mexiletine / Generic mfg. - LARVOL DELTA

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

Integrating drug effects on individual cardiac ionic currents and cardiac action potentials to understand nonclinical translation to clinical ECG changes. (PubMed, Front Pharmacol) - "The results showed that hERG block-mediated QTC prolongation with dofetilide was shortened by co-administration of lidocaine or mexiletine-drugs that inhibit INaL...Consistent with this interpretation, nifedipine, which preferentially inhibits ICaL over hERG (ICaL: 13.2 nM; hERG: 35 μM; ratio = 2,651) caused APD shortening without AP triangulation. Results from this study thus support the following: 1) diltiazem failed to reduce moxifloxacin-induced QTC prolongation due to its concomitant hERG block at clinical exposure levels; and 2) the importance of using physiologically relevant protocols to generate ion channel pharmacology and obtaining functional recordings from myocytes to provide a better understanding of nonclinical data translation to clinical ECG signals. Data used in this manuscript, including the original electrophysiology records, may be found at: https://osf.io/69ght/."

Journal

Catheter Ablation Versus Antiarrhythmic Drug Therapy for Ventricular Tachycardia in Structural Heart Disease: A Meta-Analysis of Randomized Controlled Trials (AHA 2025) - "Antiarrhythmic drugs used were amiodarone, sotalol, mexiletine, and procainamide, with earlier studies using a wide array of therapies and later often using only amiodarone and sotalol. Catheter ablation significantly reduces the risk of VT recurrence, VT storm, and hospitalizations compared to AAD therapy in patients with structural heart disease. Although no mortality benefit was observed, these findings support catheter ablation as a potentially superior initial strategy for VT management in this population. More high-quality studies are warranted to clarify the long-term safety and effectiveness of this procedure."

Retrospective data • Cardiovascular • Heart Failure • Ventricular Tachycardia

Stability Assessment of a Novel 3D-Printed Oral Dosage Form of Mexiletine Hydrochloride: A Six-Month Shelf-Life Study. (PubMed, Pharm Dev Technol) - "These findings collectively indicate that the 3D-printed Mexiletine HCl formulation demonstrates excellent stability under room temperature storage conditions-information that is essential for advancing the formulation along regulatory and commercial pathways. Our data address the common trade-off between printability and stability, demonstrating that a formulation optimized for SSE printing can maintain stability under standard storage conditions."

Journal

Separating between analgesia and sedation in evoked pain behavior using the automated reproducible mechano-stimulator (ARM). (Neuroscience 2025) - "Pain behavior will then be measured using 0.5 g and 1 g stimuli, with baseline SNI pain behavior compared against that shown with a selection of compounds that have previously been shown to decrease SNI mechano-sensitivity and cause varying levels of sedation, including morphine, gabapentin, prgabalin, mexiletine, and a robust Nav 1.8 inhibitor (A-803467). The effects of each compound on the collected behavioral readouts will then be analyzed to distinguish between compounds with greater or lesser analgesic or sedative effects. This would expand the ARM system's functionality to be the first evoked pain assay capable of making this distinction."

CNS Disorders • Neuralgia • Pain

Turning Down the Heat: Lumbar Sympathetic Block for Autoimmune-Associated Erythromelalgia (ASRA-FALL 2025) - "• She had been treated with pregabalin, duloxetine, capsaicin, and mexiletine, with partial relief but eventually returned three years later with intolerable side effects...On oblique view skin infiltration with 1% lidocaine was performed at the needle entry site...of 0.25% Bupivacaine with epinephrine 1:200000 was injected as a test dose, there was no change in the heart rate...CONCLUSION This case underscores the potential utility of LSB in patients with erythromelalgia who have failed or cannot tolerate pharmacologic therapies. While evidence remains limited, existing literature supports sympathetic blocks as a therapeutic option in select cases of both primary and secondary erythromelalgia, including those associated with autoimmune disease."

Dermatology • Fibromyalgia • Immunology • Inflammatory Arthritis • Lupus • Musculoskeletal Pain • Rheumatology • Systemic Lupus Erythematosus

Long-Term Outcomes and Post-Ablation Medication De-Escalation After Catheter Ablation for Premature Ventricular Complexes: A Nationwide Cohort Study. (PubMed, Int J Gen Med) - "Medication analysis confirmed dose de-escalation, particularly for mexiletine, propafenone, and amiodarone. Radiofrequency catheter ablation was associated with meaningful reductions in antiarrhythmic medication use, underscoring its potential therapeutic and economic benefits. These findings support radiofrequency catheter ablation as a component of long-term management strategies, while future prospective studies are needed to refine candidate selection and timing of intervention."

Journal • Cardiovascular • Congestive Heart Failure • Heart Failure

Long term safety and efficacy of lamotrigine in patients with non-dystrophic myotonia, a single-centre prospective study. (PubMed, Neuromuscul Disord) - "In most cases, lamotrigine was chosen due to prior side effects with mexiletine or cardiac contraindications to mexiletine and proved to be an effective alternative. This study provides real-world evidence supporting the long-term use of lamotrigine and the integration of lamotrigine into personalised treatment strategies for non-dystrophic myotonias."

Journal • Fatigue • Myotonic Dystrophy • Pain

Genetic and Clinical Insights into Inherited Erythromelalgia: A Comprehensive Review of Cases from China and Worldwide. (PubMed, J Invest Dermatol) - "Sex and age distributions among patients with IEM show a predominance of cases with clinical onset before the age of 10 years, whereas sex differences are not pronounced. Some patients with specific pathogenic variants respond to pharmacotherapy, such as p.L858F/H (mexiletine) and V400M, S241T, and I234T (carbamazepine), suggesting potential for personalized therapeutic approaches."

Journal • Review

Reductant-Controlled Access to Sulfinamides from Aliphatic Primary Amines. (PubMed, Org Lett) - "The reductant-controlled generation of primary or secondary alkyl radicals from pyridinium salts enables selective access to distinct sulfinamides with broad functional group compatibility. This operationally simple and scalable method is amenable to late-stage functionalization of various amine-containing drugs, exemplified by formal SO insertion into the C-N bond of mexiletine to deliver its sulfinamide analogue."

Journal

Lidocaine attenuation and treadmill exercise tests in the prediction of efficacy of mexiletine in patients with long QT syndromes (AHA 2025) - "LAT and TET are valuable tests for predicting mexiletine efficacy and subtype differentiation in patients with LQTS. Maximum QTc shortening ≥45 ms post-LAT (or ≥32 ms at 45 min) and QTc dynamics during TET optimize treatment of mexiletine, particularly for LQT2/LQT3. These findings advocate for subtypes-driven diagnostic protocols to enhance precised LQTS management."

Clinical • Cardiovascular

Sustained Ventricular Tachycardia secondary to Metastatic Sarcoma complicated by Propranolol-Induced Right Ventricular Heart Failure (AHA 2025) - "Dobutamine was discontinued and the patient was transferred out of the cardiac intensive care unit on oral amiodarone and mexiletine.DiscussionIn our case, metastatic sarcoma involving the right ventricle triggered sustained ventricular tachycardia. Amiodarone, lidocaine, and procainamide were used with improvement in ventricular rate. Propranolol was added due to its superior efficacy compared to other beta-blockers in pharmacologic cardioversion of VT storm.1 Although it successfully terminated sustained ventricular tachycardia, propranolol precipitated right ventricular failure in the context of sarcoma-induced right ventricular dysfunction, necessitating hemodynamic support with inotrope therapy."

Metastases • Cardiovascular • Congestive Heart Failure • Heart Failure • Metabolic Disorders • Pulmonary Disease • Sarcoma • Solid Tumor • Squamous Cell Carcinoma • Ventricular Tachycardia

Longitudinal Evaluation of Anti-Arrhythmic Drug Use to Predict Hospitalization or Death in Patients with Ventricular Tachycardia (AHA 2025) - "From then, use of AADs (beta-blockers, sotalol, amiodarone, dofetilide, mexiletine) in the three years following were assessed on a quarterly basis. Linking AAD use with clinical outcomes is an important first step in identifying which patient profiles respond to which individual AADs and developing tailored VT treatment approaches. Here, we demonstrate profiles of VT patients at higher risk for hospitalization or death based on individual AADs."

Clinical • Atrial Fibrillation • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Diabetes • Heart Failure • Metabolic Disorders • Ventricular Tachycardia

Development of a High-Throughput Drug Screening Platform to Identify Novel Therapeutics for Long QT Syndrome (AHA 2025) - "The high-throughput KIC screen confirmed mexiletine's APD shortening effects in SCN5A-P1332L iPSC-CMs, validating the assay's potential for efficient, large-scale drug screening. In a pilot screen, we identified 6 novel LQTS drug candidates which shortened the APD90 in SCN5A-P1332L (LQT3) and KCNH2-G604S (LQT2) iPSC-CMs more than mexiletine. The lead compound's APD shortening effects in KCNH2-G604S iPSC-CMs were confirmed with whole cell patch clamp."

Cardiovascular • KCNH2 • KCNQ1OT1

Impact of Antiarrhythmic Use on Primary Graft Dysfunction in Orthotopic Heart Transplant Patients: A Single Center Retrospective Cohort Study (AHA 2025) - "Anti-arrhythmic medications such as amiodarone have been noted to increase the risk of PGD and thus normally discontinued when patients reach a UNOS level 1-3 status...Out of the patients who had OHT and antiarrhythmics up till the day of transplant; 11 were on mexiletine; 9 were on sotalol; 7 were on digoxin; 2 were on dofetilide; and 1 on quinidine, lidocaine, and disopyramide respectively... Patients on sotalol had 5.49 times more odds off having PGD post-transplant and this was statistically significant regardless of age, gender and race."

Retrospective data • Cardiovascular • Congestive Heart Failure • Heart Failure • Transplantation

LETTING NTM PULL ON YOUR QTC STRINGS (CHEST 2025) - "She was ultimately transitioned to oral consolidation therapy via PO Clofazimine and Bedaquiline due to intolerability of Omadacycline (nausea/vomiting), Amikacin (epistaxis), and Linezolid (neuropathy)...Subsequently, she was again trialed on Azithromycin, Ethambutol, and Rifampin, with her QTc remaining acceptable... From this case, we can conclude that, in appropriate patient populations, it is reasonable to utilize Mexiletine (or other late sodium current blockers) to shorten the QT interval in patients who require MAC pharmacotherapy with QTc-prolonging agents."

Cardiovascular • Infectious Disease • Nontuberculous Mycobacterial Disease • Pulmonary Disease • Respiratory Diseases

VENTRICULAR TACHYCARDIA SECONDARY TO SCLERODERMA-RELATED MYOCARDIAL SCARRING (CHEST 2025) - "In the interim, an epicardial ablation was performed but the patient still presented with recurrent VT despite also being on amiodarone, metoprolol, and mexiletine...He had an ICD placed for his recurrent VT and was treated with Mycophenolate Mofetil... Cardiac involvement in systemic sclerosis is associated with a poor prognosis. Several studies have revealed that a significant amount of mortality in systemic sclerosis was related to the presence of a cardiac disease. In fact, it is the third leading cause of death in systemic sclerosis after ILD and pulmonary arterial hypertension."

Cardiovascular • Congestive Heart Failure • Fibrosis • Gastrointestinal Disorder • Heart Failure • Immunology • Infectious Disease • Inflammation • Interstitial Lung Disease • Pneumonia • Pulmonary Arterial Hypertension • Pulmonary Disease • Respiratory Diseases • Rheumatology • Sarcoidosis • Scleroderma • Systemic Sclerosis • Ventricular Tachycardia

Implantable Cardioverter Defibrillators for Long QT syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia? (Not so fast, Louis). (PubMed, Europace) - "As to LQTS and CPVT, the current data strongly indicate that when high risk patients are treated with either combination drug therapy comprising beta blockers and mexiletine (LQTS) or beta blockers and flecainide (CPVT) or triple therapy with left cardiac sympathetic denervation as the treatment intensifier, mortality is close to zero and most patients have no life-threatening events. Their request should be listened to, respected, and considered with empathy because immortality cannot be guaranteed. We believe that both expertise and compassion are quintessential to practicing the science and art of medicine."

Journal • Cardiovascular • Ventricular Tachycardia

A Systematic Review of Management of Cramping Pain in Patients with Amyotrophic Lateral Sclerosis. (PubMed, Eur Neurol) - "The review demonstrates the scarcity of high-quality research on cramping pain management in ALS. Mexiletine emerged as the most promising pharmacological intervention, providing notable relief, while supervised exercise therapy demonstrated beneficial effects."

Journal • Review • Amyotrophic Lateral Sclerosis • CNS Disorders • Pain

A loop in time – Atypical syncope harkens Aborted VF arrest in Andersen Tawil syndrome (AAP-NCE 2025) - "Nadolol and flecainide were implemented...She underwent transvenous dual chamber ICD implantation and a switch to sotalol and mexiletine therapy... CONCLUSION – ATS should be suspected when encountering frequent polymorphic and non-sustained PVC/VT with dysmorphic features. Syncope though common finding is often unrelated to arrhythmia (orthostatic syncope or periodic paralysis). Rhythm surveillance may help identify those rare patients who will benefit from implantable device therapy."

Cardiovascular • Ventricular Tachycardia

Advanced Cardiotoxicity Profiling Using Field Potential Imaging with UHD-CMOS-MEA in Human iPSC-Derived Cardiomyocytes. (PubMed, Toxicol Sci) - "Pharmacological testing revealed compound-specific alterations: Isoproterenol increased excitation origins, mexiletine reduced conduction velocity, and E-4031 diminished propagation area. Furthermore, chronic cardiotoxicity induced by low-dose doxorubicin (0.03 μM) was sensitively detected within 24 hours-earlier and at lower concentrations than previously reported-based on significant reductions in conduction velocity and propagation area. Collectively, these findings establish a high-resolution, mechanism-aware framework for in vitro cardiotoxicity profiling, offering improved predictive accuracy by capturing multi-ion channel interactions, spatial conduction abnormalities, and early signs of chronic dysfunction."

Journal • Cardiovascular

Mexiletine as Adjunctive Therapy in Atrial Fibrillation Following Dofetilide Treatment Failure. (PubMed, Circ Arrhythm Electrophysiol) - No abstract available

Journal • Atrial Fibrillation • Cardiovascular

Familial Primary Erythromelalgia: Diagnostic and Therapeutic Challenges (EADV 2025) - "Treatment with gabapentin, SSRIs, and aspirin led to slight improvement...Reported options include beta- blockers, tricyclic antidepressants, gabapentin, calcium channel blockers, opioids, lidocaine, mexiletine, and novel NaV1.7 blockers (e.g., funapide, vixotrigine)... Familial primary erythromelalgia is a rare and debilitating condition with limited effective treatments. A multidisciplinary and individualized approach is vital. Psychological support is crucial to improve quality of life and treatment adherence."

Dermatology • Hematological Disorders • Myeloproliferative Neoplasm • Psychiatry • Thrombocytosis • NAV1

Prospective, Long Term, Observational Study (Patient Registry) of Paediatric Myotonic Disorders (clinicaltrials.gov) - P=N/A | N=10 | Recruiting | Sponsor: Lupin Ltd.

New trial • Pediatrics