Ajmaline

( 17R ) -17.21 α - Ajmalandiol

C01BA05

Antiarrhythmic

Blockade of sodium channels

Attention

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Ajmaline is an indole alkaloid from the roots of Indian Snakeroot (Rauwolfia serpentina ). It is used as a prescription drug from the group of class I antiarrhythmic drugs for the treatment of cardiac arrhythmias. In Germany and Austria it is sold under the trade name Gilurytmal ® by the company or the pharmaceutical Carinopharm Select Handels GmbH, based in Vienna.

Effect

Ajmaline inhibits the cardiac muscle cells and the fast sodium current, reduces the speed of the depolarization during the phase 0 of the action potential. Thus, it is counted as a sodium channel blocker with prolonging effect on the action potential duration of class Ia of Vaughan Williams classification.

Pharmacokinetics

Ajmaline is administered only by intravenous injection. It has a very short initial redistribution induced plasma half-life of 12 to 15 minutes. Elimination is 90 percent hepatic. The remaining 10 percent is excreted through the kidneys.

Application

Supraventricular tachycardias ( eg AV junctional tachycardia, supraventricular tachycardia in WPW syndrome, paroxysmal atrial fibrillation), if they are symptomatic and require treatment, life-threatening ventricular tachycardias.

Contraindications and warnings

In overt cardiac failure, significant electrolyte disturbance or marked hypotension and overdose of digitalis may ajmalin not be used in severe bradycardia, SA- blocking and high-grade AV block and sinus node syndrome, with a heart pacemaker is implanted only. In cases of impaired cardiac pump function ( ejection fraction < 35 percent) and in the first three months after the heart attack, it may only be used in the case of life-threatening ventricular arrhythmias.

In case of hepatic or renal impairment, the dose should be adjusted. During treatment, renal function should be monitored.

Possible side effects

Especially feared are paradoxical pro-arrhythmic effects of ajmaline, which may occur particularly in patients with coronary heart disease. Rarely, seizures, and very rarely blood disorders may occur.