818:, thereby prolonging repolarization. Since these agents do not affect the sodium channel, conduction velocity is not decreased. The prolongation of the action potential duration and refractory period, combined with the maintenance of normal conduction velocity, prevent re-entrant arrhythmias. (The re-entrant rhythm is less likely to interact with tissue that has become refractory). The class III agents exhibit reverse-use dependence (their potency increases with slower heart rates, and therefore improves maintenance of sinus rhythm). Inhibiting potassium channels results in slowed atrial-ventricular myocyte repolarization. Class III agents have the potential to prolong the QT interval of the EKG, and may be proarrhythmic (more associated with development of polymorphic VT).
1010:
pragmatic classification that encompasses approved and potential anti-arrhythmic drugs. This will aid our understanding and clinical management of cardiac arrhythmias and facilitate future therapeutic developments. It starts by considering the range of pharmacological targets, and tracks these to their particular cellular electrophysiological effects. It retains but expands the original
Vaughan Williams classes I to IV, respectively covering actions on Na+ current components, autonomic signalling, K channel subspecies, and molecular targets related to Ca homeostasis. It now introduces new classes incorporating additional targets, including:
69:
740:
728:
716:
807:
1002:
2870:
2891:
992:
It presents the drugs on two axes, instead of one, and is presented in tabular form. On the Y axis, each drug is listed, in roughly the Singh-Vaughan
Williams order. On the X axis, the channels, receptors, pumps, and clinical effects are listed for each drug, with the results listed in a grid. It is,
1009:
A recent publication (2018) has now emerged with a fully modernised drug classification. This preserves the simplicity of the original
Vaughan Williams framework while capturing subsequent discoveries of sarcolemmal, sarcoplasmic reticular and cytosolic biomolecules. The result is an expanded but
85:
The cardiac myocyte has two general types of action potentials: conduction system and working myocardium. The action potential is divided into 5 phases and shown in the diagram. The sharp rise in voltage ("0") corresponds to the influx of sodium ions, whereas the two decays ("1" and "3",
969:. This was not a defining characteristic in an earlier review by Charlier et al. (1968), but was supported by experimental data presented by Vaughan Williams (1970). The figure illustrating these findings was also published in the same year by Singh and Vaughan Williams.
690:
Class I agents are called membrane-stabilizing agents, "stabilizing" referring to the decrease of excitogenicity of the plasma membrane which is brought about by these agents. (Also noteworthy is that a few class II agents like propranolol also have a
1718:"The 'Sicilian Gambit'. A new approach to the classification of antiarrhythmic drugs based on their actions on arrhythmogenic mechanisms. The Task Force of the Working Group on Arrhythmias of the European Society of Cardiology".
1341:
Milne JR, Hellestrand KJ, Bexton RS, Burnett PJ, Debbas NM, Camm AJ (February 1984). "Class 1 antiarrhythmic drugs â characteristic electrocardiographic differences when assessed by atrial and ventricular pacing".
872:. They thus reduce the contractility of the heart, so may be inappropriate in heart failure. However, in contrast to beta blockers, they allow the body to retain adrenergic control of heart rate and contractility.
1027:
It also allows for multiple drug targets/actions and adverse pro-arrhythmic effects. The new scheme will additionally aid development of novel drugs under development and is illustrated here.
908:
decreases conduction of electrical impulses through the AV node and increases vagal activity via its action on the central nervous system. Via indirect action, it leads to an increase in
891:
Since the development of the original
Vaughan Williams classification system, additional agents have been used that do not fit cleanly into categories I through IV. Such agents include:
86:
respectively) correspond to the sodium-channel inactivation and the repolarizing efflux of potassium ions. The characteristic plateau ("2") results from the opening of voltage-sensitive
183:
With regard to management of atrial fibrillation, classes I and III are used in rhythm control as medical cardioversion agents, while classes II and IV are used as rate-control agents.
771:, thereby decreasing sympathetic activity on the heart, which reduces intracellular cAMP levels and hence reduces Ca influx. These agents are particularly useful in the treatment of
1193:"Drug-disease interactions: reduced beta-adrenergic and potassium channel antagonist activities of sotalol in the presence of acute and chronic inflammatory conditions in the rat"
1521:
Hoshino K, Ogawa K, Hishitani T, Isobe T, Eto Y (October 2004). "Optimal administration dosage of magnesium sulfate for torsades de pointes in children with long QT syndrome".
60:
Many attempts have been made to classify antiarrhythmic agents. Many of the antiarrhythmic agents have multiple modes of action, which makes any classification imprecise.
976:(DPH): mechanism of action unknown, but others had attributed its cardiac action to an indirect action on the brain; this drug is better known as antiepileptic drug
1564:
Hoshino K, Ogawa K, Hishitani T, Isobe T, Etoh Y (April 2006). "Successful uses of magnesium sulfate for torsades de pointes in children with long QT syndrome".
90:. Each phase utilizes different channels and it is useful to compare these phases to the most common classification system â Vaughan Williams â described below.
2822:
1902:
1607:
Charlier, R; Deltour, G; Baudine, A; Chaillet, F (November 1968). "Pharmacology of amiodarone, and anti-anginal drug with a new biological profile".
1870:
943:
was a key example. Differing from other authors, Vaughan-Williams describe the main action as a slowing of the rising phase of the action potential.
931:
The initial classification system had 4 classes, although their definitions different from the modern classification. Those proposed in 1970 were:
2928:
2879:
1892:
2673:
2633:
389:
314:
Class Ib drugs shorten the action potential of myocardial cell and has a weak effect on the initiation of phase 0 of depolarization
602:
369:
Class Ic drugs do not affect action potential duration and have the strongest effect on the initiation phase 0 of depolarization
393:
3504:
2246:
1817:
1386:
1175:
698:
Class I agents are divided into three groups (Ia, Ib, and Ic) based upon their effect on the length of the action potential.
3379:
2533:
2526:
1042:
2921:
3553:
2276:
2139:
1900:
1251:
1082:
858:
3521:
1445:
Conti JB, Belardinelli L, Utterback DB, Curtis AB (March 1995). "Endogenous adenosine is an antiarrhythmic agent".
2429:
1885:
961:
Compounds that prolong the action potential: matching the modern classification, with the key drug example being
638:
17:
3548:
2914:
1036:
565:
273:
683:. Class I agents are grouped by what effect they have on the Na channel, and what effect they have on cardiac
117:, contributed to the development of the classification system. The system is therefore sometimes known as the
246:
Class Ia drugs prolong the action potential and has an intermediate effect on the 0 phase of depolarization.
3282:
3228:
3145:
3087:
3034:
2979:
2975:
2128:
1910:
899:
772:
654:
50:
3422:
2739:
989:
Another approach, known as the "Sicilian gambit", placed a greater approach on the underlying mechanism.
692:
1286:"protocol for management of haemodynamically stable ventricular tachycardia â General Practice Notebook"
2389:
1878:
947:
543:
Prevent paroxysmal atrial fibrillation and haemodynamically stable ventricular tachycardia (amiodarone)
142:
912:
production, stimulating M2 receptors on AV node leading to an overall decrease in speed of conduction.
3149:
815:
764:
522:
1745:
Vaughan
Williams EM (November 1992). "Classifying antiarrhythmic actions: by facts or speculation".
869:
80:
73:
3509:
3260:
3232:
2444:
2122:
1973:
1023:
Class VII: molecules underlying longer term signalling processes affecting structural remodeling.
861:
594:
554:
54:
2964:
2481:
2236:
680:
103:
1241:
3390:
3347:
2166:
2102:
1947:
1355:
1005:
Common anti-arrhythmic drugs under the modernized classification according to Lei et al. 2018
739:
727:
715:
462:
325:
1285:
2241:
2221:
1267:
124:
The five main classes in the
Vaughan Williams classification of antiarrhythmic agents are:
993:
therefore, not a true classification in that it does not aggregate drugs into categories.
8:
3268:
3044:
2850:
2586:
2372:
2151:
1978:
1683:
Damato, Anthony N. (1 July 1969). "Diphenylhydantoin: Pharmacological and clinical use".
1053:
919:
662:
612:
558:
379:
256:
46:
3408:
2884:
2749:
2608:
2062:
1770:
1758:
1660:
1651:
1635:
1589:
1546:
1427:
1217:
1192:
1147:
1851:
1834:
1381:. New York: Lange Medical Books/McGraw-Hill, Medical Publishing Division. p. 43.
2890:
2845:
2628:
2618:
2521:
2351:
2307:
2291:
2095:
2085:
2028:
2018:
1856:
1813:
1762:
1727:
1700:
1696:
1665:
1616:
1581:
1577:
1538:
1503:
1462:
1419:
1382:
1359:
1318:
1247:
1222:
1171:
1139:
1078:
1048:
973:
958:. This is similar to the modern classification, which focuses on the latter category.
915:
1774:
1593:
1550:
1431:
1151:
2998:
2855:
2678:
2603:
2591:
2516:
2382:
2261:
2050:
1846:
1754:
1692:
1655:
1647:
1573:
1534:
1530:
1493:
1454:
1411:
1402:
Lenz, TL; Hilleman, DE (2000). "Dofetilide, a New Class III Antiarrhythmic Agent".
1351:
1212:
1204:
1129:
918:
is an antiarrhythmic drug, but only used against very specific arrhythmias such as
684:
608:
110:
2322:
1833:
Lei, Ming; Wu, Lin; Terrar, Derek A.; Huang, Christopher L.-H. (23 October 2018).
3468:
3459:
2950:
2895:
2840:
2709:
2704:
2543:
2476:
2471:
2357:
2303:
2144:
2035:
1988:
996:
114:
87:
2941:
1415:
1118:"A Salute to Our Founding Editor-in-Chief Bramah N. Singh, MD, DPhil, DSc, FRCP"
3515:
3364:
2906:
2874:
2774:
2769:
2623:
2613:
2563:
2548:
2538:
2439:
2434:
2424:
2362:
2334:
2286:
2281:
2013:
1968:
1964:
1788:
1482:"Magnesium: an antiarrhythmic drug, but only against very specific arrhythmias"
1310:
1073:
Rang, Humphrey P.; Ritter, James M.; Flower, Rod J.; Henderson, Graeme (2012).
547:
241:
244:
block (intermediate association/dissociation) and K+ channel blocking effect.
3542:
2806:
2779:
2638:
2456:
2367:
2347:
2343:
2206:
2134:
2023:
1938:
1458:
1134:
1117:
1106:(Eds. Sandoe E; Flensted-Jensen E; Olsen KH). Astra, Elsinore. Denmark (1970)
966:
909:
806:
760:
756:
146:
3399:
3286:
3013:
2993:
2764:
2683:
2419:
2377:
2211:
2201:
2117:
2112:
1860:
1585:
1542:
1507:
1498:
1481:
1423:
1322:
1226:
1208:
1143:
955:
530:
452:
224:
219:
68:
1766:
1731:
1704:
1669:
1620:
1466:
1363:
1001:
708:
Class Ic drugs do not significantly affect the action potential (no shift)
3369:
3305:
3213:
3183:
3126:
3111:
2648:
2558:
2298:
2251:
2196:
2079:
2045:
1268:"treatment of paroxysmal atrial fibrillation â General Practice Notebook"
1102:
Vaughan
Williams, EM (1970) "Classification of antiarrhythmic drugs". In
846:
842:
791:
515:
495:
468:
440:
385:
360:
260:
42:
3430:
3335:
3315:
3198:
3178:
3173:
3158:
3121:
3116:
3106:
3101:
3069:
3008:
2826:
2797:
2755:
2724:
2719:
2658:
2653:
2643:
2581:
2567:
2507:
2462:
2410:
2330:
2326:
2267:
2227:
2182:
2178:
2068:
2004:
1954:
1919:
1915:
962:
838:
826:
795:
534:
490:
485:
430:
420:
415:
355:
350:
321:
295:
267:
1636:"The effect of amiodarone, a new anti-anginal drug, on cardiac muscle"
3476:
3445:
3440:
3435:
3404:
3359:
3330:
3246:
3241:
3208:
3193:
3168:
3163:
3096:
3074:
3064:
3050:
3023:
3018:
3003:
2734:
2714:
2688:
2663:
2598:
2576:
2404:
2317:
2191:
1376:
977:
951:
940:
936:
895:
880:
876:
830:
822:
628:
587:
582:
505:
435:
345:
305:
300:
290:
234:
229:
156:
3394:
3320:
3300:
2988:
2835:
2699:
2695:
2668:
2107:
2040:
1959:
783:
410:
329:
214:
1190:
3486:
3481:
3412:
3325:
3295:
3263:
3203:
3058:
2811:
2729:
2394:
2161:
1983:
1933:
905:
865:
834:
787:
776:
633:
537:
has mostly Class III activity, but also I, II, & IV activity
526:
510:
445:
425:
170:
166:
1444:
3188:
2493:
2156:
500:
132:
1606:
1191:
Kulmatycki KM, Abouchehade K, Sattari S, Jamali F (May 2001).
997:
Modernized Oxford classification by Lei, Huang, Wu, and Terrar
2793:
2503:
1998:
1340:
328:, though this is now discouraged given the increased risk of
2958:
2497:
1835:"Modernized Classification of Cardiac Antiarrhythmic Drugs"
38:
1563:
1520:
1020:
Class VI: connexins controlling electrotonic cell coupling
702:
Class Ia drugs lengthen the action potential (right shift)
456:
Propranolol also has some sodium channel-blocking effect.
1789:"Milestones in the Evolution of the Study of Arrhythmias"
1072:
705:
Class Ib drugs shorten the action potential (left shift)
1122:
946:
Sympatholytic drugs (drugs blocking the effects of the
935:
Drugs with a direct membrane action: the prototype was
810:
Effect of class III drugs on length of action potential
375:
Contraindicated immediately after myocardial infarction
1903:
1633:
657:, especially in heart failure and atrial fibrillation
1807:
1744:
41:
that are used to suppress abnormally fast rhythms (
367:Na channel block (slow association/dissociation).
312:Na channel block (fast association/dissociation).
93:
1801:
1370:
984:
3540:
2936:
1832:
1377:Trevor, Anthony J.; Katzung, Bertram G. (2003).
1634:Singh, BN; Vaughan Williams, EM (August 1970).
1317:, Treasure Island (FL): StatPearls Publishing,
1308:
1014:Class 0: ion channels involved in automaticity
3467:
2922:
1886:
1239:
1164:Unless else specified in boxes, then ref is:
868:, and shorten phase two (the plateau) of the
109:Vaughan Williams was a pharmacology tutor at
1901:Major chemical drug groups â based upon the
1557:
1514:
1473:
1401:
1309:Singh, Shashank; McKintosh, Rebecca (2023),
1243:Medical Pharmacology and Therapeutics E-Book
1017:Class V: mechanically sensitive ion channels
1738:
1711:
1438:
1334:
1184:
1165:
179:agents work by other or unknown mechanisms.
2929:
2915:
1893:
1879:
650:Contraindicated in ventricular arrhythmias
1850:
1812:. Oxford: Blackwell Science. p. 49.
1659:
1497:
1479:
1246:. Elsevier Health Sciences. p. 144.
1216:
1158:
1133:
1356:10.1093/oxfordjournals.eurheartj.a061633
1240:Waller, Derek G.; Sampson, Tony (2013).
1000:
956:adrenergic beta-receptors blocking drugs
805:
67:
1810:Antiarrhythmic drugs: a practical guide
1077:(7th ed.). Elsevier. p. 255.
864:. They decrease conduction through the
775:. They decrease conduction through the
603:paroxysmal supraventricular tachycardia
14:
3541:
2880:Pharmacological classification systems
2247:Selective estrogen receptor modulators
1682:
1115:
1098:
1096:
1094:
898:is used intravenously for terminating
759:. They act by blocking the effects of
145:agents. Most agents in this class are
3140:
2910:
2527:Non-steroidal anti-inflammatory drugs
1874:
886:
119:Singh-Vaughan Williams classification
3277:
3223:
1170:. Edinburgh: Churchill Livingstone.
1043:Cardiac Arrhythmia Suppression Trial
645:Work by other or unknown mechanisms
461:Decrease mortality in patients with
2959:
2140:Angiotensin II receptor antagonists
1685:Progress in Cardiovascular Diseases
1091:
801:
660:Magnesium sulfate is used to treat
550:and atrial fibrillation (ibutilide)
63:
24:
1759:10.1002/j.1552-4604.1992.tb03797.x
1652:10.1111/j.1476-5381.1970.tb09891.x
852:
750:
679:The class I antiarrhythmic agents
25:
3565:
1852:10.1161/CIRCULATIONAHA.118.035455
755:Class II agents are conventional
681:interfere with the sodium channel
674:
2889:
2869:
2868:
1578:10.1111/j.1442-200X.2006.02177.x
1104:Symposium on Cardiac Arrhythmias
738:
726:
714:
2277:Hypothalamicâpituitary hormones
1826:
1781:
1726:(10): 1112â1131. October 1991.
1676:
1640:British Journal of Pharmacology
1627:
1600:
1395:
965:, and a surgical example being
814:Class III agents predominantly
113:, Oxford. One of his students,
100:Vaughan Williams classification
94:Vaughan Williams classification
35:cardiac dysrhythmia medications
1535:10.1080/07315724.2004.10719388
1302:
1278:
1260:
1233:
1109:
1066:
985:Sicilian gambit classification
566:Wolff-Parkinson-White syndrome
394:WolffâParkinsonâWhite syndrome
320:Treat and prevent ventricular
274:Wolff-Parkinson-White syndrome
13:
1:
2029:Thrombolytics / fibrinolytics
1059:
900:supraventricular tachycardias
773:supraventricular tachycardias
655:supraventricular tachycardias
324:during and immediately after
255:Prevent paroxysmal recurrent
209:Fast sodium channel blockers
2740:Wakefulness-promoting agents
1808:Fogoros, Richard N. (1997).
1697:10.1016/0033-0620(69)90032-2
1075:Rang and Dale's pharmacology
816:block the potassium channels
51:supraventricular tachycardia
7:
1416:10.1592/phco.20.9.776.35208
1030:
693:membrane stabilizing effect
653:Adenosine is used to treat
480:Potassium channel blockers
10:
3570:
2390:Intravenous immunoglobulin
948:sympathetic nervous system
926:
821:Class III agents include:
143:sympathetic nervous system
131:agents interfere with the
102:was introduced in 1970 by
78:
3554:Cardiac electrophysiology
3499:
3458:
3421:
3378:
3346:
3276:
3259:
3222:
3139:
3085:
3032:
2973:
2949:
2864:
2820:
2792:
2748:
2557:
2492:
2455:
2403:
2316:
2260:
2220:
2177:
2061:
1997:
1909:
857:Class IV agents are slow
577:Calcium channel blockers
388:associated with abnormal
2445:Topoisomerase inhibitors
2129:reninâangiotensin system
2123:Calcium channel blockers
1459:10.1161/01.cir.91.6.1761
1135:10.1177/1074248409343182
875:Class IV agents include
870:cardiac action potential
862:calcium channel blockers
782:Class II agents include
81:Cardiac action potential
74:cardiac action potential
1480:Brugada P (July 2000).
555:ventricular tachycardia
55:ventricular tachycardia
27:Heart rhythm medication
2237:Hormonal contraception
2167:Bile acid sequestrants
1948:Proton-pump inhibitors
1911:gastrointestinal tract
1609:Arzneimittel-Forschung
1499:10.1053/euhj.2000.2142
1209:10.1038/sj.bjp.0704067
1006:
811:
601:Prevent recurrence of
467:Prevent recurrence of
104:Miles Vaughan Williams
76:
3549:Antiarrhythmic agents
3391:muscarinic antagonist
2938:Antiarrhythmic agents
1037:Antiarrhythmic agents
1004:
950:): examples included
809:
769:-adrenergic receptors
666:, a type of arrhytmia
463:myocardial infarction
326:myocardial infarction
71:
31:Antiarrhythmic agents
2846:Radiopharmaceuticals
2634:Antiparkinson agents
1290:www.gpnotebook.co.uk
1272:www.gpnotebook.co.uk
1166:Rang, H. P. (2003).
252:Increase QT interval
72:Drugs affecting the
3233:Ca channel blockers
2965:Na channel blockers
2629:Antimigraine agents
2619:Antidementia agents
2522:Anti-inflammatories
2212:Medicated dressings
2152:Antihyperlipidemics
1979:Diabetes medication
1054:Proarrhythmic agent
920:torsades de pointes
859:non-dihydropyridine
663:torsades de pointes
613:atrial fibrillation
559:atrial fibrillation
390:conduction pathways
380:atrial fibrillation
378:Prevent paroxysmal
257:atrial fibrillation
47:atrial fibrillation
3526:Never to phase III
3409:muscarinic agonist
3150:K channel blockers
2482:Immunosuppressants
2352:Antimycobacterials
2308:Antithyroid agents
2292:Mineralocorticoids
2096:Cardiac stimulants
2086:Cardiac glycosides
2078:cardiac therapy /
1974:Anti-obesity drugs
1116:Kloner RA (2009).
1007:
972:Drugs acting like
887:Class V and others
812:
595:Ca channel blocker
266:Treat ventricular
77:
3536:
3535:
3495:
3494:
3454:
3453:
3255:
3254:
3135:
3134:
2904:
2903:
2807:Ophthalmologicals
2517:Anabolic steroids
2420:Anticancer agents
2383:Ectoparasiticides
2103:Antihypertensives
2051:Antifibrinolytics
1845:(17): 1879â1896.
1819:978-0-86542-532-3
1615:(11): 1408â1417.
1388:978-0-07-139930-2
1177:978-0-443-07145-4
1049:Electrocardiogram
974:diphenylhydantoin
916:Magnesium sulfate
685:action potentials
672:
671:
639:Magnesium sulfate
611:in patients with
523:K channel blocker
169:channels and the
37:, are a class of
16:(Redirected from
3561:
3465:
3464:
3460:Ion transporters
3274:
3273:
2971:
2970:
2956:
2955:
2951:Channel blockers
2931:
2924:
2917:
2908:
2907:
2893:
2872:
2871:
2856:Senotherapeutics
2710:Neuroprotectives
2705:Mood stabilizers
2604:Anti-ADHD agents
2544:Muscle relaxants
2477:Immunostimulants
2472:Immunomodulators
2304:Thyroid hormones
2242:Fertility agents
2145:Renin inhibitors
2036:Antihemorrhagics
2003:forming organs (
1989:Dietary minerals
1895:
1888:
1881:
1872:
1871:
1865:
1864:
1854:
1830:
1824:
1823:
1805:
1799:
1798:
1796:
1795:
1785:
1779:
1778:
1747:J Clin Pharmacol
1742:
1736:
1735:
1715:
1709:
1708:
1680:
1674:
1673:
1663:
1631:
1625:
1624:
1604:
1598:
1597:
1561:
1555:
1554:
1529:(5): 497Sâ500S.
1518:
1512:
1511:
1501:
1477:
1471:
1470:
1453:(6): 1761â1767.
1442:
1436:
1435:
1399:
1393:
1392:
1374:
1368:
1367:
1338:
1332:
1331:
1330:
1329:
1306:
1300:
1299:
1297:
1296:
1282:
1276:
1275:
1264:
1258:
1257:
1237:
1231:
1230:
1220:
1197:Br. J. Pharmacol
1188:
1182:
1181:
1162:
1156:
1155:
1137:
1113:
1107:
1100:
1089:
1088:
1070:
802:Class III agents
742:
730:
718:
609:ventricular rate
384:Treat recurrent
186:
185:
141:agents are anti-
111:Hertford College
88:calcium channels
64:Action potential
33:, also known as
21:
3569:
3568:
3564:
3563:
3562:
3560:
3559:
3558:
3539:
3538:
3537:
3532:
3531:
3516:Clinical trials
3491:
3450:
3417:
3407:
3383:
3374:
3365:Benzodiazepines
3351:
3342:
3311:cardioselective
3280:
3266:
3251:
3226:
3218:
3143:
3131:
3081:
3028:
2962:
2945:
2935:
2905:
2900:
2896:Medicine portal
2860:
2816:
2788:
2783:
2775:Cough medicines
2770:Bronchodilators
2751:
2744:
2624:Antidepressants
2614:Anticonvulsants
2562:
2553:
2549:Bisphosphonates
2539:Corticosteroids
2501:
2488:
2460:
2451:
2435:Spindle poisons
2425:Antimetabolites
2408:
2399:
2321:
2312:
2287:Glucocorticoids
2282:Corticosteroids
2263:
2256:
2223:
2216:
2173:
2091:Antiarrhythmics
2064:
2057:
2014:Antithrombotics
2002:
1993:
1969:Antipropulsives
1965:Antidiarrhoeals
1942:
1913:
1905:
1899:
1869:
1868:
1831:
1827:
1820:
1806:
1802:
1793:
1791:
1787:
1786:
1782:
1753:(11): 964â977.
1743:
1739:
1717:
1716:
1712:
1681:
1677:
1632:
1628:
1605:
1601:
1562:
1558:
1519:
1515:
1478:
1474:
1443:
1439:
1404:Pharmacotherapy
1400:
1396:
1389:
1375:
1371:
1339:
1335:
1327:
1325:
1307:
1303:
1294:
1292:
1284:
1283:
1279:
1266:
1265:
1261:
1254:
1238:
1234:
1189:
1185:
1178:
1163:
1159:
1114:
1110:
1101:
1092:
1085:
1071:
1067:
1062:
1033:
999:
987:
929:
889:
855:
853:Class IV agents
804:
768:
753:
751:Class II agents
746:
743:
734:
731:
722:
719:
677:
533:
455:
115:Bramah N. Singh
96:
83:
66:
28:
23:
22:
18:Antiarrhythmics
15:
12:
11:
5:
3567:
3557:
3556:
3551:
3534:
3533:
3530:
3529:
3528:
3527:
3524:
3513:
3507:
3501:
3500:
3497:
3496:
3493:
3492:
3490:
3489:
3484:
3479:
3473:
3471:
3462:
3456:
3455:
3452:
3451:
3449:
3448:
3443:
3438:
3433:
3427:
3425:
3419:
3418:
3416:
3415:
3402:
3397:
3387:
3385:
3381:
3376:
3375:
3373:
3372:
3367:
3362:
3356:
3354:
3349:
3344:
3343:
3341:
3340:
3339:
3338:
3333:
3328:
3323:
3318:
3308:
3303:
3298:
3292:
3290:
3271:
3257:
3256:
3253:
3252:
3250:
3249:
3244:
3238:
3236:
3220:
3219:
3217:
3216:
3211:
3206:
3201:
3196:
3191:
3186:
3181:
3176:
3171:
3166:
3161:
3155:
3153:
3137:
3136:
3133:
3132:
3130:
3129:
3124:
3119:
3114:
3109:
3104:
3099:
3093:
3091:
3083:
3082:
3080:
3079:
3078:
3077:
3072:
3067:
3055:
3054:
3053:
3040:
3038:
3030:
3029:
3027:
3026:
3021:
3016:
3011:
3006:
3001:
2999:Hydroquinidine
2996:
2991:
2985:
2983:
2968:
2953:
2947:
2946:
2934:
2933:
2926:
2919:
2911:
2902:
2901:
2899:
2898:
2887:
2882:
2877:
2865:
2862:
2861:
2859:
2858:
2853:
2848:
2843:
2841:Contrast media
2838:
2832:
2830:
2818:
2817:
2815:
2814:
2809:
2803:
2801:
2794:sensory organs
2790:
2789:
2787:
2786:
2781:
2777:
2772:
2767:
2761:
2759:
2746:
2745:
2743:
2742:
2737:
2732:
2727:
2722:
2717:
2712:
2707:
2702:
2693:
2692:
2691:
2686:
2681:
2671:
2666:
2661:
2656:
2651:
2646:
2641:
2639:Antipsychotics
2636:
2631:
2626:
2621:
2616:
2611:
2609:Antiaddictives
2606:
2601:
2596:
2595:
2594:
2589:
2579:
2573:
2571:
2564:nervous system
2555:
2554:
2552:
2551:
2546:
2541:
2536:
2534:Antirheumatics
2531:
2530:
2529:
2519:
2513:
2511:
2490:
2489:
2487:
2486:
2485:
2484:
2479:
2468:
2466:
2453:
2452:
2450:
2449:
2448:
2447:
2442:
2440:Antineoplastic
2437:
2432:
2427:
2416:
2414:
2401:
2400:
2398:
2397:
2392:
2387:
2386:
2385:
2380:
2375:
2373:Antiprotozoals
2368:Antiparasitics
2365:
2360:
2355:
2348:Antibacterials
2344:Antimicrobials
2340:
2338:
2314:
2313:
2311:
2310:
2301:
2296:
2295:
2294:
2289:
2279:
2273:
2271:
2258:
2257:
2255:
2254:
2249:
2244:
2239:
2233:
2231:
2218:
2217:
2215:
2214:
2209:
2207:Antipsoriatics
2204:
2199:
2194:
2188:
2186:
2175:
2174:
2172:
2171:
2170:
2169:
2164:
2159:
2149:
2148:
2147:
2142:
2137:
2135:ACE inhibitors
2125:
2120:
2115:
2110:
2105:
2100:
2099:
2098:
2093:
2088:
2074:
2072:
2063:cardiovascular
2059:
2058:
2056:
2055:
2054:
2053:
2048:
2043:
2033:
2032:
2031:
2026:
2024:Anticoagulants
2021:
2010:
2008:
1995:
1994:
1992:
1991:
1986:
1981:
1976:
1971:
1962:
1957:
1952:
1951:
1950:
1945:
1940:
1936:
1925:
1923:
1907:
1906:
1898:
1897:
1890:
1883:
1875:
1867:
1866:
1825:
1818:
1800:
1780:
1737:
1710:
1675:
1646:(4): 657â667.
1626:
1599:
1572:(2): 112â117.
1556:
1523:J Am Coll Nutr
1513:
1472:
1437:
1410:(7): 776â786.
1394:
1387:
1369:
1333:
1301:
1277:
1259:
1252:
1232:
1203:(2): 286â294.
1183:
1176:
1157:
1128:(3): 154â156.
1108:
1090:
1083:
1064:
1063:
1061:
1058:
1057:
1056:
1051:
1046:
1040:
1032:
1029:
1025:
1024:
1021:
1018:
1015:
998:
995:
986:
983:
982:
981:
970:
959:
944:
928:
925:
924:
923:
913:
903:
888:
885:
854:
851:
803:
800:
766:
761:catecholamines
752:
749:
748:
747:
744:
737:
735:
732:
725:
723:
720:
713:
710:
709:
706:
703:
676:
675:Class I agents
673:
670:
669:
668:
667:
658:
651:
646:
643:
642:
641:
636:
631:
624:
622:
618:
617:
616:
615:
605:
597:
592:
591:
590:
585:
578:
575:
571:
570:
569:
568:
562:
551:
548:atrial flutter
544:
539:
520:
519:
518:
513:
508:
503:
498:
493:
488:
481:
478:
474:
473:
472:
471:
465:
457:
450:
449:
448:
443:
438:
433:
428:
423:
418:
413:
406:
405:Beta-blockers
403:
399:
398:
397:
396:
382:
376:
371:
365:
364:
363:
358:
353:
348:
341:
339:
335:
334:
333:
332:
316:
310:
309:
308:
303:
298:
293:
286:
284:
280:
279:
278:
277:
276:(procainamide)
270:
264:
253:
248:
239:
238:
237:
232:
227:
222:
217:
210:
207:
203:
202:
199:
196:
193:
190:
181:
180:
174:
165:agents affect
160:
155:agents affect
150:
136:
95:
92:
79:Main article:
65:
62:
26:
9:
6:
4:
3:
2:
3566:
3555:
3552:
3550:
3547:
3546:
3544:
3525:
3523:
3520:
3519:
3517:
3514:
3511:
3508:
3506:
3503:
3502:
3498:
3488:
3485:
3483:
3480:
3478:
3475:
3474:
3472:
3470:
3466:
3463:
3461:
3457:
3447:
3444:
3442:
3439:
3437:
3434:
3432:
3429:
3428:
3426:
3424:
3420:
3414:
3410:
3406:
3403:
3401:
3398:
3396:
3392:
3389:
3388:
3386:
3384:
3377:
3371:
3368:
3366:
3363:
3361:
3358:
3357:
3355:
3353:
3345:
3337:
3334:
3332:
3329:
3327:
3324:
3322:
3319:
3317:
3314:
3313:
3312:
3309:
3307:
3304:
3302:
3299:
3297:
3294:
3293:
3291:
3288:
3284:
3279:
3275:
3272:
3270:
3265:
3262:
3258:
3248:
3245:
3243:
3240:
3239:
3237:
3234:
3230:
3225:
3221:
3215:
3212:
3210:
3207:
3205:
3202:
3200:
3197:
3195:
3192:
3190:
3187:
3185:
3182:
3180:
3177:
3175:
3172:
3170:
3167:
3165:
3162:
3160:
3157:
3156:
3154:
3151:
3147:
3142:
3138:
3128:
3125:
3123:
3120:
3118:
3115:
3113:
3110:
3108:
3105:
3103:
3100:
3098:
3095:
3094:
3092:
3089:
3084:
3076:
3073:
3071:
3068:
3066:
3063:
3062:
3061:
3060:
3056:
3052:
3049:
3048:
3047:
3046:
3042:
3041:
3039:
3036:
3031:
3025:
3022:
3020:
3017:
3015:
3012:
3010:
3007:
3005:
3002:
3000:
2997:
2995:
2992:
2990:
2987:
2986:
2984:
2981:
2977:
2972:
2969:
2966:
2961:
2957:
2954:
2952:
2948:
2943:
2939:
2932:
2927:
2925:
2920:
2918:
2913:
2912:
2909:
2897:
2892:
2888:
2886:
2883:
2881:
2878:
2876:
2867:
2866:
2863:
2857:
2854:
2852:
2849:
2847:
2844:
2842:
2839:
2837:
2834:
2833:
2831:
2828:
2824:
2819:
2813:
2810:
2808:
2805:
2804:
2802:
2799:
2795:
2791:
2785:
2778:
2776:
2773:
2771:
2768:
2766:
2765:Decongestants
2763:
2762:
2760:
2757:
2753:
2747:
2741:
2738:
2736:
2733:
2731:
2728:
2726:
2723:
2721:
2718:
2716:
2713:
2711:
2708:
2706:
2703:
2701:
2697:
2694:
2690:
2687:
2685:
2684:Dissociatives
2682:
2680:
2677:
2676:
2675:
2674:Hallucinogens
2672:
2670:
2667:
2665:
2662:
2660:
2657:
2655:
2652:
2650:
2647:
2645:
2642:
2640:
2637:
2635:
2632:
2630:
2627:
2625:
2622:
2620:
2617:
2615:
2612:
2610:
2607:
2605:
2602:
2600:
2597:
2593:
2590:
2588:
2585:
2584:
2583:
2580:
2578:
2575:
2574:
2572:
2569:
2565:
2560:
2556:
2550:
2547:
2545:
2542:
2540:
2537:
2535:
2532:
2528:
2525:
2524:
2523:
2520:
2518:
2515:
2514:
2512:
2509:
2505:
2499:
2495:
2491:
2483:
2480:
2478:
2475:
2474:
2473:
2470:
2469:
2467:
2464:
2458:
2454:
2446:
2443:
2441:
2438:
2436:
2433:
2431:
2428:
2426:
2423:
2422:
2421:
2418:
2417:
2415:
2412:
2406:
2402:
2396:
2393:
2391:
2388:
2384:
2381:
2379:
2378:Anthelmintics
2376:
2374:
2371:
2370:
2369:
2366:
2364:
2361:
2359:
2356:
2353:
2349:
2345:
2342:
2341:
2339:
2336:
2332:
2328:
2324:
2319:
2315:
2309:
2305:
2302:
2300:
2297:
2293:
2290:
2288:
2285:
2284:
2283:
2280:
2278:
2275:
2274:
2272:
2269:
2265:
2259:
2253:
2250:
2248:
2245:
2243:
2240:
2238:
2235:
2234:
2232:
2229:
2225:
2222:genitourinary
2219:
2213:
2210:
2208:
2205:
2203:
2202:Antipruritics
2200:
2198:
2195:
2193:
2190:
2189:
2187:
2184:
2180:
2176:
2168:
2165:
2163:
2160:
2158:
2155:
2154:
2153:
2150:
2146:
2143:
2141:
2138:
2136:
2133:
2132:
2131:
2130:
2126:
2124:
2121:
2119:
2118:Beta blockers
2116:
2114:
2111:
2109:
2106:
2104:
2101:
2097:
2094:
2092:
2089:
2087:
2084:
2083:
2082:
2081:
2076:
2075:
2073:
2070:
2066:
2060:
2052:
2049:
2047:
2044:
2042:
2039:
2038:
2037:
2034:
2030:
2027:
2025:
2022:
2020:
2019:Antiplatelets
2017:
2016:
2015:
2012:
2011:
2009:
2006:
2000:
1996:
1990:
1987:
1985:
1982:
1980:
1977:
1975:
1972:
1970:
1966:
1963:
1961:
1958:
1956:
1953:
1949:
1946:
1944:
1937:
1935:
1932:
1931:
1930:
1927:
1926:
1924:
1921:
1917:
1912:
1908:
1904:
1896:
1891:
1889:
1884:
1882:
1877:
1876:
1873:
1862:
1858:
1853:
1848:
1844:
1840:
1836:
1829:
1821:
1815:
1811:
1804:
1790:
1784:
1776:
1772:
1768:
1764:
1760:
1756:
1752:
1748:
1741:
1733:
1729:
1725:
1721:
1714:
1706:
1702:
1698:
1694:
1690:
1686:
1679:
1671:
1667:
1662:
1657:
1653:
1649:
1645:
1641:
1637:
1630:
1622:
1618:
1614:
1610:
1603:
1595:
1591:
1587:
1583:
1579:
1575:
1571:
1567:
1560:
1552:
1548:
1544:
1540:
1536:
1532:
1528:
1524:
1517:
1509:
1505:
1500:
1495:
1491:
1487:
1483:
1476:
1468:
1464:
1460:
1456:
1452:
1448:
1441:
1433:
1429:
1425:
1421:
1417:
1413:
1409:
1405:
1398:
1390:
1384:
1380:
1373:
1365:
1361:
1357:
1353:
1350:(2): 99â107.
1349:
1345:
1337:
1324:
1320:
1316:
1312:
1305:
1291:
1287:
1281:
1273:
1269:
1263:
1255:
1253:9780702055034
1249:
1245:
1244:
1236:
1228:
1224:
1219:
1214:
1210:
1206:
1202:
1198:
1194:
1187:
1179:
1173:
1169:
1161:
1153:
1149:
1145:
1141:
1136:
1131:
1127:
1123:
1119:
1112:
1105:
1099:
1097:
1095:
1086:
1084:9780702034718
1080:
1076:
1069:
1065:
1055:
1052:
1050:
1047:
1044:
1041:
1038:
1035:
1034:
1028:
1022:
1019:
1016:
1013:
1012:
1011:
1003:
994:
990:
979:
975:
971:
968:
967:thyroidectomy
964:
960:
957:
953:
949:
945:
942:
938:
934:
933:
932:
921:
917:
914:
911:
910:acetylcholine
907:
904:
901:
897:
894:
893:
892:
884:
882:
878:
873:
871:
867:
863:
860:
850:
848:
844:
840:
836:
832:
828:
824:
819:
817:
808:
799:
797:
793:
789:
785:
780:
778:
774:
770:
762:
758:
757:beta blockers
741:
736:
729:
724:
717:
712:
711:
707:
704:
701:
700:
699:
696:
694:
688:
686:
682:
665:
664:
659:
656:
652:
649:
648:
647:
644:
640:
637:
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632:
630:
627:
626:
625:
623:
620:
619:
614:
610:
606:
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589:
586:
584:
581:
580:
579:
576:
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572:
567:
563:
560:
556:
552:
549:
545:
542:
541:
540:
538:
536:
532:
528:
524:
521:
517:
514:
512:
509:
507:
504:
502:
499:
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494:
492:
489:
487:
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483:
482:
479:
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466:
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460:
459:
458:
454:
451:
447:
444:
442:
439:
437:
434:
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429:
427:
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417:
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395:
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387:
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377:
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366:
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354:
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349:
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344:
343:
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340:
337:
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331:
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311:
307:
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302:
299:
297:
294:
292:
289:
288:
287:
285:
282:
281:
275:
271:
269:
265:
262:
259:triggered by
258:
254:
251:
250:
249:
247:
243:
240:
236:
233:
231:
228:
226:
223:
221:
218:
216:
213:
212:
211:
208:
205:
204:
201:Medical uses
200:
197:
194:
191:
188:
187:
184:
178:
175:
172:
168:
164:
161:
158:
154:
151:
148:
147:beta blockers
144:
140:
137:
135:(Na) channel.
134:
130:
127:
126:
125:
122:
120:
116:
112:
107:
105:
101:
91:
89:
82:
75:
70:
61:
58:
56:
52:
48:
44:
40:
36:
32:
19:
3469:Na/ K-ATPase
3400:Disopyramide
3370:Barbiturates
3310:
3057:
3043:
3014:Procainamide
2994:Disopyramide
2937:
2679:Psychedelics
2649:Aphrodisiacs
2323:infestations
2299:Sex hormones
2252:Sex hormones
2197:Cicatrizants
2127:
2113:Vasodilators
2090:
2080:antianginals
2077:
1929:stomach acid
1928:
1842:
1838:
1828:
1809:
1803:
1792:. Retrieved
1783:
1750:
1746:
1740:
1723:
1720:Eur. Heart J
1719:
1713:
1688:
1684:
1678:
1643:
1639:
1629:
1612:
1608:
1602:
1569:
1565:
1559:
1526:
1522:
1516:
1492:(14): 1116.
1489:
1486:Eur. Heart J
1485:
1475:
1450:
1446:
1440:
1407:
1403:
1397:
1379:Pharmacology
1378:
1372:
1347:
1344:Eur. Heart J
1343:
1336:
1326:, retrieved
1314:
1304:
1293:. Retrieved
1289:
1280:
1271:
1262:
1242:
1235:
1200:
1196:
1186:
1168:Pharmacology
1167:
1160:
1125:
1121:
1111:
1103:
1074:
1068:
1026:
1008:
991:
988:
930:
890:
874:
856:
820:
813:
781:
754:
697:
689:
678:
661:
531:beta blocker
525:
453:Beta blocker
368:
313:
263:overactivity
245:
225:Procainamide
220:Disopyramide
182:
176:
162:
152:
138:
128:
123:
118:
108:
99:
97:
84:
59:
43:tachycardias
34:
30:
29:
3512:from market
3423:Îą receptors
3306:Propranolol
3269:antagonists
3214:Vernakalant
3184:Dronedarone
3127:Propafenone
3112:Indecainide
2812:Otologicals
2784:antagonists
2750:respiratory
2725:Orexigenics
2720:Neurotoxins
2669:Euphoriants
2659:Entactogens
2654:Depressants
2644:Anxiolytics
2582:Anesthetics
2358:Antifungals
1955:Antiemetics
1943:antagonists
1839:Circulation
1691:(1): 1â15.
1566:Pediatr Int
1447:Circulation
1311:"Adenosine"
847:dronedarone
843:vernakalant
792:propranolol
516:Vernakalant
496:Dronedarone
469:tachycardia
441:Propranolol
386:tachycardia
361:Propafenone
159:(K) efflux.
45:), such as
3543:Categories
3431:Amiodarone
3336:Metoprolol
3316:Acebutolol
3287:β blockers
3199:Nifekalant
3179:Dofetilide
3174:Celivarone
3159:Amiodarone
3122:Moracizine
3117:Lorcainide
3107:Flecainide
3102:Ethacizine
3086:class Ic (
3070:Mexiletine
3033:class Ib (
3009:Prajmaline
2974:class Ia (
2735:Stimulants
2715:Nootropics
2689:Deliriants
2664:Entheogens
2599:Anorectics
2577:Analgesics
2430:Alkylating
2363:Antivirals
2318:infections
2192:Emollients
2046:Coagulants
1916:metabolism
1794:2008-07-31
1328:2023-12-12
1315:StatPearls
1295:2016-02-09
1060:References
1039:(category)
963:amiodarone
941:lignocaine
839:dofetilide
827:amiodarone
796:metoprolol
535:Amiodarone
529:is also a
491:Dofetilide
486:Amiodarone
431:Metoprolol
421:Carvedilol
416:Bisoprolol
392:, such as
356:Moricizine
351:Flecainide
322:arrhythmia
296:Mexiletine
268:arrhythmia
242:Na channel
198:Mechanism
3522:Phase III
3510:Withdrawn
3477:Digitoxin
3446:Verapamil
3441:Quinidine
3436:Bretylium
3405:Quinidine
3360:Adenosine
3331:Landiolol
3247:Verapamil
3242:Diltiazem
3209:Tedisamil
3194:Ibutilide
3169:Bunaftine
3164:Bretylium
3141:class III
3097:Encainide
3075:Tocainide
3065:Aprindine
3051:Lidocaine
3024:Sparteine
3019:Quinidine
3004:Lorajmine
2885:ATC codes
2851:Dressings
2836:Antidotes
2700:Sedatives
2696:Hypnotics
2405:malignant
2262:endocrine
2108:Diuretics
2041:Platelets
2001:and blood
1960:Laxatives
978:phenytoin
952:bretylium
937:quinidine
896:Adenosine
881:diltiazem
877:verapamil
831:ibutilide
823:bretylium
629:Adenosine
588:Verapamil
583:Diltiazem
561:(sotalol)
506:Ibutilide
436:Nebivolol
346:Encainide
306:Tocainide
301:Phenytoin
291:Lidocaine
235:Sparteine
230:Quinidine
195:Examples
192:Known as
157:potassium
153:Class III
3395:Atropine
3321:Atenolol
3301:Pindolol
3278:class II
3264:agonists
3261:Receptor
3224:class IV
2989:Ajmaline
2730:Serenics
2395:Vaccines
2162:Fibrates
1984:Vitamins
1934:Antacids
1861:30354657
1775:70464824
1594:24904388
1586:16635167
1551:30146333
1543:15466950
1508:10924290
1432:19897963
1424:10907968
1323:30085591
1227:11350865
1152:44733401
1144:19721129
1031:See also
784:atenolol
745:Class Ic
733:Class Ib
721:Class Ia
411:Atenolol
330:asystole
215:Ajmaline
163:Class IV
139:Class II
3487:Ouabain
3482:Digoxin
3413:Digoxin
3352:agonist
3326:Esmolol
3296:Nadolol
3283:Phase 4
3229:Phase 4
3204:Sotalol
3146:Phase 3
3088:Phase 0
3059:enteral
3035:Phase 3
2980:Phase 3
2976:Phase 0
2960:class I
2587:General
2494:muscles
2463:L03âL04
2459:disease
2411:L01âL02
2407:disease
2157:Statins
1767:1474169
1732:1723682
1705:5807584
1670:5485142
1661:1702721
1621:5755904
1467:7882485
1364:6723689
1218:1572777
927:History
906:Digoxin
866:AV node
835:sotalol
788:esmolol
777:AV node
763:at the
634:Digoxin
607:Reduce
527:Sotalol
511:Sotalol
446:Timolol
426:Esmolol
177:Class V
171:AV node
167:calcium
129:Class I
3505:WHO-EM
3189:E-4031
2978:â and
2894:
2873:
2821:other
2752:system
2504:joints
2457:immune
2264:system
2224:system
2065:system
1859:
1816:
1773:
1765:
1730:
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1081:
1045:(CAST)
939:, and
845:, and
794:, and
564:Treat
553:Treat
546:Treat
501:E-4031
272:Treat
189:Class
133:sodium
2875:Drugs
2592:Local
2559:brain
2498:bones
1999:blood
1771:S2CID
1590:S2CID
1547:S2CID
1428:S2CID
1148:S2CID
261:vagal
39:drugs
3267:and
2942:C01B
2502:and
2179:skin
1857:PMID
1814:ISBN
1763:PMID
1728:PMID
1701:PMID
1666:PMID
1617:PMID
1582:PMID
1539:PMID
1504:PMID
1463:PMID
1420:PMID
1383:ISBN
1360:PMID
1319:PMID
1248:ISBN
1223:PMID
1172:ISBN
1140:PMID
1079:ISBN
954:and
879:and
557:and
477:III
98:The
53:and
3285:â,
3231:â,
3148:â,
2823:ATC
2561:and
2320:and
1847:doi
1843:138
1755:doi
1693:doi
1656:PMC
1648:doi
1574:doi
1531:doi
1494:doi
1455:doi
1412:doi
1352:doi
1213:PMC
1205:doi
1201:133
1130:doi
695:.)
574:IV
402:II
338:Ic
283:Ib
206:Ia
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