic Medical Center, the BrugadaDrugs.org Advisory Board and Cardionetworks from any claims arising out of his/her use of the website.
Principal limitation
It should be clear to the users of this site that the principal limitation of the association between certain drugs, Brugada syndrome and arrhythmias, is that there are quite often only (a number of) case reports and experimental studies suggesting an effect in Brugada syndrome. Further, there may conflicting results and there may be large variability for Brugada syndrome patients in their response to certain drugs. This response may also differ in different conditions (e.g. with or without fever, drug in therapeutic range, overdosed or in combination with other drugs etc.). Clinical decision making should be based on more than the presence or absence of a (single) association in another patient.