Please login or register to print this page.


European Medicines Agency

News & Views

EMA recommends restricting use of Multaq

The European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) has recommended restricting the use of Multaq. The anti-arrhythmic medicine should only be prescribed for maintaining heart rhythm in patients with paroxysmal or persistent atrial fibrillation (AF) for the maintenance of sinus rhythm after successful cardioversion, they say.

The Committee found that, due to an increased risk of liver, lung and cardiovascular adverse events, Multaq should only be prescribed after alternative treatment options have been considered. It also recommended a number of other risk minimisation measures to reduce the risk of injuries to liver, lung and cardiovascular system.

Patients who are currently taking Multaq are recommended to have their treatment evaluated by their doctor at their next scheduled appointment.

The review of the overall balance of benefits and risks of Multaq was initiated in January 2011 because of reports of severe liver injury in patients treated with the medicine. During the review the CHMP was informed of the early termination of a clinical trial, the PALLAS study, due to the occurrence of severe cardiovascular side effects such as cardiovascular death, stroke and cardiovascular hospitalisation in patients taking the medicine.

The PALLAS study investigated the use of Multaq compared to placebo in patients over 65 years of age with permanent AF and several risk factors. Although Multaq has not been approved for this patient population, the CHMP was concerned about the outcome of the PALLAS study and extended its review to also look at the data relating to cardiovascular safety of the medicine as well as other data that became available on the risk of damage to the lungs.

On the basis of the evaluation of the currently available data, the Committee concluded that there was an increased risk of Multaq causing injury to the liver as well as the lungs when used in accordance with the currently approved prescribing information. The Committee also considered that the cardiovascular events shown in the population in the PALLAS study could mean an increased risk of cardiovascular side effects for some patients with non-permanent AF.

However, the Committee considered that the availability of a range of treatments for a difficult condition such as AF was important and that for some patients with non-permanent AF Multaq remains a useful treatment option. The CHMP therefore was of the opinion that the benefits of Multaq outweigh its risks in these patients, provided that further changes to the information for prescribers and patients will be introduced to minimise the risk of injury to the liver, lung and heart. These include:

- Treatment with Multaq should be restricted to patients with paroxysmal or persistent AF when sinus rhythm has been obtained. It is no longer indicated for use in patients when AF is still present.

- Treatment with Multaq should only be started and monitored by a specialist after other anti-arrhythmic medicines have been considered.

- Multaq must not be used in patients with permanent AF, heart failure or left ventricular systolic dysfunction (impairment of the left side of the heart).

- Doctors should consider discontinuation of treatment if AF reoccurs.

- Multaq must not be used in patients who have had previous liver or lung injury following treatment with amiodarone, another anti-arrhythmic medicine.

- Patients on Multaq should have their lung and liver function as well as their heart rhythm regularly monitored. Especially the liver function should be closely monitored during the first few weeks of treatment.

The Committee’s opinion has now been forwarded to the European Commission for the adoption of a decision.

Published on: September 28, 2011

Members Area

Log in or Register now.



Subscribe to our RSS feed


Sign up for our regular email newsletters & be the first to know about fresh articles and site updates.


    None Found


  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

You are not logged in

You need to be a member to print this page.
Sign up for free membership, or log in.

You are not logged in

You need to be a member to download PDF's.
Sign up for free membership, or log in.