mexiletine / Generic mfg. - LARVOL DELTA

Metastatic Misroute: Primary Pancreatic Neuroendocrine Tumor With Intracardiac Metastasis (ACG 2026) - "She was treated with capecitabine-temozolomide, though capecitabine was discontinued due to chest pain. Follow-up imaging demonstrated progression with gastric invasion despite therapy and lutetium Lu-177 dotatate was initiated...She developed recurrent ventricular arrhythmias, including torsades de pointes during amiodarone infusion requiring transition to lidocaine, mexiletine, sotalol, and metoprolol...Figure: Cardiac MR was done and showed 3 abnormally enhancing masses in the left ventricle. Figure: CT revealing large pancreatic NET."

Metastases • Cardiovascular • Diabetes • Gastrointestinal Disorder • Gastrointestinal Neuroendocrine Tumor • Metabolic Disorders • Neuroendocrine Tumor • Oncology • Ovarian Cancer • Solid Tumor • Type 1 Diabetes Mellitus • Type 2 Diabetes Mellitus

Toxicology of caffeine poisoning: molecular mechanisms, toxicokinetic profiles, and clinical implications. (PubMed, Front Toxicol) - "Interactions with drugs like mexiletine drastically reduce clearance...When massive ingestions saturate endogenous detoxification, hemodialysis becomes essential for survival. Unregulated markets for pure caffeine require stricter regulatory interventions and intensified clinical surveillance."

Journal • Review • Cardiovascular • CYP1A2

Open-label Extension Study in Paediatric Patients Who Have Completed the MEX-NM-301 Study. (clinicaltrials.gov) - P=N/A | N=12 | Completed | Sponsor: Lupin Ltd. | Active, not recruiting ➔ Completed | Trial primary completion date: Jan 2026 ➔ Jun 2026

Trial completion • Trial primary completion date • Pediatrics

Pain Management in Erythromelalgia: A Systematic Review and Graded Appraisal Across Etiological Subtypes. (PubMed, Eur J Pain) - "This systematic review provides a comprehensive, graded evaluation of the full spectrum of pain-management strategies in erythromelalgia, including systemic, topical, interventional and non-pharmacological approaches, across reported aetiological subtypes. Integrating risk-of-bias appraisal and GRADE certainty ratings, it identifies moderate-certainty evidence for aspirin in myeloproliferative neoplasm-associated disease and low-certainty evidence for conventional sodium-channel blockers in selected primary forms, while evidence for other interventions remains low or very low. These patterns suggest that aetiology may inform treatment selection, but require prospective validation."

Journal • Review • Dermatology • Hematological Disorders • Myeloproliferative Neoplasm • Oncology • Pain • Rare Diseases

Innervated human cardiac muscle model reveals sympathetic drivers of KCNH2-associated arrhythmias. (PubMed, Nat Commun) - "β-adrenoreceptor blockade was insufficient to rescue the pro-arrhythmic phenotype, while mexiletine targeting both neurons and cardiomyocytes, proved to be more effective. Collectively, our data establishes iEHM as a New Approach Methodology that provides a human-relevant, physiologically integrated model for mechanistic investigations and pharmacological testing."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure • KCNH2

Essential antiarrhythmic drug accessibility worldwide: A multi-survey study and comprehensive evaluation of access and supply challenges. (PubMed, Europace) - "Physicians worldwide frequently encounter problems accessing guideline recommended antiarrhythmic drugs for their patients, which putatively impacts on their patients' quality of life and life expectancy. This highlights systemic vulnerabilities that extend across national and institutional boundaries, urging close collaboration among clinicians, policymakers, manufacturers, and institutions to guarantee timely and equitable treatment for all patients."

Journal • Cardiovascular • Pediatrics

Mexiletine in drug-refractory ventricular arrhythmias: real-world effectiveness and tolerability (ESC 2026) - "Adverse effects were frequent, and overall mortality remained high, reflecting advanced underlying disease. Prospective studies are warranted to clarify its role in this setting."

Clinical • Real-world • Real-world effectiveness • Real-world evidence • Cardiomyopathy • Cardiovascular • Heart Failure • Hypotension

Long QT syndrome: should we use mexiletine in all long QT syndrome type 2? and how? (ESC 2026) - No abstract available

Cardiovascular

Sodium Channel Blockers Demonstrate Binding Affinity for the Tandem Tudor Domain of the Epigenetic Hub UHRF1. (PubMed, ChemMedChem) - "A targeted follow-up screen focusing on sodium channel blockers yields two additional, although less promising hits, mexiletine and triamterene...Finally, a previously undocumented interdomain interaction between TTD and its N-terminal adjacent Ubiquitin-like domain is reported, introducing a novel, potentially druggable UHRF1 regulatory feature. Together, these findings establish hydroxyprocaine as a highly viable chemical scaffold for TTD-targeted drug development."

Journal • Anesthesia • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • Targeted Protein Degradation • TP53 • UHRF1

Recurrent Cardiac Arrest in a Pediatric Patient with Hypertrophic Cardiomyopathy and a Myocardial Bridge: Player or Spectator? (PubMed, Pediatr Cardiol) - "Atenolol was started after his second SCA at age 12. After a third SCA he was transitioned to Nadolol and Mexiletine, and underwent transvenous ICD implantation due to delayed shock secondary to under-sensing on epicardial system. He had two additional episodes of SCA, for which he was started on Amiodarone and transferred to our institution for transplant evaluation in the setting of biventricular systolic dysfunction...MB can cause significant compression leading to compromised coronary flow and myocardial ischemia distinct from the intrinsic underlying cardiomyopathy in HCM. Modifiable causes should be considered in cases of recurrent SCA, as treatment may alter prognostic implications."

Journal • Cardiomyopathy • Cardiovascular • Fibrosis • Hypertrophic Cardiomyopathy • Immunology • Myocardial Ischemia • Pediatrics • Transplantation

Management of Refractory Ventricular Tachyarrhythmias and Ventricular Storm in a Patient on Mechanical Circulatory Support (ASA 2026) - "After ROSC, Impella CP was placed for severe LV dysfunction (LVEF 10%) and VA-ECMO was started for persistent hypoperfusion with multiorgan failure.The ICU course was complicated by recurrent ventricular arrhythmias and ventricular storm despite antiarrhythmic therapy with amiodarone and mexiletine, minimization of vasoactive medications, ventricular overdrive pacing, and mechanical support optimization. On HOD#9, a right stellate ganglion block was placed without further episodes of ventricular arrhythmia.This case demonstrates the complexities of arrhythmia control in multisystem organ failure."

Clinical • Cardiovascular • Ventricular Tachycardia

Expression Defects of SCN5A Common Polymorphisms S524Y and H558R in the Q1077 Splice Variant Can Be Rescued by Mexiletine. (PubMed, Cells) - "The magnitude of the expression defects caused by H558R and S524Y in the Q1077 splice background is similar to that observed with arrhythmia-associated SCN5A mutations, and we show for the first time that the defects for both polymorphisms can be rescued with mexiletine. Although it is unknown whether they result in heightened arrhythmia susceptibility in patients homozygous for the minor allele, our result may have implications for therapy for mutations with loss-of-function phenotypes modified by these common polymorphisms."

Journal • Cardiovascular • CNS Disorders • Genetic Disorders • NAV1

Case Report: Overlap of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia in two Chinese children with CALM2-related calmodulinopathy. (PubMed, Front Pediatr) - "She remained event-free on propranolol and propafenone for two years...Despite treatment with propranolol plus mexiletine, syncopal episodes continued, with the QTc interval further prolonged to 0.62 s...Patients who experience recurrent syncope coexisting with significant sinus bradycardia may have more severe phenotypes with higher risk of malignant arrhythmias, warranting earlier or more aggressive evaluation for device therapy. Genetic testing is recommended for suspected pediatric channelopathies with phenotype-guided individualized treatment."

Journal • Cardiovascular • Gene Therapies • Pediatrics • Ventricular Tachycardia • CALM2

Universal Metal-Free Deborylation-Deuteration via Redox-Decoupled Tandem Flow Electrosynthesis. (PubMed, J Am Chem Soc) - "The platform demonstrates industrial-grade durability with continuous operation for over 1200 h and enables scalable, unprotected synthesis of deuterated drug d-mexiletine. Overall, this strategy significantly expands the design space of flow electrochemistry, paving an exciting path toward green, economic, and efficient electrosynthesis."

Journal

Extravascular Implantable Cardioverter-Defibrillator Therapy for Malignant Ventricular Arrhythmias in a Child with Congenital Long QT Syndrome: A Case Report. (PubMed, J Cardiovasc Dev Dis) - "In children with drug-refractory cLQTS2, the extravascular ICD provides defibrillation and antitachycardia pacing (ATP) while avoiding transvenous lead complications and preserving venous access. This case shows that with precise preoperative planning and lead redundancy, the device appears feasible and can be implanted without short-term complications in young children. Larger studies with longer follow-up are needed to evaluate long-term device performance."

Journal • Cardiovascular • Musculoskeletal Diseases • Orthopedics • Ventricular Tachycardia • KCNH2

Multimodality Risk Stratification in Athletes With Long QT Syndrome. (PubMed, JACC Case Rep) - "Individualized risk assessment including resting and stress electrocardiography, genotype analysis, and electromechanical window measurement provides a more accurate estimate of arrhythmic risk than does resting QTc interval alone. Genotype-guided therapy and structured sports counseling allow most patients with LQTS to safely engage in exercise and even competitive athletics under expert supervision. Shared decision making and emergency preparedness, including automated external defibrillator access and multidisciplinary collaboration, are essential to balancing athletic participation with long-term safety in patients with LQTS."

Journal • Cardiovascular • Heart Failure • KCNH2 • KCNQ1OT1

Common genetic variants of the cardiac sodium channel alter patient response to class 1b antiarrhythmics. (PubMed, J Precis Med (Amst)) - "Lidocaine and its analog mexiletine both have a primary amine that blocks Na+ current...Our results suggest that the unique genetic background of patients should inform therapeutic approaches to treat and prevent arrhythmias associated with common cardiac pathologies. This work exemplifies a New Approach Methodology (NAM) framework for cardiac pharmacology, replacing population-averaged drug testing with a patient-derived, genotype-informed in vitro platform capable of prospectively identifying adverse drug-genotype interactions."

Journal • Cardiovascular • Myocardial Infarction • Ventricular Tachycardia • NAV1

An Unusual Genetic Variant of Long QT Syndrome with Late Presentation in the Sixth Decade. (PubMed, J Innov Card Rhythm Manag) - "Her evaluation revealed a prolonged corrected QT (QTc) interval, and, after excluding acquired causes, she was managed with a dual-chamber implantable cardioverter-defibrillator, β-blocker and mexiletine therapy, and a base rate of 80 bpm...Upon diagnosis of congenital long QT syndrome, her antiepileptic drugs were discontinued. At 6-month follow-up, she remained free of arrhythmic events with noted improvement in her QTc interval, highlighting the critical importance of accurate diagnosis and genotype-guided therapy in such cases."

Journal • Cardiovascular • CNS Disorders • Epilepsy • Ventricular Tachycardia

Real-World Evaluation of Lamotrigine as an Anti-Myotonic Therapy in Myotonic Dystrophy Type 1 (ICNMD 2026) - "Mexiletine, the most commonly used anti-myotonic agent, has limited availability and is often associated with adverse effects... This pilot open-label study provides preliminary evidence supporting the efficacy and safety of lamotrigine as an anti-myotonic treatment in patients with DM1. These results warrant further investigation in larger, randomized, placebo-controlled clinical trials to better define its therapeutic role (Risi B et al. 2025)."

Clinical • HEOR • Real-world • Real-world evidence • Genetic Disorders • Muscular Dystrophy • Myotonic Dystrophy

Automated Patch-Clamp Electrophysiology for Drug Discovery and Genotype-Phenotype Correlation in Skeletal Muscle and Pain Disorders (ICNMD 2026) - "Automated patch clamp is a powerful and versatile approach for both drug screening and functional phenotyping of ion channel disorders. The platform reliably captured the state-dependent block of Nav1.7 by mexiletine and validated the two cell models for analgesic drug discovery. Furthermore, Patchliner enabled the identification of mutation-specific electrophysiological and molecular phenotypes in DMD, supporting its utility for genotype–phenotype correlation studies and the development of personalized therapeutic strategies."

Duchenne Muscular Dystrophy • Genetic Disorders • Muscular Dystrophy • Musculoskeletal Pain • Neuralgia • Pain • CACNA1S • NAV1

Polymorphic ventricular tachycardia with mutation in KCNJ2: case report. (PubMed, Front Cardiovasc Med) - "She was sequentially treated with metoprolol, verapamil, amiodarone, moricizine, and mexiletine, along with three radiofrequency catheter ablation sessions, but the therapeutic effect was unsatisfactory. Arrhythmias due to KCNJ2 mutations respond poorly to antiarrhythmic drugs, but flecainide may be a promising therapeutic option. Arrhythmias associated with KCNJ2 mutations tend to have a more benign clinical course, but identifying mutation carriers at risk of life-threatening arrhythmias remains challenging."

Journal • Cardiovascular • Gene Therapies • Heart Failure • Ventricular Tachycardia

Global pharma major Lupin Limited (Lupin) announced that the European Medicines Agency (EMA) has approved a change to the terms of marketing authorization for NaMuscla, supported by the Pediatric Investigation Plan (PIP). (Indian Pharma Post) - "The approval includes two new dosage strengths, 62 mg and 83 mg capsules, in addition to the existing 167 mg, and the revised indications that cover symptomatic treatment of myotonia in children (6–11 years, weighing at least 20 kg), adolescents (12–17 years), and adults (≥18 years) with non-dystrophic myotonic disorders."

ANDA • Musculoskeletal Diseases • Pain

Case Report: Nadolol-mexiletine combination therapy for refractory neonatal long QT syndrome: a case series beyond sodium channelopathies. (PubMed, Front Pediatr) - "No ICD implantation was performed and no deaths occurred during follow-up. These observations support further evaluation of mexiletine as an adjunct in refractory neonatal LQTS, including non-LQT3 subtypes."

Journal • Cardiovascular • Ventricular Tachycardia • KCNQ1OT1

An Observational Study in Adult Patients With Non-dystrophic Myotonic Disorders (clinicaltrials.gov) - P=N/A | N=53 | Completed | Sponsor: Lupin Ltd. | Active, not recruiting ➔ Completed

Trial completion • Genetic Disorders • Muscular Dystrophy • Myotonic Dystrophy

Amiodarone-Induced Thyrotoxicosis Presenting as A Rare Case of Ventricular Tachycardia Storm (ENDO 2026) - "Methimazole was stopped and propylthiouracil was started at 200 mg every four hours with metoprolol. Amiodarone was discontinued and replaced with lidocaine and mexiletine...High-dose intravenous hydrocortisone was initiated with continued cholestyramine and beta blockade...Ultrasound findings, lack of response to thionamides, and steroid responsiveness supported type II disease. Early recognition, accurate subtype identification, and coordinated cardiac and endocrine management are essential to prevent life-threatening arrhythmias."

Clinical • Atrial Fibrillation • Cardiovascular • Endocrine Disorders • Movement Disorders • Ophthalmology • Ventricular Tachycardia