Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Mexiletine is a class I B antiarrhythmic with electrophysiologic properties similar to lidocaine and is useful in suppression of ventricular arrhythmias.
The drug exhibits a high degree of oral bioavailability, is approximately 60% protein bound, and undergoes renal clearance at a rate of 10.3 mL/min/kg. Mexiletine has a volume of distribution of 9.5 L/kg at a half-life of 11 hours. Myocardial infarction and uremia reduce the rate of clearance and increase the half-life of mexiletine, requiring dosage adjustment guided by drug monitoring.
Mexiletine toxicity occurs at concentrations >2.0 mcg/mL (trough value) and is characterized by symptoms of nausea, hypotension, sinus bradycardia, paresthesia, seizures, intermittent left bundle branch block, and temporary asystole.
Assessing achievement of optimal therapeutic concentrations
Assessing potential toxicity
Optimal response to mexiletine occurs when the serum concentration is within the range of 0.8 to 2.0 mcg/mL (trough value).
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
No significant cautionary statements
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Therapeutic concentration: 0.8-2.0 mcg/mL (trough value)
Toxic concentration: >2.0 mcg/mL (trough value)
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Burtis CA, Ashwood ER, Bruns DE, et al: Tietz Textbook of Clinical Chemistry and Molecular Diagnosis (Fifth edition), Elsevier, St. Louis, USA, 2012
2. Joseph SP, Holt DW: Electrophysiological properties of mexiletine assessed with respect to plasma concentrations. Eur J Cardiol 1980;11:115-121