Dofetilide is available only to hospitals and prescribers who have received appropriate dosing and treatment initiation education. To minimize the risk of an induced arrhythmia, patients initiated or re-initiated on dofetilide should be admitted for a minimum of 3 days to a facility that can calculate creatinine clearance, provide continuous electrocardiographic monitoring and cardiac resuscitation.

Pharmacists should become familiar with dofetilide by reviewing the attached drug information, educational slide presentation and package insert prior to any dispensing and patient counseling. (Located in the I Drive )

Initiation of dofetilide in the hospital:

1. Prior to prescribing dofetilide the physician must:

• Screen concomitant medications
• Calculate CrCl (ABW)
• Obtain a baseline QTc.

2. The pharmacist will document the above information has been collected and recorded before dispensing on a DocForm.

3. The pharmacist will verify via telephone or Internet that the physician is an authorized prescriber. You must have the MGH Pharmacy's DEA # (AT9729433) and the prescribing physician's DEA number.

• www.tikosynlist.com
• Call Center: 1-800-788-7353

4. Once verified, the pharmacist can dispense dofetilide with a Patient Information sheet. The pharmacist will provide patient counseling.

5. Patient education forms can be found on the pharmacy's home drive (I-drive) or in the dofetilide binder located in the triage area.

6. A perpetual list of authorized prescribers will be maintained on the pharmacy's home drive (I-drive).

Under no circumstances is dofetilide to be dispensed without verifying that the prescribing physician has received the necessary dofetilide education and has registered with the company.

Patients who are admitted for reasons other than cardiac problems and are on dofetilide therapy will need to have the following:

• Baseline QTc, SCr, CrCl, K⁺, Mg⁺⁺⁺
• Daily: QTc, SCr, CrCl, K⁺, Mg⁺⁺
• EP Consult

• Dofetilide is located in the central distribution area, and is supplied as both unit dose tablets, as well as bottles containing a 7-day supply (14 capsules)
• Once the decentralized pharmacist has approved an order the pharmacy will dispense a 3-day supply of unit dose medication to the patient care unit.

• The decentralized pharmacist is to be paged when a patient begins dofetilide therapy.
• The decentralized pharmacist is then responsible for:
  1. Educating the patient, and documenting this on the MGH Patient Family Teaching Log located in the medical record or at the patient bedside.
  2. Verifying the dose based on CrCl (see package insert)
  3. Verify the QTc (see package insert)
  4. Screening for drug interactions (see package insert)
  5. Delivering a 7-day supply of drug directly to the patient or to the nurse for storage until discharge.

• The physician will fax a patient enrollment form to CVS ProCare Pharmacy (1-800-238-7828). Patient Enrollment Form is located on the I-Drive
• The outpatient pharmacy will not be filling these prescriptions.
• If the patient is admitted for a dose titration, it is recommended that the patient be admitted for 3 days and the above repeated.