Tikosyn is a brand-name prescription medication. It’s FDA-approved to treat certain forms of arrhythmias called atrial fibrillation (AFib) and atrial flutter. An arrhythmia is an irregular heart rate or rhythm. To be specific, Tikosyn is used to:

  • convert AFib or atrial flutter to a normal sinus rhythm (a healthy heart rhythm)
  • maintain a normal sinus rhythm after your rhythm has been converted from AFib or atrial flutter for at least 1 week

Tikosyn should be used only if your AFib or atrial flutter is causing serious symptoms, such as heart palpitations, chest pain, and shortness of breath. This is because Tikosyn may cause serious changes in your heart rhythm that, in rare cases, can be fatal.

You shouldn’t use Tikosyn if you have a heart rhythm disorder called paroxysmal atrial fibrillation. For details on Tikosyn’s uses, see “Tikosyn for AFib” below.

Tikosyn drug details

Tikosyn belongs to a group of drugs called class III antiarrhythmics, which are medications that are used to treat arrhythmias.

Tikosyn comes as a capsule that you swallow. The drug is available in three strengths: 125 micrograms (mcg), 250 mcg, and 500 mcg. To learn how often you’ll likely take Tikosyn, see the “Tikosyn dosage” section below.

Effectiveness

For information on the effectiveness of Tikosyn, see the “Tikosyn for AFib“ section below.

Tikosyn is available as a generic drug called dofetilide. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. Generics tend to cost less than brand-name drugs.

In some cases, the brand-name drug and the generic version may come in different forms and strengths.

Tikosyn can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Tikosyn. These lists don’t include all possible side effects.

For more information on the possible side effects of Tikosyn, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to report to the FDA a side effect you’ve had with Tikosyn, you can do so through MedWatch.

Mild side effects

Mild side effects of Tikosyn can include:*

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

* This is a partial list of mild side effects from Tikosyn. To learn about other mild side effects, talk with your doctor or pharmacist, or see Tikosyn’s Medication Guide.
† For more information on these side effects, see “Side effect details” below.

Serious side effects

Serious side effects from Tikosyn aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include:

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” below.
† For more information on this side effect, see “Side effect details” below.

Side effect details

You may wonder how often certain side effects occur with this drug, or whether certain side effects pertain to it. Here’s some detail on certain side effects this drug may or may not cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Tikosyn. However, it’s not known how many people who took Tikosyn in clinical trials experienced this side effect.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (warmth and redness in your skin)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • trouble breathing

Call your doctor right away if you have a severe allergic reaction to Tikosyn. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Chest pain

Chest pain is a possible side effect of Tikosyn use. In clinical trials, chest pain was reported in:

  • 10% of people with supraventricular arrhythmia* who took Tikosyn
  • 7% of people with supraventricular arrhythmia* who took a placebo (treatment with no active drug)

During your Tikosyn treatment, it’s important to see your doctor if you have chest pain. This is because in some cases, it can be a symptom of a serious condition such as a heart attack. Your doctor can help rule out other causes of your chest pain. They may also be able to suggest ways to help ease your discomfort.

* The two conditions that Tikosyn treats, atrial fibrillation (AFib) and atrial flutter, are a type of supraventricular arrhythmia. This is an irregular heart rhythm that occurs in the atria (upper chambers) of the heart.

Dizziness

Dizziness can occur with Tikosyn treatment. Dizziness is a common side effect that was reported in:

  • 8% of people with supraventricular arrhythmia* who took Tikosyn
  • 6% of people with supraventricular arrhythmia* who took a placebo

If you become dizzy while you’re taking Tikosyn, talk with your doctor. They may be able to recommend ways to decrease this side effect.

* The two conditions that Tikosyn treats, AFib and atrial flutter, are a type of supraventricular arrhythmia. This is an irregular heart rhythm that occurs in the atria (upper chambers) of the heart.

Headache

Headache is a common side effect of Tikosyn. In clinical trials, headaches were reported by:

  • 11% of people with supraventricular arrhythmia* who took Tikosyn
  • 9% of people with supraventricular arrhythmia* who took a placebo

If you develop headaches that don’t go away or are bothersome to you while using Tikosyn, talk with your doctor. They can recommend ways to help ease this side effect.

* The two conditions that Tikosyn treats, AFib and atrial flutter, are a type of supraventricular arrhythmia. This is an irregular heart rhythm that occurs in the atria (upper chambers) of the heart.

Arrhythmia

An arrhythmia (irregular heart rate or rhythm) can occur with Tikosyn use. Tikosyn has a boxed warning for this side effect. A boxed warning is the most serious warning from the FDA.

The two conditions that Tikosyn treats, atrial fibrillation (AFib) and atrial flutter, are a type of supraventricular arrhythmia. This is an irregular heart rhythm that occurs in the atria (upper chambers) of the heart.

The type of arrhythmia that Tikosyn can cause is called a ventricular arrhythmia. This is an arrhythmia that occurs in the ventricles (lower chambers) of the heart. Ventricular arrhythmias are typically more serious than supraventricular arrhythmias. They can lead to more serious side effects, and even in rare cases, death.

In one clinical trial of people being treated for supraventricular arrhythmia, death occurred in:

  • 0.9% of people who took Tikosyn
  • 0.4% of people who took a placebo

Torsades de pointes

Tikosyn can cause a type of ventricular arrhythmia called torsades de pointes. As with other ventricular arrhythmias, in rare cases, torsades de pointes can be fatal.

In clinical trials of people with any type of arrythmia, torsades de pointes occurred in:

  • between 0.3% and 10.5% of people who took Tikosyn
  • 0% of people who took a placebo

Symptoms of torsades de pointes can include heart palpitations, chest pain, trouble breathing, and dizziness.

Other ventricular arrhythmias

Other types of arrhythmias may occur from Tikosyn use. They include other ventricular arrhythmias, such as ventricular fibrillation or ventricular tachycardia. In total, ventricular arrhythmias occurred in:

  • between 2.6% and 15.8% of people who took Tikosyn
  • 2.7% of people who took a placebo

Women who take Tikosyn have a three times greater risk than men of developing torsades de pointes, a type of ventricular arrhythmia (see above). However, clinical trials didn’t show women to be at an increased risk of other ventricular arrhythmias.

Arrhythmias in people with structural heart disease

Two other trials also compared Tikosyn and a placebo in people with any type of arrhythmia and structural heart disease. Structural heart disease is heart disease due to a problem with the structure of the heart. In these trials, structural heart disease included heart valve problems.

Researchers found that people with structural heart disease who took Tikosyn didn’t have an increased risk of death when compared with people who took a placebo. These studies showed that death occurred in:

  • between 31% and 36% of people who took Tikosyn
  • between 32% and 37% of people who took a placebo

Monitoring at the start of treatment

Because of the risk for arrhythmia, you’ll need to remain under a doctor’s care for at least 3 days when you first start or restart taking Tikosyn. They’ll help make sure your heart rhythm is normal and can treat you if you develop an arrhythmia. (Arrhythmias occur most often when you first use Tikosyn.)

The monitoring usually takes place in a hospital. Your doctor will keep track of your heart rate as well as your kidney function through blood tests. This helps make sure that your Tikosyn dose is right for you before you go home.

Even after the first 3 days of treatment, it’s still important to watch for symptoms of arrhythmia. These can include feeling dizzy and having a fast heart rate.

While you’re taking Tikosyn, tell your doctor right away if you develop any symptoms of arrhythmia. In some cases, arrhythmias can be serious and in rare cases, even fatal. Talk with your doctor or pharmacist if you have any questions about the possible risks of using Tikosyn.

Weight gain (not a side effect)

Weight gain isn’t a side effect people usually experience with Tikosyn. Weight gain wasn’t reported in clinical trials of people who took the medication.

In rare cases, Tikosyn can cause peripheral edema (swelling of the arms or legs). Although Tikosyn doesn’t cause weight gain, peripheral edema can cause you to gain weight. Peripheral edema can also be caused by other conditions, such as congestive heart failure.

If you notice that you’re gaining weight while taking Tikosyn, talk with your doctor. They may be able to help determine what’s causing the weight gain and how you can manage it.

The Tikosyn dosage your doctor prescribes will depend on several factors. These include:

  • the type and severity of the condition you’re using Tikosyn to treat
  • other medical conditions you may have
  • your kidney function
  • your QT interval (a measure of your heart rhythm)

Typically, your doctor will start you on the starting dosage. Then they’ll adjust it over time to reach the amount that’s right for you. Your doctor will ultimately prescribe the smallest dosage that provides the desired effect.

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Tikosyn comes as a capsule that you swallow. It’s available in the following strengths:

  • 125 mcg (0.125 mg)
  • 250 mcg (0.25 mg)
  • 500 mcg (0.5 mg)

Dosage to convert AFib and atrial flutter to normal sinus rhythm

Tikosyn can be used to convert atrial fibrillation (AFib) and atrial flutter to a normal sinus rhythm. A normal sinus rhythm is another way of saying a healthy heart rhythm.

For this purpose, the usual dosage is 500 mcg, twice a day. If blood tests show that you have kidney problems, your doctor may have you start with a lower dosage.

Your doctor will monitor your heart for the first 3 days after you start or restart Tikosyn treatment. After your first dose of Tikosyn, they’ll note your QT interval, which is a measure of your heart rhythm. If the QT interval (a measure of your heart rhythm) becomes too long, your doctor will likely reduce your dosage of Tikosyn. Or they may switch you to a different medication for your AFib or atrial flutter.

A QT interval that’s too long can lead to torsades de pointes. This is a type of arrhythmia* that, in rare cases, can be fatal.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” below.

Continued monitoring

During the 3 days, your doctor will keep monitoring you after each dose of Tikosyn. In some cases, it may take your heart rhythm longer than 3 days to convert to a normal rhythm.

Once you have a normal heart rhythm, your doctor will likely have you take the maintenance dosage of Tikosyn. For details, see the “Dosage to maintain normal sinus rhythm in AFib and atrial flutter” section right below.

Dosage to maintain normal sinus rhythm in AFib and atrial flutter

To maintain a normal sinus rhythm for AFib or atrial flutter, you’ll likely keep taking the same dosage as you did to convert your heart rhythm. (See “Dosage to convert AFib and atrial flutter to normal sinus rhythm” above for details.)

Your doctor will monitor your kidney function and QT interval while you take Tikosyn and adjust your dosage if needed.

What if I miss a dose?

If you miss a dose of Tikosyn, talk your doctor about when you should take your next dose.

In most cases, you’ll be advised to skip the missed dose and take your next dose at the regularly scheduled time. You shouldn’t take two doses at the same time to make up for a missed dose.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Tikosyn is meant to be used as a long-term treatment. If you and your doctor determine that Tikosyn is safe and effective for you, you’ll likely take it long term.

As with all medications, the cost of Tikosyn can vary. To find current prices for Tikosyn capsules (or other forms) in your area, check out GoodRx.com.

The cost you find on GoodRx.com is what you may pay without insurance. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Tikosyn, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide if the drug will be covered.

If you’re not sure if you’ll need to get prior authorization for Tikosyn, contact your insurance company.

Financial assistance

If you need financial support to pay for Tikosyn, help is available. NeedyMeds lists programs that may provide assistance to lower the cost of Tikosyn. For more information and to find out if you’re eligible for support, visit the NeedyMeds website.

Generic version

Tikosyn is available in a generic form called dofetilide. A generic drug is an exact copy of the active drug in a brand-name medication. The generic is considered to be as safe and effective as the original drug. And generics tend to cost less than brand-name drugs. To find out how the cost of dofetilide compares to the cost of Tikosyn, visit GoodRx.com.

If your doctor has prescribed Tikosyn and you’re interested in using dofetilide instead, talk with your doctor. They may have a preference for one version or the other. You’ll also need to check your insurance plan, as it may only cover one or the other.

There are no known drug interactions between Tikosyn and alcohol. However, one of the side effects of Tikosyn is dizziness. And drinking alcohol while taking Tikosyn may make your dizziness worse.

Talk with your doctor about how much alcohol is safe for you to drink during your Tikosyn treatment.

Here are answers to some frequently asked questions about Tikosyn.

What should I know about coming off Tikosyn?

Be sure to talk with your doctor before you stop taking Tikosyn. They’ll likely want to monitor your heart rhythm, including your QT interval (a measure of your heart rhythm). This helps make sure they’re normal after you stop Tikosyn treatment.

In some cases, you doctor may switch you from Tikosyn to a different drug that can interact with Tikosyn. They’ll probably have you stop taking Tikosyn at least 2 days before you start using the new medication. This is called a washout period. It’s done to make sure no Tikosyn is left in your body to interact with the new drug.

If you have any questions about stopping Tikosyn treatment, talk with your doctor.

Does Tikosyn cause hair loss?

No, Tikosyn shouldn’t cause hair loss. In three clinical trials of the drug, hair loss wasn’t reported as a side effect.

If you experience hair loss while taking Tikosyn, talk with your doctor. They may be able to determine what’s causing you to lose hair and see if there are any ways to help stop it from occurring.

Can I use Tikosyn with Tylenol or cold medicine?

Yes. You can take Tikosyn with acetaminophen (Tylenol) or cold medication. There are no drug interactions between Tikosyn and Tylenol or cold medications.

However, some other medications used to treat atrial fibrillation (AFib) or atrial flutter may interact with decongestant drugs. Decongestants are medications that can help clear nasal congestion.

If you have any questions about which pain or cold medications are safe to take while using Tikosyn, talk with your doctor or pharmacist.

Why do I need to stay in the hospital when I start taking Tikosyn?

Tikosyn can cause an irregular heart rate or rhythm called an arrhythmia,* so your doctor will monitor you for at least 3 days after you start taking the drug. They’ll help make sure your heart rate and rhythm are normal and can treat you if you develop an arrhythmia. (Arrhythmias occur most often when you first use Tikosyn.)

The monitoring usually takes place in a hospital and is also necessary if you restart Tikosyn treatment. Your doctor will keep track of your heart rate as well as your kidney function through blood tests. This helps make sure that your Tikosyn dose is right for you before you go home.

For more information, see the “Arrhythmia” section in “Tikosyn side effects” above. You can also ask your doctor if you have any questions about starting Tikosyn treatment.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” below.

Is Tikosyn a beta-blocker?

No, Tikosyn isn’t a beta-blocker. Tikosyn a type of drug called an antiarrhythmic. To be more specific, Tikosyn is a potassium channel blocker. Both beta-blockers and potassium channel blockers normalize your heart rhythm, but they work in different ways.

Beta-blockers stop the adrenaline hormone from working in your body. This can help treat tachycardia (a fast resting heartbeat), ease stress on your heart, and lower blood pressure.

Potassium channel blockers slow down how quickly your heart conducts electricity. These drugs help treat an irregular heart rhythm known as atrial fibrillation (AFib).

If you have any questions about Tikosyn or other drugs used to help treat heart rhythm, talk with your doctor or pharmacist.

You may wonder how Tikosyn compares with other medications that are prescribed for similar uses. Here we look at how Tikosyn and sotalol are alike and different.

Ingredients

Tikosyn is a brand-name medication. It contains the active drug ingredient dofetilide.

Sotalol is a generic medication. It’s also the active drug ingredient in the brand-name medication Betapace.

Uses

The Food and Drug Administration (FDA) has approved Tikosyn to treat certain forms of arrhythmias called atrial fibrillation (AFib) and atrial flutter. An arrhythmia is an irregular heart rate or rhythm. AFib and atrial flutter are a type of arrhythmia called a supraventricular arrhythmia. For details, see the “Tikosyn for AFib” section below.

Sotalol* is FDA-approved to treat ventricular arrhythmias that are life threatening. To learn more about taking sotalol, talk with your doctor.

* Sotalol was previously approved as two different medications for different conditions. Sotalol is FDA approved for ventricular arrhythmia, while sotalol AF is FDA approved to maintain normal sinus rhythm for AFib and atrial flutter. Newer versions of the medications list both conditions. If you have questions about which form of sotalol to take, talk with your doctor.

Drug forms and administration

Tikosyn comes as a capsule that you swallow. You’ll likely take it twice a day.

Sotalol comes as a tablet that you swallow. You’ll likely take it twice a day.

Side effects and risks

Tikosyn and sotalol both contain drugs to treat irregular heart rates or rhythms. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Tikosyn, with sotalol, or with both drugs (when taken individually).

Serious side effects

These lists contain examples of serious side effects that can occur with Tikosyn, with sotalol, or with both drugs (when taken individually).

* Tikosyn and sotalol have a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Effectiveness

Tikosyn and sotalol have different FDA-approved uses, but they’re both used to maintain normal heart rate or rhythm in people with AFib or atrial flutter.

The use of Tikosyn and sotalol in treating AFib has been directly compared in a clinical study. The results showed that there was no difference in how long it took for people’s heart rate or rhythm to return to normal whether they took Tikosyn or sotalol. There were also no significant differences in side effects of people who took either Tikosyn or sotalol.

However, another study showed that sotalol was more effective than Tikosyn in treating people with AFib. Sotalol was most effective in people who didn’t have structural heart disease, such as a heart valve problem. (Structural heart disease is heart disease due to a problem with the structure of the heart.)

Costs

According to estimates on GoodRx.com, Tikosyn costs significantly more than sotalol. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Tikosyn is a brand-name drug. It’s also available in a generic form called dofetilide.

Sotalol is a generic drug. Brand-name medications usually cost more than generics.

The Food and Drug Administration (FDA) approves prescription drugs such as Tikosyn to treat certain conditions.

Tikosyn to convert AFib and atrial flutter to normal sinus rhythm

Tikosyn is approved to treat certain forms of arrhythmias called atrial fibrillation (AFib) and atrial flutter. An arrhythmia is an irregular heart rate or rhythm. AFib and atrial flutter are a type of arrhythmia called a supraventricular arrhythmia, which occurs in the atria (upper chambers) of the heart.

To be specific, Tikosyn is used to convert (change) atrial flutter or AFib to a normal sinus rhythm. A normal sinus rhythm is a healthy heart rhythm. If you have AFib or atrial flutter, your heart doesn’t beat normally.

Tikosyn should be used only if your AFib or atrial flutter is causing serious symptoms, such as heart palpitations, chest pain, and shortness of breath. This is because Tikosyn may cause serious changes in your heart rhythm that, in rare cases, can be fatal.*

You shouldn’t use Tikosyn if you have a heart rhythm disorder called paroxysmal atrial fibrillation. This disorder may occur once in a while but then goes away by itself. In this case, it’s not known if Tikosyn will have an effect.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

AFib and atrial flutter explained

AFib is a condition in which your atria pump faster than your heart’s lower chambers. Also, your heart rhythm is irregular, which increases your risk of heart attack and stroke.

With atrial flutter, your heart rate becomes very fast. Your heart’s atria pump more quickly than the lower chambers. However, your heart may still have a normal rhythm. Atrial flutter may eventually become AFib.

Tikosyn is used to change AFib or atrial flutter to a normal rate or rhythm.

Effectiveness for converting AFib and atrial flutter to normal sinus rhythm

In clinical trials, Tikosyn was an effective medication to convert AFib or atrial flutter to a normal sinus rhythm. People took Tikosyn or a placebo (treatment with no active drug) twice a day. The conversion occurred in:

  • 6% of people who took 125 micrograms (mcg) of Tikosyn
  • 10% to 11% of people who took 250 mcg of Tikosyn
  • 29% to 30% of people who took 500 mcg of Tikosyn
  • 1% of people who took a placebo

For 70% of people whose condition was converted to normal sinus rhythm, conversion happened within 24 to 36 hours of starting treatment with Tikosyn.

Tikosyn to maintain normal sinus rhythm in AFib and atrial flutter

Tikosyn is approved to treat certain forms of arrhythmias called atrial fibrillation (AFib) and atrial flutter. An arrhythmia is an irregular heart rate or rhythm. AFib and atrial flutter are a type of arrhythmia called a supraventricular arrhythmia, which occurs in the atria (upper chambers) of the heart.

To be specific, Tikosyn is used to maintain a normal sinus rhythm in people with AFib or atrial flutter. A normal sinus rhythm is a healthy heart rhythm. If you have AFib or atrial flutter, your heart doesn’t beat normally.

Tikosyn should be used only if your AFib or atrial flutter is causing serious symptoms, such as heart palpitations, chest pain, and shortness of breath. This is because Tikosyn may cause serious changes in your heart rhythm that, in rare cases, can be fatal.*

You shouldn’t use Tikosyn if you have a heart rhythm disorder called paroxysmal atrial fibrillation. This disorder may occur once in a while but then goes away by itself. In this case, it’s not known if Tikosyn will have an effect.

To learn about Afib and atrial flutter, see the “AFib and atrial flutter explained” section above.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Effectiveness for maintaining normal sinus rhythm in AFib and atrial flutter

In clinical trials, Tikosyn was an effective medication to maintain sinus rhythm in people with AFib or atrial flutter.

Study results after 6 months

In the studies, people took Tikosyn or a placebo (treatment with no active drug) twice a day. After 6 months, a normal sinus rhythm was maintained in between:

  • 38% and 41% of people who took 125 micrograms (mcg) of Tikosyn
  • 44% to 49% of people who took 250 mcg of Tikosyn
  • 52% to 57% of people who took 500 mcg of Tikosyn
  • 22% to 32% of people who took a placebo

However, within 6 months, AFib or atrial flutter returned in some people who were taking Tikosyn or a placebo twice a day. As a result, they stopped treatment. AFib or atrial flutter returned in between:

  • 48% and 55% of people who took 125 mcg of Tikosyn
  • 42% to 49% of people who took 250 mcg of Tikosyn
  • 27% to 33% of people who took 500 mcg of Tikosyn
  • 63% to 72% of people who took a placebo

Study results after 1 year

Researchers then looked at the people who kept taking Tikosyn or a placebo twice a day. After 1 year, a normal sinus rhythm was maintained in between:

  • 25% to 32% of people who took 125 mcg of Tikosyn
  • 26% to 42% of people who took 250 mcg of Tikosyn
  • 46% to 49% of people who took 500 mcg of Tikosyn
  • 16% to 22% of people who took a placebo

However, within 1 year, AFib or atrial flutter returned in some people who were taking Tikosyn or a placebo twice a day. As a result, they stopped treatment. AFib or atrial flutter returned in between:

  • 58% and 59% of people who took 125 mcg of Tikosyn
  • 47% to 57% of people who took 250 mcg of Tikosyn
  • 32% to 36% of people who took 500 mcg of Tikosyn
  • 72% to 76% of people who took a placebo

The purpose of maintenance treatment is to keep someone in normal sinus rhythm for as long as possible. However, it’s expected that the symptoms of AFib or atrial flutter may return in some people.

Tikosyn can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase the number of side effects or make them more severe.

Tikosyn and other medications

Below are medications that can interact with Tikosyn. This section doesn’t contain all drugs that may interact with Tikosyn.

Before taking Tikosyn, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Tikosyn and certain antibiotics

You may not be able to take certain antibiotics while you’re using Tikosyn. This is because some antibiotics can cause your QT interval (a measure of your heart rhythm) to become longer. Tikosyn can also cause your QT interval to become too long. Taking two drugs that can lengthen the QT interval can increase your risk of developing an arrhythmia* (irregular heart rate or rhythm).

Examples of antibiotics that can interact with Tikosyn include:

The risk of taking Tikosyn and these antibiotics isn’t known because the combination hasn’t been studied. However, it’s not recommended that you take Tikosyn and certain antibiotics.

Tikosyn and trimethoprim

Another antibiotic called trimethoprim (Primsol) interacts with Tikosyn in a different way. You shouldn’t take Tikosyn with any drug that contains only trimethoprim or trimethoprim/sulfamethoxazole (Bactrim). This is because trimethoprim prevents your body from getting rid of Tikosyn. As a result, Tikosyn can build up in your body, causing serious and sometimes life threatening side effects such as an arrhythmia.* For more about possible side effects, see the “Tikosyn side effects” section above.

Talking with your doctor

Some antibiotics, such as the ones mentioned above, can cause very serious side effects if you take them with Tikosyn. However, taking other antibiotics (such as amoxicillin) with Tikosyn shouldn’t cause problems.

If you need an antibiotic while you’re taking Tikosyn, be sure to ask your doctor which antibiotic is right for you.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Tikosyn and drugs that can increase the level of Tikosyn

Many drugs can prevent your body from getting rid of Tikosyn. This can cause Tikosyn to build up, increasing your risk of side effects such as an arrhythmia.* (For more about possible side effects, see the “Tikosyn side effects” section above.)

Some drugs shouldn’t be taken with Tikosyn at all. And other drugs should be taken with caution when used with Tikosyn. This means that in some cases, it may not be safe to take certain medications during your Tikosyn treatment.

Examples of drugs that shouldn’t be taken with Tikosyn include:

  • hydrochlorothiazide (Microzide), alone or with other drugs
  • verapamil (Verelan)
  • cimetidine (Tagamet)
  • trimethoprim, alone or with sulfamethoxazole
  • prochlorperazine (Procomp)
  • dolutegravir (Tivicay)
  • megestrol (Megace ES)
  • ketoconazole (Nizoral, Xolegel, others)

Examples of drugs that can be taken with caution when using Tikosyn include:

  • metformin
  • amiloride (Midamor)
  • cimetidine
  • CYP3A4 inhibitors, such as:
    • diltiazem (Cartia XT, Cardizem)
    • amiodarone (Nexterone, Pacerone)
    • nefazodone
    • quinine (Qualaquin)

Before you start Tikosyn treatment, talk with your doctor or pharmacist about any medications you’re taking. They can tell you if the drugs interact with Tikosyn and if you should avoid using certain medications during your treatment.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Tikosyn and certain diuretics

You shouldn’t take Tikosyn along with certain diuretics, such as hydrochlorothiazide (Microzide) and a combination pill of hydrochlorothiazide and triamterene. Using these drugs with Tikosyn can cause Tikosyn to build up in your body, increasing your risk of serious side effects like an arrhythmia.*

Tikosyn and triamterene

Taking the medication triamterene (Dyrenium) alone, without hydrochlorothiazide, can keep your body from getting rid of Tikosyn. This can cause the drug to build up, leading to side effects such as an arrhythmia.* Because of this risk, your doctor may want to monitor you more often.

Tikosyn and diuretics that may decrease potassium levels

Taking Tikosyn along with other diuretics may also increase your risk of side effects.

Certain diuretics can cause your potassium levels to become too low. And low potassium levels can increase your risk of developing an arrhythmia.*

Examples of diuretics that may decrease your potassium levels include:

  • chlorthalidone
  • indapamide
  • metolazone (Zaroxolyn)

Your doctor will monitor your potassium levels before and during your Tikosyn treatment. This helps make sure that your levels are within a normal range and you aren’t at risk of serious side effects.

Talking with your doctor

Before you start Tikosyn treatment, talk with your doctor or pharmacist about any diuretic medication you’re taking. They’ll be able to tell you if the drugs interact with Tikosyn. And to learn more about possible side effects of Tikosyn, see the “Tikosyn side effects” section above.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Tikosyn and tricyclic antidepressant drugs

It’s not known what the risk is of taking Tikosyn and tricyclic antidepressants because the combination hasn’t been studied. However, it’s not recommended that you take Tikosyn and tricyclic antidepressants.

Tricyclic antidepressants can cause your QT interval (a measure of your heart rhythm) to become longer. Tikosyn can also cause your QT interval to become too long. Using two drugs that can lengthen your QT interval can increase your risk of developing an arrhythmia.*

Examples of tricyclic antidepressants include:

  • amitriptyline
  • desipramine (Norpramin)
  • doxepin (Silenor)
  • nortriptyline (Pamelor)

If you’re taking an antidepressant, talk with your doctor before using Tikosyn. They can determine whether it’s a tricyclic antidepressant and adjust your treatment plan if needed.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Tikosyn and digoxin

Taking Tikosyn and digoxin (Lanoxin) can increase your risk of developing a serious heart arrhythmia.* In rare cases, this condition can be life threatening. However, there is no increased risk of death in people who take Tikosyn and digoxin.

If you’re taking digoxin during your Tikosyn treatment, your doctor may monitor you more often to be sure you aren’t experiencing side effects. (To learn about possible side effects of Tikosyn, see the “Tikosyn side effects” section above.)

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Tikosyn and other antiarrhythmic drugs

If you’re taking an antiarrhythmic drug and your doctor wants to switch you to Tikosyn, be sure to talk with them first. Tikosyn is a type of class III antiarrhythmic drug. And the use of some medications, such as class I or other class III antiarrhythmic drugs, needs to be stopped a few days before you start Tikosyn treatment. The amount of time depends on which medication you’re taking.

Examples of class I antiarrhythmics include:

  • lidocaine
  • procainamide

Examples of class III antiarrhythmics include:

  • amiodarone (Nexterone, Pacerone)
  • dronedarone (Multaq)

If you’re taking amiodarone and your doctor is switching you to Tikosyn, they’ll check your blood levels before you start Tikosyn treatment. This helps make sure that the amiodarone doesn’t cause serious side effects, such as an arrhythmia.* You can also wait 3 months after you stop using amiodarone to begin Tikosyn treatment. This helps make sure that the level of amiodarone in your body decreases enough so that it won’t interact with Tikosyn.

Talk with your doctor about the best way for you to stop taking other antiarrhythmic drugs before using Tikosyn.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Tikosyn and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Tikosyn. However, you should still check with your doctor or pharmacist before using any of these products while taking Tikosyn.

Tikosyn and foods

A protein in your liver called CYP3A4 partially breaks down Tikosyn. Drinking grapefruit juice or eating grapefruit can block the function of this protein. As a result, Tikosyn can build up in your body, increasing your risk of side effects, such as an arrhythmia.*

If you consume grapefruit or grapefruit juice during your Tikosyn treatment, your doctor may monitor you more often than usual for any side effects.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

Your doctor may have you take Tikosyn with other medications to treat atrial fibrillation (AFib) or atrial flutter.

Many people with AFib or atrial flutter take drugs to decrease their heart rate. If your heart beats too quickly, sometimes it doesn’t pump blood properly. So your doctor may prescribe a medication to decrease your heart rate, helping your heart to pump correctly.

Some examples of medications used to decrease heart rate include:

Your doctor may also have you take a blood thinner to help reduce your risk of heart attack or stroke. These conditions can be caused by a blood clot. And when you have AFib or atrial flutter, you’re at an increased risk of developing a blood clot.

Examples of blood thinners that may help reduce the risk of heart attack or stroke include:

Like sotalol (above), the drug amiodarone has uses similar to those of Tikosyn. Here’s a comparison of how Tikosyn and amiodarone are alike and different.

Ingredients

Tikosyn is a brand-name medication. It contains the active drug ingredient dofetilide.

Amiodarone is a generic medication. It’s also the active drug ingredient in the brand-name medications Nexterone and Pacerone.

Uses

The Food and Drug Administration (FDA) has approved Tikosyn to treat certain forms of arrhythmias called atrial fibrillation (AFib) and atrial flutter. An arrhythmia is an irregular heart rate or rhythm. AFib and atrial flutter are a type of arrhythmia called a supraventricular arrhythmia. For details, see the “Tikosyn for AFib” section above.

Amiodarone isn’t FDA-approved to treat AFib, but the drug is often used off-label for this use. Off-label is when a drug is used for a different purpose than what it is approved to treat.

Amiodarone is FDA-approved to treat the following:

  • ventricular arrhythmias that are life threatening
  • fast, life threatening heart rate

To learn more about amiodarone’s uses, talk with your doctor.

Drug forms and administration

Tikosyn comes as a capsule that you swallow. You’ll likely take the drug twice a day.

Amiodarone comes as a tablet that you swallow. You’ll likely take the medication two to three times a day.

Side effects and risks

Tikosyn and amiodarone both contain medications used to treat irregular heart rates or rhythms. Therefore, these medications can cause very similar side effects, but some different ones as well. Below are examples of these side effects.

Mild side effects

These lists contain up to 10 of the most common mild side effects that can occur with Tikosyn, with amiodarone, or with both drugs (when taken individually).

  • Can occur with Tikosyn:
    • chest pain
  • Can occur with amiodarone:
    • vomiting
  • Can occur with both Tikosyn and amiodarone:
    • nausea
    • dizziness

Serious side effects

These lists contain examples of serious side effects that can occur with Tikosyn, with amiodarone, or with both drugs (when taken individually).

* Amiodarone has a boxed warning for these side effects. A boxed warning is the most serious warning from the FDA.
Tikosyn has a boxed warning for arrhythmia. For more information, see “Arrhythmia” in “Side effect details” above.

Effectiveness

Tikosyn and amiodarone have different FDA-approved uses. Tikosyn is approved to convert or maintain a normal heart rhythm in people with AFib or atrial flutter. And amiodarone can be used off-label to treat AFib and atrial flutter.

The use of Tikosyn and amiodarone in treating AFib has been directly compared in a clinical study. The results showed that amiodarone was more effective at controlling AFib than Tikosyn. Amiodarone was even more effective in people with structural heart disease, such as a heart valve problem. (Structural heart disease is heart disease due to a problem with the structure of the heart.)

Costs

According to estimates on GoodRx.com, Tikosyn costs significantly more than amiodarone. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Tikosyn is a brand-name drug. It’s also available in a generic form called dofetilide.

Amiodarone is a generic drug. Brand-name medications usually cost more than generics.

Other drugs are available that can treat atrial fibrillation (AFib) and atrial flutter. Some may be a better fit for you than others. If you’re interested in finding an alternative to Tikosyn, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Alternatives for AFib and atrial flutter

Examples of other drugs that may be used to maintain a normal sinus rhythm (a healthy heart rhythm) with AFib and atrial flutter include:

  • quinidine
  • disopyramide (Norpace)
  • flecainide (Tambocor)
  • sotalol (Betapace, Betapace AF, Sorine, Sotylize)
  • amiodarone (Nexterone, Pacerone)
  • dronedarone (Multaq)

You should take Tikosyn according to your doctor’s or healthcare provider’s instructions.

Tikosyn comes as a capsule that you swallow.

When to take

You’ll likely take Tikosyn twice a day, at about the same time each day.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Taking Tikosyn with food

You can take your dose of Tikosyn with or without food.

Can Tikosyn be crushed, split, or chewed?

It’s not known whether it’s safe to open up Tikosyn capsules. However, if you’re having trouble swallowing the capsules, talk with your doctor. They may be able to recommend a different medication that’s easier for you for you take.

Tikosyn is used to treat certain forms of arrhythmias called atrial fibrillation (AFib) and atrial flutter. An arrhythmia is an irregular heart rate or rhythm. AFib and atrial flutter are a type of arrhythmia called a supraventricular arrhythmia, which occurs in the atria (upper chambers) of the heart.

AFib is a condition in which your atria pumps faster than the lower chambers. Your heart rhythm is irregular, which increases your risk of heart attack and stroke.

With atrial flutter, your heart rate becomes very fast. Your heart’s atria pump more quickly than the lower chambers. However, your heart may still have a normal rhythm. Atrial flutter may eventually become AFib.

Tikosyn is approved to:

  • convert atrial flutter or AFib to a normal sinus rhythm (a healthy heart rhythm)
  • maintain a normal sinus rhythm after your rhythm has been converted from AFib or atrial flutter for at least 1 week

What Tikosyn does

Tikosyn works by blocking potassium channels in your heart. Potassium channels are part of what helps your heart generate electrical signals, which then cause your heart to beat.

By blocking these channels, Tikosyn stops the irregular electrical signals that occur with AFib or atrial flutter. When your heart rhythm returns to normal, your risk of serious side effects such as heart attack and stroke decreases.

How long does it take to work?

Tikosyn should start working after you take your first dose of the medication. It may take a few doses before you start to notice a decrease in your AFib or atrial flutter symptoms.

It’s not known if Tikosyn is safe to take during pregnancy. There haven’t been any clinical trials or study results to determine if the drug is a safe option to use while pregnant.

In studies of animals who were given Tikosyn while pregnant, there was decreased growth of the fetus and an increased risk of birth defects. However, animal studies don’t always predict what will occur in humans.

At this time, Tikosyn is recommended only for use during pregnancy if the benefit to the mother outweighs the risk to the baby.

If you’re pregnant or planning to become pregnant, talk with your doctor before using Tikosyn. They can recommend the best treatment option for you.

It’s not known if Tikosyn is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor about your birth control needs while you’re using Tikosyn.

For more information about taking Tikosyn during pregnancy, see the “Tikosyn and pregnancy” section above.

You shouldn’t breastfeed while taking Tikosyn. It’s not known if the drug is present in breast milk or if it can have an effect on a breastfed child.

If you’re breastfeeding or planning to breastfeed, talk with your doctor before using Tikosyn. They can review your treatment options and healthy ways to feed your child.

This drug comes with several precautions.

FDA warning: Arrhythmia

This drug has a boxed warning. This is the most serious warning from the Food and Drug Administration (FDA). A boxed warning alerts doctors and patients about drug effects that may be dangerous.

A new or worsening arrhythmia (irregular heart rate or rhythm) can occur with Tikosyn use. When you first start or restart taking Tikosyn, you’ll remain under a doctor’s care for at least 3 days. This allows them to monitor and treat any possible ventricular arrhythmias that could develop. (Ventricular arrhythmias are caused by a problem with your heart’s lower chambers.) The monitoring usually takes place in a hospital. Your doctor will track your heart rate as well as your kidney function through blood tests.

Other precautions

Before taking Tikosyn, talk with your doctor about your health history. Tikosyn may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

  • Kidney problems. Tikosyn is removed from your body through your kidneys. So if your kidneys aren’t working properly, Tikosyn may build up in your body. This can cause side effects such as an arrhythmia. Your doctor will perform blood tests before you start using Tikosyn to make sure your kidneys are healthy enough to remove the drug properly. Talk with your doctor about any kidney problems that you have before you start taking Tikosyn.
  • Liver problems. People with severe liver problems haven’t been included in clinical trials of Tikosyn. So it’s not known how the drug will work in this group of people. If you have a liver condition, such as hepatitis, talk with your doctor before taking Tikosyn. They can determine how severe your condition is and if the drug is an option for you.
  • Heart problems. If you have certain heart conditions, such as long QT syndrome,Tikosyn may not be the right medication for you. This is because the drug can lengthen your QT interval (a measure of your heart rhythm). If your QT interval becomes too long, it can cause serious side effects such as chest pain or heart attack. If you have a history of heart problems, talk with your doctor before starting Tikosyn treatment. They can review your medication choices.
  • Allergic reaction. If you’ve had an allergic reaction to Tikosyn or any of its ingredients, you shouldn’t take Tikosyn. Ask your doctor what other medications are better options for you.
  • Pregnancy. It’s not known if Tikosyn is safe to take during pregnancy. For more information, please see the “Tikosyn and pregnancy” section above.
  • Breastfeeding. You shouldn’t breastfeed while taking Tikosyn. For more information, please see the “Tikosyn and breastfeeding” section above.

Note: For more information about the potential negative effects of Tikosyn, see the “Tikosyn side effects” section above.

Using more than the recommended dosage of Tikosyn can lead to serious side effects. Do not use more Tikosyn than your doctor recommends.

Overdose symptoms

Symptoms of an overdose can include:

  • QT prolongation (a type of heart rhythm problem), possibly leading to a new or worsening arrhythmia*
  • heart attack

In clinical trials, there were two overdoses in people who took Tikosyn. One person didn’t have any symptoms from taking too much Tikosyn. However, the other person had a type of arrhythmia* called a ventricular arrhythmia and a heart attack.

* Tikosyn has a boxed warning for arrhythmia. A boxed warning is the most serious warning from the FDA. For more information, see “Arrhythmia” in “Side effect details” above.

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor right away. You can also call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. But if your symptoms are severe, immediately call 911 or your local emergency number, or go to the nearest emergency room.

When you get Tikosyn from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

You should store Tikosyn capsules at room temperature (59°F to 86°F/15°C to 30°C) in a tightly sealed container. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms. And be sure to keep Tikosyn away from children.

Disposal

If you no longer need to take Tikosyn and have leftover medication, it’s important to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information on how to dispose of your medication.

The following information is provided for clinicians and other healthcare professionals.

Indications

Tikosyn is indicated for use in patients to:

  • convert atrial fibrillation (AFib) or atrial flutter to normal sinus rhythm
  • maintain normal sinus rhythm in people who have AFib or atrial flutter and have converted to normal sinus rhythm for more than 1 week

Tikosyn can cause ventricular arrhythmias, so it should be used only in patients who have serious signs and symptoms of AFib or atrial flutter. Tikosyn has a boxed warning for arrhythmia.

Tikosyn should increase the amount of time that a patient is in normal sinus rhythm. However, symptoms of AFib or atrial flutter may return in some patients.

Tikosyn is not effective in patients who have paroxysmal AFib.

Administration

Tikosyn is a capsule that is taken twice a day by mouth.

Mechanism of action

Tikosyn is a class III antiarrhythmic drug. It works by blocking the potassium channels, which modulates the rapid portion of the delayed rectifier potassium current. This obstruction causes an increase in the refractory period, which allows for the atria and ventricles to rest for a longer period, decreasing the impulses that lead to AFib or atrial flutter.

Pharmacokinetics and metabolism

Tikosyn is more than 90% orally bioavailable. The maximum blood plasma concentration occurs at about 2 to 3 hours post-dose. The half-life of the drug is about 10 hours.

The drug does not reach steady state for 2 to 3 days after dosing has started. Tikosyn is about 60% to 70% protein bound. It has a volume of distribution of 3 liters/kilogram.

About 80% of the Tikosyn dose is eliminated via the urine. Tikosyn is also partially broken down by CYP3A4 in the liver.

Contraindications

Tikosyn is contraindicated in patients:

  • with prolonged QT syndromes that are acquired or congenital, where a baseline QT interval is greater than 440 milliseconds (ms) or greater than 500 ms in patients who have ventricular conduction issues
  • with severe renal problems where creatinine clearance is less than 20 milliliters/minute
  • with an allergy to the drug
  • who are taking any of the following drugs:
    • verapamil (Verelan)
    • cimetidine (Tagamet)
    • trimethoprim (Primsol)
    • ketoconazole
    • prochlorperazine (Procomp)
    • dolutegravir (Tivicay)
    • megestrol (Megace ES)
    • hydrochlorothiazide (Microzide) alone or with other drugs

Storage

Tikosyn capsules should be stored at room temperature (59°F to 86°F/15°C to 30°C) in a tightly sealed container. This drug should be kept from humidity and moisture.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.