Self-Administered Etripamil for PSVT Has Minimal Blood Pressure, Heart Rate Effects, With Nerendra Singh, MD

Although calcium channel blockers (CBBs) typically carry a risk of hypotension, the recently approved, self-administered nasal spray etripamil results in minimal blood pressure reduction when treating paroxysmal supraventricular tachycardia (PSVT).1

These data were presented at the American College of Cardiology (ACC) Scientific Sessions 2026 in New Orleans, Louisiana, by James Ip, MD, a professor of medicine and the director of cardiac pacing and implantable devices at Weill Cornell Medicine. At the conference, the HCPLive editorial team spoke with Narendra Singh, MD, assistant professor at Mercer University Atlanta Campus, director of clinical research at NSC Cardiology, and co-author of the study, to learn more.1

“This provides a huge amount of reassurance that we’re not seeing a big drop in blood pressure, and we’re not seeing a big drop in heart rate,” Singh told HCPLive in an exclusive interview. “Hopefully, for both the patients and for the clinicians, this will improve the comfort level of offering and using this drug.”

Etripamil nasal spray received approval from the US Food and Drug Administration (FDA) in December of 2025, indicating it for the conversion of acute symptomatic episodes of PSVT to sinus rhythm in adult patients. This approval was based in large part on the NODE clinical trial program, which included data from >1800 participants with >2000 episodes of PSVT.2

The present study analyzed NODE-301 parts 1-3 to assess etripamil’s effects on blood pressure and symptoms of hypotension. Singh and colleagues examined the mean heart rate and blood pressure change from baseline for 30-45 minutes post-test dose of etripamil 70mg in enrolled patients. A descriptive analysis was also conducted to investigate symptoms of potential hypotension or syncope treatment-emergent adverse events across the trials conducted during PSVT episodes self-treated out of the clinic.1

Ultimately, the team reported minimal changes from baseline in either heart rate or blood pressure following etripamil use. The mean change in systolic blood pressure was 1.8 mmHg (standard deviation [SD], 11.2) over 30 minutes after a single dose of etripamil (n = 440) and 0.0 mmHg (SD, 12) over 45 minutes for repeat doses (n = 714). Among the 1610 patients enrolled in all 3 parts of NODE-301, treatment-emergent adverse events of hypotension and syncope within 24 hours were 0.4% and 0.1%, respectively. Medical intervention was not required in any event.1

With these data, Singh and colleagues determined that etripamil nasal spray does not share the common hypotension risk of other CCBs, thereby supporting its safe self-administration for PSVT treatment.1

“Within the clinical trial itself, we actually had given a second dose 10 minutes later and still shown that there isn’t a big variation in terms of blood pressure and heart rate,” Singh said. “We can provide that reassurance to patients, but we still caution them that if they feel lightheaded or dizzy, we want them to check their blood pressure and heart rate, because in the real world we are going to see some variation.”

Editors’ Note: Singh reports disclosures with Amgen, AstraZeneca, Bayer, Cleveland Clinic, Eli Lilly, Janssen, and others.

References

1. Ip J, Noseworthy P, Rafii F, et al. Minimal Blood Pressure Effects of Intranasal Etripamil in Trials for Paroxysmal Supraventricular Tachycardia. Abstract presented at the American College of Cardiology Scientific Sessions 2026, New Orleans, LA. March 28-30, 2026.

2. Milestone Pharmaceuticals. Milestone Receives FDA Approval of CARDAMYST (etripamil) as First and Only Self-Administered Nasal Spray for Adults with Paroxysmal Supraventricular Tachycardia (PSVT). December 12, 2025. Accessed April 8, 2026. https://investors.milestonepharma.com/news-releases/news-release-details/milestone-receives-fda-approval-cardamysttm-etripamil-first-and/