General Description
Moricizine hydrochloride (also known as ethmozine) is a phenothiazine derivative with class I antiarrhythmic properties, classified as a class IB agent but with unique characteristics. It was available for the treatment of life-threatening ventricular arrhythmias.
Mechanism of Action
Moricizine slows the fast inward sodium channel current during phase 0 of the action potential, predominantly in Purkinje fibers and ventricular muscle. It also reduces automaticity and prolongs effective refractory period without significantly altering QT interval. Unlike other class I agents, moricizine has minimal effects on conduction velocity at therapeutic concentrations. The drug also possesses membrane-stabilizing and mild anti-ischemic properties.
Application
Prior to withdrawal, moricizine was indicated for the treatment of documented ventricular arrhythmias, including sustained ventricular tachycardia, that were life-threatening in nature. It was used after failure of more established antiarrhythmics. The Cardiac Arrhythmia Suppression Trial (CAST) demonstrated increased mortality in post-myocardial infarction patients, leading to its fall from use.