When initiating dofetilide, what medication should be discontinued to avoid potential drug interactions?

Dofetilide is an antiarrhythmic medication used primarily for the treatment of atrial fibrillation and atrial flutter. It is important to manage potential drug interactions carefully when initiating treatment with dofetilide, as this medication is primarily excreted renally and has a risk of causing Torsades de Pointes, a dangerous form of ventricular tachycardia.

Hydrochlorothiazide should be discontinued because it can cause electrolyte imbalances, particularly hypokalemia and hypomagnesemia. These imbalances can increase the risk of dofetilide-induced arrhythmias, especially the potentially life-threatening Torsades de Pointes. Furthermore, hydrochlorothiazide can also impair renal function, which could further complicate the safe use of dofetilide, given its dependence on renal clearance.

While sertraline, atorvastatin, and metoprolol tartrate are also used in the management of various conditions, they do not carry the same risk of significant drug interactions with dofetilide as hydrochlorothiazide does. Sertraline and atorvastatin are generally considered safe to use concurrently with dofetilide, and metoprolol, being a beta-blocker, is