Comprehensive medication guide to Mexiletine including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$30 copay on most commercial insurance plans; Tier 1–2 generic on most formularies. Medicare Part D typically lists mexiletine on Tier 2 with copays of $5–$20 after the deductible.
Estimated Cash Pricing
$80–$140 retail for generic mexiletine per 30-day supply; as low as $31–$35 with a free GoodRx or SingleCare coupon for a 30-day supply.
Medfinder Findability Score
75/100
Summarize with AI
On this page
Mexiletine hydrochloride (formerly sold as brand name Mexitil, now discontinued) is an oral prescription medication classified as a Class 1B antiarrhythmic agent. It is used primarily to treat life-threatening ventricular arrhythmias — abnormal heart rhythms originating in the lower chambers of the heart. Mexiletine is structurally similar to lidocaine and is often described as the oral equivalent of that well-known local anesthetic.
Mexiletine is available only as a generic in the United States, in three capsule strengths: 150 mg, 200 mg, and 250 mg. Multiple manufacturers supply it, including Teva and Lannett. The brand name Mexitil was voluntarily discontinued by Boehringer Ingelheim and is no longer commercially available.
Beyond its FDA-approved arrhythmia indication, mexiletine is also used off-label for long QT syndrome type 3 (LQT3), myotonic dystrophy, and diabetic peripheral neuropathy. It is a non-controlled substance requiring a standard prescription.
We have a 99% success rate finding medications, even during nationwide shortages.
Need this medication?
Mexiletine works by blocking fast voltage-gated sodium channels in heart muscle cells (cardiac myocytes) and nerve cells. When these sodium channels are blocked, the rate at which sodium ions rush into the cell during the electrical action potential is slowed — reducing the excitability of the cell and making it less likely to fire spontaneous or chaotic electrical signals.
Specifically, mexiletine reduces the upstroke velocity of phase 0 of the cardiac action potential and shortens the action potential duration (APD). Unlike some other antiarrhythmic drugs, it does not significantly prolong the QRS complex or QT interval, making it useful in certain patients where QT prolongation is a concern. Mexiletine exhibits use-dependence — meaning its effect is greatest at faster heart rates, which is beneficial during dangerous fast arrhythmias like ventricular tachycardia.
The drug is metabolized primarily by the liver via the CYP1A2 and CYP2D6 enzyme systems. It has approximately 90% oral bioavailability and a half-life of around 11 hours, allowing for three-times-daily or, in stable patients, twice-daily dosing.
150 mg — capsule
Starting or low-maintenance dose; available as generic from Teva, Lannett, and others
200 mg — capsule
Most common maintenance dose (200 mg q8h); standard starting dose per prescribing guidelines
250 mg — capsule
Higher maintenance dose for patients requiring more aggressive arrhythmia control (up to 400 mg q8h)
As of 2026, mexiletine is not in a national shortage — the last FDA/ASHP-documented shortage occurred in 2020 when Teva had an active pharmaceutical ingredient (API) delay, which was resolved in April 2021. Multiple generic manufacturers currently supply mexiletine, including Teva and Lannett.
Despite no national shortage, patients may still encounter empty shelves at individual pharmacies. Mexiletine is a specialty cardiac drug with relatively low prescription volume, so many retail pharmacies stock only small quantities and may run out between reorders. The drug is more reliably stocked at hospital outpatient pharmacies, independent pharmacies, and through mail-order services.
If you're struggling to find mexiletine at your local pharmacy, medfinder contacts pharmacies near you to check which ones have your prescription ready to fill — saving you the time and frustration of calling around yourself.
Mexiletine is not a controlled substance, so any licensed prescriber with a valid state license can prescribe it without special DEA authorization or mandatory prescribing programs. However, because mexiletine is used for serious arrhythmias that require cardiac monitoring at initiation, it is most commonly initiated by cardiac specialists.
Cardiac Electrophysiologists (EP): The primary specialty for initiating mexiletine therapy in ventricular arrhythmia and LQT3 patients
Cardiologists: Can initiate and manage mexiletine for ventricular arrhythmias
Primary Care Physicians (PCPs): Commonly manage ongoing mexiletine refills for stable patients and may prescribe for off-label neuropathy use
Neurologists: May prescribe for myotonic dystrophy or peripheral neuropathy indications
Nurse Practitioners (NPs) and Physician Assistants (PAs): Can prescribe mexiletine in most states with appropriate prescribing authority, particularly for stable ongoing therapy
Telehealth is generally not appropriate for initiating mexiletine therapy, as guidelines recommend in-person EKG monitoring when starting the drug. However, once therapy is stable, follow-up appointments and refill prescriptions may be possible via telehealth through your cardiologist's or PCP's virtual care service.
No. Mexiletine is not a controlled substance and is not scheduled by the DEA under the Controlled Substances Act. Any licensed prescriber with a valid state license can prescribe mexiletine without special DEA registration requirements, prescribing limits, or mandatory monitoring programs.
Because mexiletine is not controlled, patients may receive 30-day or 90-day supplies, and refills can be authorized on the prescription. There are no restrictions on prescription quantity like those that apply to Schedule II controlled substances. Mail-order pharmacy enrollment is straightforward with no special requirements beyond a standard prescription.
Mexiletine has a notable side effect profile, primarily affecting the gastrointestinal and nervous systems. Most common side effects include:
Nausea and vomiting (most common — take with food or antacid)
Heartburn and dyspepsia
Dizziness and lightheadedness
Tremor and shaking
Coordination problems
Headache and drowsiness
Chest discomfort
Worsened or new arrhythmia (proarrhythmic effect)
Liver toxicity: jaundice, dark urine, upper right abdominal pain (rare)
DRESS (drug reaction with eosinophilia and systemic symptoms): rash, fever, swollen lymph nodes
Blood disorders: low WBC or platelets (unusual bleeding or infection signs)
Heart failure exacerbation (chest pain, shortness of breath, severe edema)
Know what you need? Skip the search.
Amiodarone (Pacerone, Nexterone)
Class III antiarrhythmic; broader spectrum but with extensive toxicity monitoring requirements (thyroid, liver, lungs); long half-life of 40-55 days
Flecainide (Tambocor)
Class IC antiarrhythmic; effective for arrhythmias in structurally normal hearts; contraindicated in structural heart disease or post-MI patients
Propafenone (Rythmol)
Class IC antiarrhythmic with mild beta-blocking properties; same contraindications as flecainide; available as immediate-release and extended-release
Lidocaine (IV)
Class IB antiarrhythmic; mechanistically identical to mexiletine but IV-only; used acutely in hospital settings for ventricular arrhythmia management
Prefer Mexiletine? We can find it.
Pimozide (Orap)
majorContraindicated. Mexiletine inhibits CYP1A2, raising pimozide levels and creating risk of fatal QTc prolongation.
Tizanidine (Zanaflex)
majorContraindicated. CYP1A2 inhibition dramatically increases tizanidine levels causing severe sedation and hypotension.
Duloxetine (Cymbalta)
majorContraindicated. Mexiletine inhibits CYP1A2, significantly increasing duloxetine exposure.
Dofetilide (Tikosyn)
majorContraindicated. Additive cardiac electrophysiologic effects create risk of fatal arrhythmia.
Phenytoin (Dilantin)
majorPhenytoin induces CYP1A2 and CYP2D6, significantly lowering mexiletine plasma levels and reducing effectiveness. Monitor mexiletine levels.
Rifampin
majorPotent CYP1A2 inducer; can dramatically lower mexiletine blood levels, potentially causing treatment failure.
Fluoxetine (Prozac) / Paroxetine (Paxil)
moderateCYP2D6 inhibitors that increase mexiletine blood levels; monitor for increased mexiletine side effects.
Fluvoxamine
majorPotent CYP1A2 inhibitor; avoid coadministration — significantly raises mexiletine exposure.
Theophylline
moderateMexiletine inhibits CYP1A2, raising theophylline levels significantly. Monitor theophylline concentrations closely.
Cimetidine (Tagamet)
moderateOTC antacid that can raise mexiletine levels. Avoid cimetidine; use alternative antacids (calcium carbonate, PPIs) instead.
Mexiletine is a well-established Class 1B antiarrhythmic that remains an important option for patients with serious ventricular arrhythmias, LQT3, and certain off-label conditions. Despite no current national shortage, its specialty status means finding it consistently at retail pharmacies can be challenging. As a generic drug, it is generally affordable — especially with free discount cards from GoodRx or SingleCare that can reduce the cash price by up to 78%.
Patients on mexiletine for life-threatening arrhythmias should proactively ensure a reliable supply by enrolling in mail-order pharmacy and never stopping the medication abruptly without medical guidance. Regular cardiac monitoring (EKG, Holter) and liver function tests are important parts of staying safely on this medication long-term.
If you're having trouble locating mexiletine at your pharmacy, medfinder contacts pharmacies near you to find which ones have your prescription in stock — saving you hours of frustrating phone calls.
Medfinder Editorial Standards
Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
ChatGPT
Claude
Perplexity
Grok
Gemini