Etripamil: The First FDA-Approved Intranasal L-Type Calcium Channel Blocker for Acute Termination of Paroxysmal Supraventricular Tachycardia

Abstract

Objectives:

The objectives were to evaluate etripamil, an intranasal L-type nondihydropyridine calcium channel blocker (CCB), for the treatment of acute supraventricular tachycardia.

Data Sources:

We conducted a literature search from PubMed, Embase, Cochrane, and Web of Science using key words etripamil, CARDAMYST, and MSP-2017 until April 2026.

Study Selection and Data Extraction:

We analyzed English-language studies focusing on the pharmacology, efficacy, and safety of etripamil.

Data Synthesis:

Etripamil is a fast-acting intranasal CCB developed for the acute management of paroxysmal supraventricular tachycardia (PSVT). Etripamil significantly increased the rate and shortened the time to conversion of acute symptomatic, atrioventricular node-dependent PSVT to sinus rhythm compared with placebo. Etripamil was generally well tolerated; adverse events were primarily mild to moderate and intranasal-related. Notably, there was no significant increase in serious adverse events compared with placebo, with cardiovascular events being rare.

Relevance to Patient Care and Clinical Practice in Comparison to Existing Drugs:

Etripamil nasal spray is the first nonparenteral, patient-administered therapy approved for the acute termination of PSVT. Etripamil is the only intranasal agent that significantly increases conversion to sinus rhythm compared with placebo in phase III trials. However, its role in certain higher-risk populations, including patients with atrial fibrillation with rapid ventricular rates, remains to be further defined in post-marketing studies and clinical trials.

Conclusion:

Etripamil is an effective and well-tolerated intranasal medication for the acute treatment of PSVT in adults, providing rapid conversion to sinus rhythm and offering a safe, patient-administered option to reduce symptom burden and potentially decrease emergency department utilization.