ABC | Volume 112, Nº5, May 2019

Updated Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(5):649-705 Table 12 – Drugs used to treat SVPT in elderly patients 290 Cardioversion in the emergency room Drug Initial dose Repeat Total dose Precautions 1 st choice Adenosine 6 mg in rapid bolus IV over 10 seconds 12 mg every 15 minutes 30 mg Patients with CAD and active bronchial asthma 2 nd choice Verapamil 5 mg IV over 3 to 5 minutes 5 mg after 15 minutes 10 mg LV dysfunction and hypotension Patients with severe LV dysfunction Amiodarone 300 mg IV over 30 minutes diluted in 0.9% saline solution or 100 to 250 mL 5% glucose solution - 300 mg in bolus IV and 900 to 1,200 mg over the following 24 h May be associated with digitalis IV to better control HR Drugs used for maintenance following reversion to sinus rhythm Calcium channel blockers Diltiazem (start with short half-life formulations and, if tolerated, substitute with extended release formulations, following dose adjustment) 30 mg 3×/day Increase the dose by 50% every 14 days, if well tolerated, until the desired resting HR (60 to 70 bpm) has been reached 180 to 240 mg/day Use caution with tachycardia-bradycardia syndrome and LV dysfunction Verapamil 120 mg/day Idem 240 mg/day Idem Beta-blockers Metoprolol 50 mg/day Double the dose until the desired HR of 60 to 70 bpm has been reached 200 mg/day Atenolol 25 mg/day 200 mg/day Propranolol (In this order of preference, on account of liposolubility) 40 mg/day 240 mg/day Carvedilol 3.125 mg 2×/day Double the dose every 2 weeks 25 mg 2×/day Digoxin Preferential in patients with HF 0.125 mg/day Take care with patients > age 75 and creatinine > 1.5 mg/dL 0.25 mg/day (In the most elderly patients, debilitated patients, and patients with ERD, the dose should be adjusted in accordance with response and maintained at lower doses to 0.125 mg, 2–3×/week) Amiodarone Pay attention to collateral effects, especially those that are thyroid-related 600 mg/day for 10 days Reduce to 400 mg/day for 10 days and maintain 200 mg/day Monitor hepatic function, thyroid function, QTc interval, and eye fundus every 6 months Maintain 100 to 200 mg/day DAC: doença arterial coronariana; FC: frequência cardíaca; IC: insuficiência cardíaca; IRC: insuficiência renal terminal; IV: via intravenosa; TPSV: taquicardia paroxística supraventricular; VE: ventrículo esquerdo. 691