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Mexiletine for Veterinary Use

Veterinary: Prescribe Now
Pet Owners: Pick Up and Fill a New Prescription

by Barbara Forney, VMD  


Overview

Therapeutic Class:  Oral antiarrhythmic

Species:  Dogs

Ventricular arrhythmias

FDA Status:

Basic Information

Mexiletine is a class 1B, sodium channel blocker, anti-arrhythmia drug which 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.

Dogs

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.

Side Effects

  • The most common side effects are related to the GI tract including nausea and vomiting. Giving food with mexiletine has been shown to decrease the incidence of GI side effects.
  • Other possible side effects include central nervous system signs such as dizziness, loss of balance and trembling, shortness of breath, and cardiac signs including PVCs or chest pain.
  • Rare side effects reported in humans include seizures, and bone marrow suppression.

Precautions

  • Mexiletine should be used with extreme caution in animals with the following conditions: 2nd or 3rd degree AV heart block, intraventricular conduction abnormality, sinus node function abnormality, cardiogenic shock, congestive heart failure, myocardial infarction, liver dysfunction, hypotension, or seizure disorders.

Drug Interactions

  • Concurrent use with lidocaine increases the likelihood of adverse effects.
  • There are a number of drugs that may cause drug interactions either through changing the rate of absorption or changing the rate of metabolism of mexiletine. This list includes: antacids, atropine, opiates, cimetidine, griseofulvin, metoclopramide, phenobarbital, phenytoin, primidone, rifampin, theophylline.
  • Drugs which change urinary acidity may affect the renal excretion of mexiletine. These drugs include methionine, ammonium chloride, potassium phosphate, sodium phosphate, citrates, sodium bicarbonate, and carbonic anhydrase inhibitors.

Overdose

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.

About the Author

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.

You can purchase books by Dr. Forney at www.exclusivelyequine.com

The information contained on this site is general in nature and is intended for use as an informational aid. It does not cover all possible uses, actions, precautions, side effects, or interactions of the products shown, nor is the information intended as medical advice or diagnosis for individual health problems or for making an evaluation as to the risks and benefits of using a particular product. You should consult your doctor about diagnosis and treatment of any health problems. Information and statements have not been evaluated by the Food and Drug Administration ("FDA"), nor has the FDA approved the products to diagnose, cure or prevent disease.

Wedgewood Pharmacy's compounded veterinary preparations are not intended for use in food and food-producing animals.

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