Ajmaline Intravenous for adults

Who can administer

Administration RESTRICTED - see Appendix 1

This drug may only be used under supervision of a cardiologist in the Coronary Care unit
Advanced cardio-pulmonary life-support systems must be immediately available ^{(ref 1)}
Ensure isoprenaline injection has been ordered and is ready for use if required- see separate monograph.
Unlicensed medicine - not routinely stocked in GUH - reorder when used
This monograph refers specifically to the use of the drug in the diagnosis of Brugada syndrome
There are numerous drug interactions (e.g. other antiarrhythmic drugs, enzyme inducers, drugs which cause QTc interval prolongation)

Gilurytmal injection 50mg per 10ml ampoule

Already in solution

Draw up using a 5 micron filter needle

Not required-product ready for use

Slow intravenous injection (for the diagnosis of Brugada syndrome)

Administer each 10mg over one minute ^{(ref 1)} (see Dose below), followed by 5ml Glucose 5%^{(ref 3)}

Ajmaline challenge in the diagnosis of Brugada syndrome ^{(ref 1,2)}

Administer 10mg every two minutes until termination indicated (see below) OR target dose of 1mg/kg (to a usual maximum total dose of 80mg)
Check ECG and observations after each bolus

Drug administration should be terminated if ^{(ref 1,2)}

Maximum dose reached, OR
Diagnostic Brugada pattern in at least one ECG lead: J point or ST segment elevation of 2mm with coved ST elevation in more than one right precordial lead (positive result)
Occurrence of ventricular ectopic beats or ventricular tachycardia
Sinus arrest
2nd or 3rd degree AV nodal block
Prolongation of QRS duration by more than 30%

Monitor for tissue damage if extravasated (low pH) ^{(ref 3)}
Continue ECG monitoring for at least 1 hour afterwards or until ECG normalises or any adverse effects resolve ^{(ref 3)}
During testing monitor blood pressure and pulse at 5 minute intervals until recovery is evident^{(ref 3)}
Consider also monitoring SaO2^{(ref 3)}
Serum sodium levels during administration should not exceed 145 to 150mmol/L^{(ref 3)}

SPC translated from German to English Dec 2010 (linked on Medusa IV website)

1: Ajmaline for the Diagnosis of Brugada Syndrome, Brighton and Sussex hospitals May 2020

2: Ajmaline test- Brugada syndrome. University Hospitals of Leicester 21/01/2022

3: Intravenous drug administration guide, Medusa , Review date 14/4/2016, - downloaded 09/05/2023

Class 1a antiarrhythmic