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Mexiletine is a Class 1B, sodium channel blocker, anti-arrhythmia drug that is used to treat chronic ventricular arrhythmias in the dog. The mechanism of action is similar to lidocaine. Mexiletine is used to treat ventricular arrhythmias including PVC’s and ventricular tachycardia. If an animal has responded well to lidocaine during an acute episode, it is likely to respond well to mexiletine. Mexiletine is well-absorbed orally and has a bioavailability of approximately 85%. It is primarily excreted in the urine although approximately 10% is metabolized by the liver and excreted in the feces. The half-life of this drug may be prolonged in animals with reduced cardiac output, or after an acute myocardial infarction. The half-life may also be prolonged in animals with hepatic dysfunction or severe kidney disease.
The most commonly used oral drugs for the chronic treatment of ventricular arrhythmias are atenolol, sotalol, procainamide, amiodarone, and mexiletine. Mexiletine may be combined with either atenolol or sotalol in instances when monotherapy is not adequate. Mexiletine may be used to treat inherited cardiomyopathy in Boxers and dilated cardiomyopathy in Doberman pinschers. A positive response to therapy would be an 85% reduction of ventricular premature contractions. The complete elimination of ventricular arrhythmia is not considered a realistic goal.
Overdose with mexiletine carries a significant risk of toxicity. It is reported in the human literature that central nervous system signs precede cardiovascular signs. In experimental work in dogs, a four-fold overdose consistently produced CNS signs within 10 minutes of oral administration. If recognized in time, GI-emptying protocol should be attempted in conjunction with urinary acidification and supportive care.
Dr. Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania. She has a master's degree in animal science from the University of Delaware and graduated from the University of Pennsylvania School of Veterinary Medicine in 1982.
She began to develop her interest in client education and medical writing in 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
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