Antiarrhythmic drugs. Part 3: rate-control drugs

Rate control drugs are used to reduce the ventricular rate during atrial arrhythmias and are widely used in both primary and secondary care. In this final instalment of a three-part series, we evaluate three commonly used rate control agents; bisoprolol, diltiazem, and digoxin. Of these, bisoprolol has the widest range of indications as it is also used in the prevention of ventricular arrhythmias. It has the best safety profile of the three drugs due to its combined renal and hepatic excretion. Diltiazem and digoxin have a narrower range of use, and carry a greater risk of toxicity due to a reliance on either hepatic or renal elimination. These issues are explored alongside consideration of evidence base for use, dosing, and interactions. The focus is on information that supports safe prescribing and administration. This document is the Accepted Manuscript version of a Published Work that appeared in final form in British Journal of Cardiac Nursing, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work see https://www.magonlinelibrary.com/doi/full/10.12968/bjca.2019.007