mexiletine / Generic mfg. - LARVOL DELTA

A Simple Dual-Track HPLC-UV Methodology for Monitoring Primary Antiarrhythmic Drugs and Their Active Metabolites in Serum. (PubMed, Pharmaceuticals (Basel)) - "Objectives: The aim of the work was to present a method for routine determination of antiarrhythmic drugs, propafenone (PPF), its two metabolites, 5-hydroxypropafenone (5OHPPF) and N-depropylpropafenone (NDPPF), mexiletine (MEX), amiodarone (AD) and desethylamiodarone (DEAD) in serum. For all analytes, precision and accuracy fulfilled EMA requirements, i.e., ≤15% (≤20% for LLOQ), ensuring the reliability of the measurements. The method can be suitable for laboratories equipped with basic HPLC apparatus as an economical alternative to the LC-MS/MS technique."

Journal

Non-Invasive Programmed Stimulation (NIPS) to Guide the Subsequent VT Therapeutic Strategies (clinicaltrials.gov) - P=N/A | N=51 | Recruiting | Sponsor: IRCCS Ospedale San Raffaele | Not yet recruiting ➔ Recruiting

Enrollment open • Cardiovascular • Ventricular Tachycardia

Namuscla - opinion on variation to marketing authorisation (European Medicines Agency) - "On 26 March 2026, the Committee for Medicinal Products for Human Use (CHMP) adopted a positive opinion, recommending a change to the terms of the marketing authorisation for the medicinal product Namuscla...Namuscla is indicated for the symptomatic treatment of myotonia in children aged 6 to 11 years weighing at least 20 kg, adolescents aged 12 to 17 years and adult patients ≥ 18 years with non-dystrophic myotonic disorders."

CHMP • Myotonic Dystrophy

The Perfect Storm: Ventricular Tachycardia in a Scarred Heart (SCCM 2026) - "The patient transitioned to oral mexiletine and amiodarone. In refractory cases, catheter ablation or stellate ganglion blocks may be necessary. This case underscores the complexity of managing VT storm in elderly patients with structural heart disease, highlighting the need for individualized, multidisciplinary care."

Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Coronary Artery Disease • Heart Failure • Infectious Disease • Myocardial Infarction • Ventricular Tachycardia

Rhythm Managed, Liver Damaged: Cholestatic Liver Injury From Mexiletine Use (SCCM 2026) - "His course was complicated by ventricular fibrillation cardiac arrest and recurrent monomorphic ventricular tachycardia (VT) requiring defibrillation, cardioversions, amiodarone and lidocaine infusions. This case demonstrates that mexiletine may rarely be associated with cholestatic liver injury without evidence of hypersensitivity. Awareness of this pattern of liver injury should inform therapeutic use of mexiletine."

Cardiovascular • Eosinophilia • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Hepatology • Hypertension • Immunology • Liver Failure • Obesity • Ventricular Tachycardia

VENTRICULAR TACHYCARDIA IN PREGNANCY (ACC 2026) - "Previously diagnosed with idiopathic VT from the cardiac crux and declined ablation, treated with Diltiazem 20mg and Flecainide 100mg...For recurrent VT antiarrhythmic therapy with Flecainide, Sotalol, or Mexiletine is recommended. VT is a rare but important to recognize complication of pregnancy. Arrhythmia in pregnancy should be managed with a multidisciplinary approach."

Cardiovascular • Ventricular Tachycardia

LEFT VENTRICULAR PSEUDOANEURYSM IN A PATIENT WITH INCESSANT MONOMORPHIC VT AND PRIOR VT ABLATION: RECONSIDER THE REDO! (ACC 2026) - "Patient was on chronic mexiletine therapy for arrhythmia suppression. Decision-Making: He was placed on IV amiodarone and admitted to the ICU... LV pseudoaneurysm is an incredibly rare complication of VT ablations. Furthermore, in preparation for repeat VT ablation, multimodal imaging including TTE and CT/MRI are critical for preprocedural planning as VT ablations may carry prohibitive procedural risks in these patients."

Clinical • Cardiomyopathy • Cardiovascular

A COMPLEX CASE OF ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY REQUIRING MULTIPLE ABLATIONS AND HEART TRANSPLANTATION (ACC 2026) - "Management was complicated by intolerance and inefficacy of several antiarrhythmics, including sotalol, flecainide, mexiletine, and amiodarone. ARVC presents ongoing therapeutic challenges. Antiarrhythmic drugs and catheter ablation remain mainstays, though recurrence is common. A 2019 study showed an average of two ablations per patient."

Clinical • Cardiomyopathy • Cardiovascular • Fibrosis • Genetic Disorders • Immunology • Transplantation • Ventricular Tachycardia

ARRHYTHMOGENIC POTENTIAL OF SYNTHETIC CANNABIS: EVIDENCE OF QTC PROLONGATION (ACC 2026) - "TDS was treated with intravenous magnesium, amiodarone, and lidocaine. The patient transitioned to oral mexiletine on discharge... Increasing evidence suggests that synthetic cannabis is pro-arrhythmogenic, causing prolonged QTc, which may have revealed an underlying channelopathy or peripartum cardiomyopathy in this patient. K2 induced cardiac arrest requires special drug testing, telemetry monitoring, and genetic testing. As healthcare providers, we must be aware of synthetic cannabis as a trigger for sudden cardiac death in young people and counsel patients on possible adverse cardiac effects of commercially available cannabis products."

Cardiomyopathy • Cardiovascular • Gynecology

TUBERCULOSIS MYOCARDITIS: A NOT MISS DIAGNOSIS (ACC 2026) - "Patient improved with RIPE therapy, corticosteroids, antiarrhythmics (lidocaine, mexiletine) and other clinical support... TB myocarditis remains an under-recognized and often fatal complication of disseminated TB. Due to its rare and sudden presentation, it is frequently diagnosed only at autopsy. Clinical suspicion should be raised in patients with active TB and new-onset arrhythmias, heart failure, or cardiogenic shock."

Cardiovascular • Congestive Heart Failure • Cough • Heart Failure • Infectious Disease • Inflammation • Pulmonary Disease • Respiratory Diseases • Tuberculosis • Ventricular Tachycardia

MITRAL ANNULAR DISJUNCTION IN A PATIENT WITH RECURRENT VENTRICULAR FIBRILLATION AND ASSOCIATED SINUS VENOSUS ATRIAL SEPTAL DEFECT (ACC 2026) - "MAD is commonly associated with MVP and has been linked to ventricular arrhythmia and sudden cardiac death. Although the exact mechanism of arrhythmia is unclear, it is typically associated with increased wall stress and fibrosis. MAD is also associated with congenital ASD, usually the secundum type."

Clinical • Cardiomyopathy • Cardiovascular • Endocrine Disorders • Fibrosis • Immunology • Ventricular Tachycardia

METASTATIC LYMPHOPLASMACYTIC LYMPHOMA TO THE SYMPATHETIC CHAIN CAUSING VT STORM (ACC 2026) - "Case: A 68-year-old man with relapsed stage IV lymphoplasmacytic lymphoma (LPL) and doxorubicin-induced cardiomyopathy with EF 24% was admitted for syncope, hypotension, and VT storm. Decision-Making: Three months prior to the current presentation, he was admitted for initiation of venetoclax for LPL when he suffered a VT arrest after the second 200 mg dose of therapy...The patient could not tolerate amiodarone and so mexiletine was started... Metastatic LPL to the sympathetic chain is rare; its recognition as a potential cause of VT storm requires a high index of suspicion after common etiologies are ruled out. In this case, the putative mechanism of VT was enhanced sympathetic nervous system signaling in the setting of LPL infiltration of the sympathetic chain."

Metastases • Cardiomyopathy • Cardiovascular • Hematological Malignancies • Hypotension • Lymphoma • Lymphoplasmacytic Lymphoma • Non-Hodgkin’s Lymphoma • Ventricular Tachycardia • Waldenstrom Macroglobulinemia • CD20

VENTRICULAR TACHYCARDIA AS HARBINGER OF SYSTEMIC SCLEROSIS CARDIAC INVOLVEMENT (ACC 2026) - "CMR has a crucial role in identifying patients at higher risk of arrhythmias that can impact management strategies."

Cardiovascular • Congestive Heart Failure • Fibrosis • Heart Failure • Immunology • Inflammation • Interstitial Lung Disease • Pulmonary Disease • Respiratory Diseases • Scleroderma • Systemic Sclerosis • Ventricular Tachycardia

USING THE DELPHI METHOD TO IDENTIFY EVIDENCE GAPS IN SUPPORT OF HTA SUBMISSIONS FOR RARE PEDIATRIC CONDITIONS: A CASE STUDY IN NON-DYSTROPHIC MYOTONIAS (ISPOR 2026) - "The opportunities for addressing evidence gaps are limited due to practical constraints; thus, there is a need for a structured methodology to reliably address uncertainty introduced by them.Here we present how a clinician Delphi panel, supported by proxy-payer interviews, can help manufacturers identify and address evidence gaps in rare pediatric disorders. Data from pediatric patients with NDM enrolled in the MEX-NM-301 and MEX-NM-303 mexiletine trials were used as a case study... A clinician Delphi panel, supported by proxy-payer interviews, reliably identified evidence gaps in the case study trials. Evidence gaps identified by proxy-payers and clinicians often overlap in such rare pediatric indications; thus, addressing them can reduce uncertainties during HTA appraisal and clinician prescribing. The Delphi Method is likely broadly applicable to identify evidence gaps in other rare pediatric conditions."

Case study • Clinical • Myotonic Dystrophy • Pediatrics

Multimodal Therapies to Manage Refractory Ventricular Arrhythmias in Patients Supported with HeartMate 3 Left Ventricular Assist Device (ISHLT 2026) - "He was discharged on amiodarone and mexiletine.Case 2: A 71-y-o male with ischemic cardiomyopathy underwent HM3 implantation after presenting with electrical storm and cardiogenic shock. Due to frailty and infection, catheter ablation and surgical sympathectomy were deferred. Summary These cases highlight the complexity of VA management in HM3 patients and the need for multimodal approach including both neuromodulation and advanced ablation techniques."

Clinical • Cardiomyopathy • Cardiovascular • Congestive Heart Failure • Heart Failure • Infectious Disease • Nephrology • Renal Disease

Emergency pharmacotherapy in rhythmology (PubMed, Herzschrittmacherther Elektrophysiol) - "In addition to classical antiarrhythmic drugs, substances that act on the atrioventricular (AV) node, beta blockers, calcium channel blockers, adenosine, glycosides and catecholamines also play a central role in acute treatment.As no new antiarrhythmic drugs have been approved for clinical practice in the past 15 years, established substances continue to be of particular importance. In addition, antiarrhythmic drugs that are not regularly available in Germany, such as procainamide or mexiletine, are also being discussed, as they may be prognostically relevant, particularly in complex bail-out situations involving ventricular arrhythmias."

Journal • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Heart Failure • Ventricular Tachycardia

Top-Down Exfoliation of Ultrathin Chiral 2D Nanosheets for High-Resolution Gas Chromatography. (PubMed, Anal Chem) - "Experiments showed that the stationary phase of 2D nanosheets, prepared by exfoliating BPDS-PBIM, exhibited exceptional separation performance for complex pharmaceutical molecules (e.g., ibuprofen, ketoprofen, flurbiprofen, fenoprofen, mexiletine hydrochloride) and chiral compounds with different polarity. This work not only demonstrates the powerful potential of BPDS-PBIM as a chiral stationary phase but also suggests its broad application prospects in fields such as pharmaceutical analysis, flavor and fragrance quality control, and chemical reaction monitoring."

Journal • CDKN1A

Mexiletine prevents transient heart failure in a polymicrogyria child with an ATP1A3 variant: a case report. (PubMed, Eur Heart J Case Rep) - "Because bradycardia could trigger transient HF, we administered cilostazol. Based on the proposed pathophysiological mechanism, we selected mexiletine, which blocks Na+ channels particularly in the inactivated state, reducing INa, L and the subsequent Ca2+ overload. Mexiletine was administered safely, successfully preventing transient HF."

Journal • Cardiovascular • CNS Disorders • Congestive Heart Failure • Epilepsy • Heart Failure

Unlocking the catalytic potential of transaminase: A two-decade evolution toward green and scalable biocatalysis. (PubMed, Bioorg Chem) - "Although these enzymes are now regularly used in industry for the synthesis of Sitagliptin, Mexiletine, Dolutegravir, etc., there is still scope for improvement involving challenges such as equilibrium thermodynamics, co-product removal, limited substrate tolerance, and scope. This review focuses on the detailed use of these enzymes in the pharmaceutical industry over the past 20 years and comprehensive approaches encompassing protein and equilibrium engineering, immobilization, continuous-flow biocatalysis, smart donors, and multi-enzymatic cascades, which have been and are being used for their evolution into the pharmaceutical industry."

Journal • Review

Common Genetic Variants of The Cardiac Sodium Channel Alter Patient Response to Class 1b Antiarrhythmics. (PubMed, bioRxiv) - "This paradoxical proarrhythmic phenotype shifts the paradigm of conventional antiarrhythmic therapy with mexiletine, suggesting that background variants may alter pharmacological responses leading to unanticipated consequences. Our results suggest that the unique genetic background of patients should inform therapeutic approaches to treat and prevent arrhythmias associated with common cardiac pathologies."

Journal • Cardiovascular • Myocardial Infarction • Ventricular Tachycardia • NAV1

Successful Functional Outcome in a Dog With Ventricular Tachycardia Treated With Antiarrhythmics, Cardioversion, Cardiopulmonary Resuscitation, and Intra-Arrest Lipid Emulsion. (PubMed, J Vet Emerg Crit Care (San Antonio)) - "This report describes a case of CPA secondary to intractable VT refractory to both injectable antiarrhythmic medication and attempted electrical cardioversion. Evidence suggests that antiarrhythmic medications can have positive or negative effects on the DFT, which may affect the success of electrical cardioversion or defibrillation. ILE was administered to bind the lipophilic antiarrhythmic medications due to concern that they were increasing the DFT. In patients with malignant arrhythmias, use of antiarrhythmic medication is often essential; however, clinicians should consider its potential impact on the DFT during subsequent cardioversion or defibrillation."

Journal • Anesthesia • Cardiomyopathy • Cardiovascular • Ventricular Tachycardia

Repositioning lidocaine as a TMEM16A Ca2+-activated Cl- channel blocker for the treatment of pulmonary arterial hypertension. (PubMed, J Pharmacol Exp Ther) - "Among NaV channel blockers, the antiarrhythmic drugs, mexiletine and quinidine, inhibited TMEM16A currents, whereas the anticonvulsants, phenytoin and carbamazepine, showed no effect. SIGNIFICANCE STATEMENT: Lidocaine, a voltage-gated Na+ channel blocker widely used as a local anesthetic and antiarrhythmic drug, significantly inhibited TMEM16A Ca2+-activated Cl- channels. Lidocaine also ameliorated pulmonary arterial hypertension (PAH) progression in experimental PAH rats, suggesting that it directly targets TMEM16A ClCa channels and represents a promising repositioned therapeutic option for PAH."

Journal • Anesthesia • Cardiovascular • Hypertension • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases

Mutation-specific roles of sustained sodium current (INa) in guiding precision medicine for long QT syndrome type 3. (PubMed, PNAS Nexus) - "Electrophysiological properties were analyzed using patch-clamp techniques, and pharmacological responses to flecainide, mexiletine, and ranolazine were evaluated. This study highlights the role of sustained INa in LQTS3 severity and underscores the importance of mutation-specific treatments. By tailoring treatments to the electrophysiological characteristics of each mutation, precision medicine offers a promising approach to improving patient outcomes in LQTS3."

Journal • Cardiovascular

ECG artefact or life-threatening arrhythmia? A neonatal presentation of Long QT syndrome type 3 with a de novo SCN5A mutation. (PubMed, Cardiol Young) - "Genetic testing identified a de novo SCN5A c.796C > G (p.L266V) mutation associated with Long QT syndrome type 3. At 1 year of age, the patient remains stable and asymptomatic while receiving combined therapy with propranolol and mexiletine."

Journal • Cardiovascular

Shenlian-Fumai Formula Attenuates Ventricular Arrhythmias via Modulating Sodium Channel Function in Heart Failure Mice. (PubMed, J Ethnopharmacol) - "SLFM exhibits antiarrhythmic and cardioprotective effects in HF by regulating sodium channel function and CaMKII signaling, highlighting its potential as a therapeutic option for HF-related VAs. However, all data were obtained from a single batch of SLFM, limiting generalizability and requiring validation with additional batches and harvest years."

Journal • Preclinical • Cardiovascular • Congestive Heart Failure • Fibrosis • Heart Failure • Immunology