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Vernakalant hydrochloride parenteral

Updated 2 Feb 2023 | Supraventricular arrhythmias


Infusion of vernakalant hydrochloride.

Drugs List

  • BRINAVESS 500mg/25ml concentrate for solution for infusion
  • vernakalant hydrochloride 500mg/25ml concentrate for solution for infusion
  • Therapeutic Indications


    Atrial fibrillation


    Dose is by patient's body weight, with a maximum calculated dose based on 113kg.

    Monitor patient for any signs or symptoms of a sudden decrease in blood pressure or heart rate during the administration period of 10 minutes - stop the infusion immediately if signs develop with or without symptomatic hypotension or bradycardia.

    If conversion to sinus rhythm occurs during the initial or second infusion, continue the infusion to completion. If haemodynamically stable atrial flutter is observed after the initial infusion, the second infusion may be administered as patients may convert to sinus rhythm.


    Initial infusion: 3mg/kg over a 10 minute period. Do not exceed the initial dose of 339mg (84.7ml of 4mg/ml solution).

    If conversion to sinus rhythm has not occurred with initial infusion or within 15 minute observation period, a 2mg/kg second infusion should be administered over 10 minutes. The maximum second infusion of 226mg (56.5ml of 4mg/ml solution) should not be exceeded. Cumulative doses of greater than 5mg/kg should not be administered within 24 hours.


    For intravenous infusion.


    Children under 18 years
    QT interval greater than 440 milliseconds at baseline
    Sinus node dysfunction
    Systolic blood pressure below 100mmHg
    Congestive cardiac failure with LVEF below 36%
    Constrictive pericarditis
    Hypertrophic obstructive cardiomyopathy
    New York Heart Association class III failure
    New York Heart Association class IV failure
    Non paced second/third degree AV block
    Restrictive cardiomyopathy
    Severe aortic stenosis
    Severe bradycardia
    Severe hepatic impairment
    Within 30 days of an acute coronary syndrome episode

    Precautions and Warnings

    New York Heart Association class I failure
    New York Heart Association class II failure
    Valvular heart disease

    Advise ability to drive/operate machinery may be affected by side effects
    Avoid intravenous Class I & III antiarrhythmics 4 hrs before or after dose
    Correct hypovolaemia prior to administration
    Treatment to be initiated and supervised by a specialist
    Dilute and use as an infusion
    Oral antiarrhythmics may be started or resumed 2 hours after treatment
    Correct hypokalaemia before treatment
    Monitor blood pressure during administration and for at least 15 mins after
    Monitor vital signs and ECG for 2 hours from start of infusion
    May convert atrial fibrillation to atrial flutter
    Discontinue if hypotension occurs for any reason
    Discontinue if patient develops ECG changes
    Discontinue if severe bradycardia occurs

    Pregnancy and Lactation


    Vernakalant hydrochloride is contraindicated during pregnancy.

    The manufacturer does not recommend using vernakalant hydrochloride during pregnancy. Animal studies have shown malformations after repeated oral exposure. Human data is limited and as such a potential risk cannot be ruled out.


    Use vernakalant hydrochloride with caution during breastfeeding.

    The manufacturer advises caution if vernakalant hydrochloride is used when breastfeeding. There is no information on the excretion of vernakalant and its metabolites in animal milk and the presence in human breast milk is unknown.

    Side Effects

    Atrial flutter
    Bundle branch block
    Burning sensation
    Cardiogenic shock
    Chest discomfort
    Choking sensation
    Cold sweat
    Complete AV block
    Dry mouth
    Eye irritation
    Faecal urgency
    Feeling hot
    Feeling of suffocation
    First degree AV block
    Hot flushes
    Increased lacrimation
    Local reaction at injection site
    Nasal congestion
    Nasal discomfort
    Oral paraesthesia
    Pain at application site
    Painful extremities
    Prolongation of QT interval
    Sinus arrest
    Sinus bradycardia
    Throat irritation
    Vasovagal syncope
    Ventricular extrasystoles
    Ventricular tachycardia
    Visual disturbances
    Widened QRS complex


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: June 2019

    Reference Sources

    Summary of Product Characteristics: Brinavess 20mg/ml concentrate for solution for infusion. Correvio. Revised August 2018.

    NICE Evidence Services Available at: Last accessed: 06 September 2019

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