Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Article Comments (1)

Should Multaq Be Used To Treat AF? This Physician Answers With A Resounding “No”

What should I have told the doctor who recently asked me about dronedarone (Multaq)?

“Supposedly, it’s [Multaq] just like Amiodarone, but without the side effects?” he asked.

Gosh…Should I, or shouldn’t I?

I took a big cleansing breath, reminding myself to stay civil, as at least Sanofi-Aventis, the makers of Multaq, sponsor a cycling team. Then I gave him my long answer:

I started with the fact that Multaq barely made it through the approval process. One of the original studies with Multaq (ANDROMEDA), a randomized trial of Multaq in patients with severe heart failure, showed that patients who took the drug were twice as likely to die.

Multaq eventually won approval for use in patients without significant heart failure and mild forms of AF, based on the results of the ATHENA trial—which randomized 4628 patients with non-permanent AF to either standard therapy or standard therapy plus Multaq. The ATHENA investigators didn’t exactly say that Multaq works, rather they claimed that it reduced a composite of hospitalizations and death.

This started the marketing machine in motion, the likes of which I have not ever witnessed. Paid experts, “thought leaders,” as they are called, touted Multaq in endless venues—at special CME events, on the internet, at national meetings and of course, during evening dinners. There were posters, TV and magazine ads, lunches, breakfasts, key chains, and tee shirts, but not logo’d pens.

When doctors started using Multaq to treat AF they found that the drug did not suppress AF-episodes. Now, to be fair, no AF drug works much more than 50% of the time, but Multaq almost never works. Since it was approved, I have yet to see a single patient in which Multaq suppressed AF for more than 6 months.

Not only does Multaq not work in AF-suppression, the drug also causes significant side effects. More than a small number of patients report intolerable GI adverse effects—diarrhea and nausea are the most common. Additionally, the drug may cause excessive lowering of heart rate, and insomnia, both of which contribute to an AF patient’s chief complaint, fatigue.

Thus far, we could summarize Multaq as an expensive, aggressively marketed AF drug which doesn’t work and often makes people feel ill, though less frequently hospitalized.

“At least it was safe,” said the company.


A recent report suggested that Multaq may be associated with unpredictable and abrupt-onset liver failure. This was distressing enough, but yesterday, Sanofi announced that it was terminating its latest study, called the PALLUS trial–an investigation into whether Multaq would work as a rate-control drug in patients with permanent AF. The trial was stopped prematurely because of an increased rate of cardiovascular events in patients who took Multaq. Taken together, and along with the original ANDROMEDA trial, these reports suggest that Multaq isn’t a very safe drug.


That was a long discussion for a doctor’s lounge question.

I could have just said, “I cannot recommend Multaq to my patients with AF.”


P.S. My colleague, Dr Wes Fisher has this outstanding, much more detailed and very professional summary of the Multaq debacle.

Here is a list of my previous posts on Multaq.

*This blog post was originally published at Dr John M*

You may also like these posts

    None Found

Read comments »

One Response to “Should Multaq Be Used To Treat AF? This Physician Answers With A Resounding “No””

  1. Aaron Emmel, PharmD, BCNSP says:

    Nice post. I saw the barrage of propaganda touting this as the “safer” amiodarone as well. Problem is, as you pointed out, not only does it not work very well but it doesn’t appear to be too safe. Bad in heart failure, reports of liver failure, more QT prolongation, now reports of kidney injury…

Return to article »

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »

Commented - Most Popular Articles