Comprehensive medication guide to Propafenone including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$30 copay for generic IR tablets on most commercial plans and Medicare Part D; Tier 1–2 on most formularies. Extended-release capsules may require prior authorization and carry higher copays.
Estimated Cash Pricing
$131–$173 retail for generic IR tablets (90 count); as low as $16–$33 with GoodRx or SingleCare coupons for a 30-day supply. ER capsules retail $400–$1,100 but can be found for $27–$67 with discount cards.
Medfinder Findability Score
78/100
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Propafenone is a prescription antiarrhythmic medication used to treat and prevent serious heart rhythm disorders (arrhythmias). It is sold under the brand names Rythmol (immediate-release tablets) and Rythmol SR (extended-release capsules), with generic versions widely available. Propafenone was first approved by the FDA in November 1989 and belongs to the Class IC antiarrhythmic drug class — a category of sodium channel blockers.
Propafenone is FDA-approved for three indications: paroxysmal atrial fibrillation (AF) in patients without structural heart disease, paroxysmal supraventricular tachycardia (PSVT) with disabling symptoms, and documented life-threatening ventricular arrhythmias such as sustained ventricular tachycardia. It is also used off-label as a "pill-in-the-pocket" strategy for acute AF cardioversion.
Propafenone comes in immediate-release (IR) tablets (150 mg, 225 mg, 300 mg) taken three times daily, and extended-release (ER) capsules (225 mg, 325 mg, 425 mg) taken twice daily. It is not a controlled substance and is available as a generic at most major pharmacies.
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Propafenone works primarily by blocking fast sodium channels in cardiac muscle cells and conduction tissue. This slows the speed at which electrical signals travel through the heart — reducing abnormal automaticity, slowing conduction velocity, and interrupting the reentrant electrical circuits that cause arrhythmias like atrial fibrillation and PSVT.
What makes propafenone unique among Class IC antiarrhythmics is its additional pharmacological properties. It has mild beta-adrenergic blocking activity (similar to a weak beta-blocker), mild calcium channel blocking activity, and at higher concentrations can slightly prolong the cardiac action potential. These combined effects make it effective for both rhythm control and partial rate control in atrial fibrillation.
Propafenone is metabolized primarily by the liver enzyme CYP2D6, with additional involvement of CYP3A4 and CYP1A2. About 6% of Caucasians are poor metabolizers of CYP2D6, which leads to higher drug concentrations and more pronounced beta-blocking effects at standard doses. Your cardiologist will titrate your dose carefully based on your response and any side effects.
150 mg — tablet (immediate-release)
Starting dose for most patients; taken every 8 hours (3x daily)
225 mg — tablet (immediate-release)
Mid-range dose; taken every 8 hours
300 mg — tablet (immediate-release)
Maximum IR dose; taken every 8 hours
225 mg — capsule (extended-release)
Starting ER dose; taken every 12 hours (2x daily)
325 mg — capsule (extended-release)
Mid-range ER dose; taken every 12 hours
425 mg — capsule (extended-release)
Maximum ER dose; taken every 12 hours
As of 2026, propafenone is not on the FDA's national drug shortage list. Multiple generic manufacturers — including ANI Pharmaceuticals, Strides Pharma, and Aurobindo — produce both the immediate-release tablet and extended-release capsule formulations, providing supply chain redundancy. The immediate-release tablets (150 mg, 225 mg, 300 mg) are generally well-stocked at large chain pharmacies.
However, localized stocking gaps do occur, particularly for the extended-release capsule formulation (225 mg, 325 mg, 425 mg) and at smaller independent pharmacies. Patients who are prescribed propafenone ER may encounter more difficulty finding it in stock compared to the IR tablets. Large chain pharmacies such as Costco, Walmart, CVS, and Walgreens are more likely to maintain consistent inventory.
If you're having trouble finding propafenone at your local pharmacy, medfinder can call pharmacies near you to find which ones have your specific prescription in stock — saving you hours on hold.
Propafenone is not a controlled substance and has no special DEA prescribing requirements. However, because it carries an FDA boxed warning and requires ECG monitoring before and during therapy, the initial prescription is typically issued by a specialist with expertise in cardiac arrhythmias. Long-term maintenance prescriptions may be managed by primary care in some cases.
Propafenone cannot be initiated via telehealth alone due to ECG monitoring requirements. However, patients already established on propafenone may use telehealth for routine follow-up and refill management with their cardiologist.
No. Propafenone is not a controlled substance. It is not classified under any DEA schedule (Schedule I-V). While propafenone is a prescription-only medication due to its cardiac effects and the need for medical monitoring, it does not have abuse potential and is not subject to the additional dispensing restrictions that apply to opioids, stimulants, or other scheduled drugs.
This means patients can receive propafenone prescriptions for up to a 90-day supply, refills are permitted without special restrictions, and prescriptions can be called in or sent electronically to pharmacies without the additional safeguards required for controlled substances. However, propafenone does carry an FDA boxed warning due to its potential proarrhythmic effects, and requires appropriate medical supervision and monitoring during treatment.
The following side effects were reported in more than 5% of patients in clinical trials:
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Flecainide (Tambocor)
Most similar alternative — also Class IC. Comparable efficacy for AF and PSVT, lacks propafenone's beta-blocking activity. Generic available.
Dronedarone (Multaq)
Class III antiarrhythmic with good safety profile. Used for AF rhythm control; no generic available; approved for patients with structural heart disease.
Sotalol (Betapace)
Class III with beta-blocking properties. Effective for AF and ventricular arrhythmias; requires in-hospital initiation; renally dose-adjusted.
Amiodarone (Cordarone, Pacerone)
Most effective antiarrhythmic for AF rhythm maintenance. Reserved for refractory cases due to significant multi-organ toxicity profile.
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Digoxin
majorPropafenone increases digoxin blood levels via P-glycoprotein inhibition. Digoxin dose reduction and level monitoring required.
Warfarin (Coumadin)
majorPropafenone increases warfarin's anticoagulant effect. INR should be monitored closely; warfarin dose reduction typically needed.
CYP2D6 inhibitors (paroxetine, fluoxetine, sertraline, quinidine)
majorIncrease propafenone blood levels significantly. Combined use increases risk of proarrhythmia and side effects.
CYP3A4 inhibitors (ketoconazole, erythromycin, ritonavir, grapefruit juice)
majorIncrease propafenone levels. Avoid grapefruit entirely. Paxlovid (nirmatrelvir/ritonavir) is contraindicated with propafenone.
Beta-blockers (metoprolol, propranolol)
moderatePropafenone increases levels of CYP2D6-metabolized beta-blockers; combined beta-blocking effect can cause excessive bradycardia or hypotension.
Orlistat (Alli, Xenical)
majorReduces propafenone absorption. Abrupt orlistat discontinuation can cause dangerous propafenone level spikes — seizures and cardiac events reported.
Rifampin
moderateStrong CYP3A4 inducer; significantly decreases propafenone levels, potentially causing arrhythmia recurrence.
Amiodarone / Class IA antiarrhythmics
majorAdditive risk of excessive QRS widening, QT prolongation, and cardiac depression. Avoid combination.
Propafenone (Rythmol) has been a cornerstone of cardiac rhythm management for over 35 years. As a Class IC antiarrhythmic, it is most effective — and safest — in patients with structurally normal hearts who need rhythm control for atrial fibrillation or PSVT. Generic availability and multiple manufacturers make it generally accessible, though patients may occasionally encounter stocking gaps, particularly for the extended-release formulation.
Cost is manageable for most patients, with discount cards reducing the generic IR tablet price to as little as $16-$33. Insurance coverage is generally strong for the immediate-release tablets on most commercial plans and Medicare Part D. The FDA boxed warning deserves respect — this is a medication that requires proper monitoring and should never be stopped abruptly.
If you're struggling to find propafenone at a pharmacy near you, medfinder can help. Enter your medication details and location, and medfinder will call pharmacies near you to find which ones have propafenone in stock — then text you the results so you can fill your prescription without the phone-tree hassle.
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