Is Meletine Safe for Post-Heart Attack Patients with Arrhythmia?

Meletonin 100mg

Hello Doctor, I experienced cardiac shock leading to a myocardial infarction at the end of April.
After emergency treatment, I had five stents placed in my coronary arteries.
I started cardiac rehabilitation in mid-May, and during the second session, I began to notice issues with arrhythmia.
Currently, my doctor has prescribed "Meletine 100mg," to be taken once in the morning and once in the evening.
Recently, I came across information from the Hsin Tung Pharmaceutical Company regarding this medication, which states a contraindication: "Patients with ventricular arrhythmias should not use Meletine within three months post-myocardial infarction or if there is inadequate cardiac output (left ventricular ejection fraction less than 35%), unless there is a life-threatening situation." I would like to ask you, Doctor, since Meletine seems to be a common treatment for arrhythmias, is it suitable for me given that I had stents placed only a month ago? Not every source discussing this medication mentions this contraindication, so I am concerned about whether I can take this medication in my current condition.
Thank you for your response.

Wang Bóbo, 70~79 year old female. Ask Date: 2020/06/05

Dr. Wu Xueming reply Cardiology

Although there are some contraindications and precautions for the use of medications, unless it is an absolute contraindication, the attending physician will still make appropriate prescriptions and adjustments based on the patient's condition.
If there are concerns about the medication, it is advisable to return to the outpatient clinic and discuss them with the original attending physician to address any doubts you may have.

Reply Date: 2020/06/05

More Info

Meletine, also known as mexiletine, is a medication primarily used to treat certain types of arrhythmias, particularly ventricular arrhythmias. It is classified as a Class 1B antiarrhythmic agent, which means it works by stabilizing the cardiac cell membranes and reducing the excitability of the heart muscle. However, its use in patients with a recent history of myocardial infarction (heart attack) and particularly in those with compromised cardiac function raises important considerations.

In your case, having experienced a heart attack and undergoing stenting, it is crucial to evaluate the safety of Meletine, especially given the warning you mentioned regarding its use in patients with ventricular arrhythmias. The contraindication you referenced indicates that Meletine should not be used in patients with ventricular arrhythmias unless there is a life-threatening situation, particularly within three months following a myocardial infarction or in cases of significantly reduced cardiac output (left ventricular ejection fraction below 35%).

Given that you are only one month post-stenting and have reported experiencing arrhythmias, it is essential to discuss your specific situation with your cardiologist. They will consider several factors, including:
1. Current Cardiac Function: Your left ventricular ejection fraction (LVEF) and overall cardiac function will significantly influence the decision to use Meletine. If your LVEF is above 35% and your heart function is stable, your doctor may consider the benefits of Meletine against the risks.

2. Type of Arrhythmia: The nature of the arrhythmia you are experiencing is also critical. If it is a life-threatening arrhythmia, the risks may be outweighed by the need for treatment.

3. Other Medications: Your current medication regimen and any potential interactions with Meletine should be evaluated. It is important to ensure that all medications you are taking work harmoniously without increasing the risk of adverse effects.

4. Monitoring: If Meletine is prescribed, close monitoring of your heart rhythm and overall cardiac function will be necessary to ensure safety and efficacy.

5. Alternative Treatments: If Meletine is deemed too risky, your healthcare provider may suggest alternative treatments for managing your arrhythmia that are safer given your recent cardiac history.

In summary, while Meletine can be effective for treating arrhythmias, its use in patients with a recent history of myocardial infarction and compromised cardiac function is complex and requires careful consideration. It is vital to have an open discussion with your cardiologist about your symptoms, the risks associated with Meletine, and the best course of action for your specific situation. Regular follow-ups and monitoring will be essential in managing your heart health effectively.

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