Antiarrhythmic drugs. Part 3: rate-control drugs

Abstract

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 article 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 owing to its combined renal and hepatic excretion. Diltiazem and digoxin have a narrower range of use and carry a greater risk of toxicity as a result of their 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.