Dronedarone is a drug which was developed to replace the very effective , (but side effect prone ) antiarrhythmic drug Amiodarone.
After years of study , Dronedarone has been approved for use in some* of our patients with atrial fibrillation
* Who are they ?
That is the only thing , we are unclear about Dronedarone ! ! !
The recent studies on Dronedarone DIONYSOS have clearly proven it , to be a less effective agent in controlling AF , but has a advantage of fewer adverse effects.
Hence , for preventing the potential side effects of Amiodarone , let our patients take an inefficient drug ! This is how we are inclined to think ! But the medical industry can not be blamed altogether , after years of research they develop a molecule and they would like to have at least a small pie in the atrial fibrillation market place !
It again proves the centuries old adage, that all drugs are poisons .If a drug lacks side effects it ceases to have the desired effect also . If you want a drug with zero side effect a sugar coated placebo is the best choice !
Is there really a role for Dronedarone ?
- Yes , may be in patients who have recurrent AF in spite of stabilising the underlying conditions that perpetuate AF( Hypertension, CAD, COPD etc)
- When Amiodarone is contraindicated or withdrawn due to side effects
- Remember , Digoxin, Beta blockers, or even calcium blockers , can have an important role in the chronic management of AF. But they are unpopular for many reasons other than academics!
Final message
Dronedarone is power-less antiarrhythmic drug ( “Less- powerful ” could be a more polite and decent word !) that has a specific role in the management of AF when efficient rate or rhythm control is deemed unnecessary !
Why don’t we have study with one to one comparison of Digoxin ,Beta blocker and Dronedarone in the chronic management of atrial fibrillation !
Dr.S.Venkatesan MD 