What is the initiation requirement for dofetilide therapy?

• A. Hospital initiation with continuous QT monitoring and renal function assessment
• B. Outpatient start with weekly ECG
• C. No monitoring required
• D. Daily hepatic function tests

Answer: (A)

Dofetilide has a narrow safety margin and can cause dangerous QT prolongation, leading to torsades de pointes. Because it is cleared by the kidneys, renal function directly influences drug exposure, so assessing kidney function and adjusting the dose are essential during initiation. Starting this medication in a hospital allows continuous ECG (telemetry) monitoring to detect QT changes in real time and to respond quickly if the QT interval lengthens or electrolytes are imbalanced. Baseline QTc measurement and ongoing electrolyte management (keeping potassium and magnesium within optimal ranges) are key parts of the process, along with monitoring renal function to guide dosing. These precautions are why initiation is done in a hospital setting with continuous QT monitoring and renal assessment. Outpatient start lacks the necessary monitoring, hepatic tests are not the primary concern here, and no monitoring would miss potentially life‑threatening QT changes.