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Biotransformation Antiarrhythmic drugs (AADs) undergo metabolism in the liver through CYP450 isoenzymes, resulting in active metabolites that either block sodium (Na+) channels (such as mexiletine and propafenone), extend action potential duration (APD) [for instance, N-acetylprocainamide (NAPA)], or cause central nervous system (CNS) toxicity (as seen with lidocaine) (11)

The compound distributes preferentially to metabolically active organs, showing highest concentrations in the kidneys and liver, followed by the stomach wall, thymus, spleen, and intestines