Issues for surgery
Risk of cardiac arrhythmias if omitted.
Risk of cardiac complications (i.e. bradycardia, hypotension, conduction disturbances and decreased cardiac output) if continued.
Advice in the perioperative period
Elective surgery
Continue.
If patient is symptomatic (i.e. chest pain, palpitations, syncope, dyspnoea or new fatigue) and haemodynamically unstable discuss with a cardiologist.
Check blood pressure, ECG, and potassium pre-operatively.
Post-operative advice
Restart post-operatively when enteral intake resumed.
Interactions with common anaesthetic agents
Bradycardia
Propafenone can increase the risk of bradycardia when used concomitantly with the following:
- alfentanil, fentanyl or remifentanil
- neostigmine
- propofol
- suxamethonium
Local anaesthetics
Concomitant use of local anaesthetics is predicted to increase the risk of cardiodepression when given with propafenone. Manufacturer advises monitor.
Antimuscarinic action
Antimuscarinic action of propafenone (e.g. blurred vision, dry mouth, urinary retention, tachycardia, confusion) may be additive with agents that also have antimuscarinic effects such as atropine and glycopyrronium.
Interactions with other common medicines used in the perioperative period
Antimuscarinic action
Antiemetics
Antimuscarinic action of propafenone (e.g. blurred vision, dry mouth, urinary retention, tachycardia, confusion) may be additive with antiemetics that also have antimuscarinic effects such as cyclizine, haloperidol, levomepromazine or prochlorperazine.
Nefopam
Antimuscarinic action of propafenone (e.g. blurred vision, dry mouth, urinary retention, tachycardia, confusion) may be additive with nefopam which also has antimuscarinic effects.
Macrolides
Co-administration of propafenone with macrolide antibiotics (i.e., clarithromycin, erythromycin) might lead to increased levels of propafenone via inhibition of CYP3A4 – manufacturer advises monitor and adjust dose if necessary.
Whilst single surgical prophylactic doses should not pose a problem, continued post-operative treatment may require close monitoring.
Further information
None relevant.
References
Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. https://bnf.nice.org.uk/interactions/ [Accessed on 2nd February 2023]
Summary of Product Characteristics – Arythmol® (propafenone) 150 mg Tablets. Mylan Products Ltd. Accessed via www.medicines.org.uk 09/04/2023 [date of revision of the text March 2021]
Baxter K, Preston CL (eds), Stockley’s Drug Interactions (online) London: Pharmaceutical Press. http://www.medicinescomplete.com [Accessed on 9th April 2023]