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American Journal of Cardiovascular... Dec 2020Amiodarone is an effective antiarrhythmic medication frequently used in practice for both ventricular and atrial arrhythmias. Though classified as a class III... (Review)
Review
Amiodarone is an effective antiarrhythmic medication frequently used in practice for both ventricular and atrial arrhythmias. Though classified as a class III antiarrhythmic, it affects all phases of the cardiac action potential. However, the drug has several side effects, including thyroid abnormalities, pulmonary fibrosis, and transaminitis, for which routine monitoring is recommended. It also interacts with several medications, such as warfarin, simvastatin, and atorvastatin, and many HIV antiretroviral medications. Given the common use of this medication in medical practice, it is vital that clinicians understand the indications, contraindications, dosing, side effects, and interactions of this medication. A thorough understanding of these topics is essential for clinicians to ensure safe and effective use of amiodarone.
Topics: Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Dose-Response Relationship, Drug; Drug Interactions; Humans
PubMed: 32166725
DOI: 10.1007/s40256-020-00401-5 -
Journal of Cardiothoracic and Vascular... May 2021Amiodarone is an effective antiarrhythmic that frequently is used during the perioperative period. Amiodarone possesses a significant adverse reaction profile.... (Review)
Review
Amiodarone is an effective antiarrhythmic that frequently is used during the perioperative period. Amiodarone possesses a significant adverse reaction profile. Amiodarone-induced pulmonary toxicity (AIPT) is among the most serious adverse effects and is a leading cause of death associated with its use. Despite significant advances in the understanding of AIPT, its etiology and pathogenesis remain incompletely understood. The diagnosis of AIPT is one of exclusion. The clinical manifestations of AIPT are categorized broadly as acute, subacute, and chronic. Acute AIPT is a rarer and more aggressive form of the disease, most often encountered in cardiothoracic surgery. Acute respiratory distress syndrome (ARDS) is the predominating pattern of amiodarone's acute pulmonary toxicity. The incidence, risk factors, pathogenesis, and diagnosis of acute AIPT are speculative. Early cardiothoracic literature investigating AIPT often attributed amiodarone to the development of postoperative ARDS. Subsequent studies have found no association between amiodarone and acute AIPT and ARDS development. As a drug that is frequently prescribed to a patient population deemed most at risk for this fatal disease, the conflicting evidence on acute AIPT needs further investigation and clarification.
Topics: Amiodarone; Anti-Arrhythmia Agents; Drug-Related Side Effects and Adverse Reactions; Humans; Lung Diseases; Respiratory Distress Syndrome
PubMed: 33262034
DOI: 10.1053/j.jvca.2020.10.060 -
Journal of Clinical Pharmacology Nov 1991Amiodarone is a unique antiarrhythmic agent originally developed as a vasodilator. Classified electrophysiologically as a Type III antiarrhythmic, it also has both... (Review)
Review
Amiodarone is a unique antiarrhythmic agent originally developed as a vasodilator. Classified electrophysiologically as a Type III antiarrhythmic, it also has both nonspecific antisympathetic and direct, fast channel-membrane effects. Hemodynamic effects of orally administered amiodarone (a negative inotropic agent) are usually negligible, and are usually compensated for by induced vasodilation. Effects on thyroid and hepatic function may help to explain some of the unique pharmacologic as well as toxicologic effects of the drug. Amiodarone is poorly bioavailable (20-80%) and undergoes extensive enterohepatic circulation before entry into a central compartment. The principal metabolite, mono-n-desethyl amiodarone is also an antiarrhythmic. From this central compartment, it undergoes extensive tissue distribution (exceptionally high tissue/plasma partition coefficients). The distribution half-life of amiodarone out of the central compartment to peripheral and deep tissue compartments (t1/2 alpha) may be as short as 4 hours. The terminal half-life (t1/2 beta) is both long and variable (9-77 days) secondary to the slow mobilization of the lipophilic medication out of (primarily) adipocytes. A pharmacokinetically based loading scheme is described, and data suggesting a role for routine amiodarone plasma levels are presented.
Topics: Administration, Oral; Amiodarone; Arrhythmias, Cardiac; Biological Availability; Hemodynamics; Humans; Metabolic Clearance Rate; Tissue Distribution
PubMed: 1753010
DOI: 10.1002/j.1552-4604.1991.tb03673.x -
The New England Journal of Medicine Feb 1987
Review
Topics: Amiodarone; Arrhythmias, Cardiac; Humans; Kinetics
PubMed: 3543680
DOI: 10.1056/NEJM198702193160807 -
Best Practice & Research. Clinical... Dec 2009Assessment of TSH and TPO-Ab before starting amiodarone (AM) treatment is recommended. The usefulness of periodic TSH measurement every 6 months during AM treatment is... (Review)
Review
Assessment of TSH and TPO-Ab before starting amiodarone (AM) treatment is recommended. The usefulness of periodic TSH measurement every 6 months during AM treatment is limited by the often sudden explosive onset of AIT, and the spontaneous return of a suppressed TSH to normal values in half of the cases. AM-induced hypothyroidism develops rather early after starting treatment, preferentially in iodine-sufficient areas and in females with TPO-Ab; it is due to failure to escape from the Wolff-Chaikoff effect, resulting in preserved radioiodine uptake. AM-induced thyrotoxicosis (AIT) occurs at any time during treatment, preferentially in iodine-deficient regions and in males. AIT can be classified in type 1 (iodide-induced thyrotoxicosis, best treated by potassium perchlorate in combination with thionamides and discontinuation of AM) and type 2 (destructive thyrotoxicosis, best treated by prednisone; discontinuation of AM may not be necessary). AIT is associated with a higher rate of major adverse cardiovascular events (especially of ventricular arrhythmias). Uncertainty continues to exist with respect to the feasibility of continuation of AM despite AIT, the appropriate methods to distinguish between AIT type 1 and 2 as well as the advantages of AIT classification into subtypes in view of possible mixed cases, and the best policy when AM needs to be restarted.
Topics: Amiodarone; Anti-Arrhythmia Agents; Dronedarone; Female; Humans; Hypothyroidism; Male; Pregnancy; Pregnancy Complications, Cardiovascular; Thyroid Function Tests; Thyroid Gland; Thyrotoxicosis; Thyrotropin
PubMed: 19942150
DOI: 10.1016/j.beem.2009.07.001 -
The Journal of the Louisiana State... May 1989Amiodarone is an antiarrhythmic agent with unique electrophysiological and pharmacokinetic properties and a wide spectrum of antiarrhythmic activity. Its clinical... (Review)
Review
Amiodarone is an antiarrhythmic agent with unique electrophysiological and pharmacokinetic properties and a wide spectrum of antiarrhythmic activity. Its clinical efficacy is not confined to ventricular arrhythmias but extends to supraventricular arrhythmias including those associated with Wolff-Parkinson-White Syndrome. Though a highly effective drug, amiodarone causes significant side effects. In this article, the electrophysiologic and pharmacokinetic properties, the clinical efficacy, and the adverse effects of amiodarone are reviewed.
Topics: Amiodarone; Arrhythmias, Cardiac; Drug Interactions; Hemodynamics; Humans
PubMed: 2659709
DOI: No ID Found -
Vnitrni Lekarstvi 2021Amiodarone is one of the more frequently used drugs in the treatment of supraventricular and ventricular arrhythmias. Many adverse effects, more or less serious, are...
Amiodarone is one of the more frequently used drugs in the treatment of supraventricular and ventricular arrhythmias. Many adverse effects, more or less serious, are associated with its administration. Amiodaron-induced pulmonary toxicity (AIPT) is quite rare but represents one of the most severe adverse effects with high mortality. We present an 80 years old patient, who used amidorane due to paroxysmal atrial fibrillation for several years. Within 3 months, he was repeatedly hospitalized for a bilateral pneumonia. Eventually, AIPT was diagnosed. Early diagnosis, proper therapy of AIPT and changed antiarrhythmic therapy has significantly improved the clinical status of our patient. In this case we demonstrate typical clinical presentations of AIPT as well as the most common diagnostic procedures and recommended treatment methods. Finally, some other commonly used therapeutical options for supraventricular arrhythmias are mentioned. Future options are outlined.
Topics: Aged, 80 and over; Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Drug-Related Side Effects and Adverse Reactions; Humans; Lung Diseases; Male; Pneumonia
PubMed: 35459353
DOI: No ID Found -
Lijecnicki Vjesnik 2015Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and... (Review)
Review
Amiodarone is a benzofuran derivative that contains up to 40% of iodine. Amiodarone is used for treatment and prevention of life threatening supraventricular and ventricular tachyarrhythmias. The effects on thyroid gland vary from abnormalities in thyroid function tests to overt amiodarone induced hypothyroidism (AIH) and thyrotoxicosis (AIT). Patients with AIH are treated with L-thyroxine and may continue treatment with amiodarone. Two different forms of AIT have to be distinguished: amiodarone induced hyperthyroidism (AIT I) and thyroiditis (AIT II). AIT I is treated with antithyroid drugs, while total thyroidectomy and iodine-131 are used for definitive treatment. AIT II is treated with glucocorticoids. Patients with AIT have to stop treatment with amiodarone. Dronedarone is a less potent antiarrhythmic agent with structural and pharmacological properties similar to amiodarone. Dronedarone is devoid of iodine with fewer adverse effects and therefore it may be used in high risk patients for development of AIT or AIH.
Topics: Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Diagnosis, Differential; Disease Management; Dronedarone; Humans; Thyroid Diseases; Thyroid Function Tests
PubMed: 26380478
DOI: No ID Found -
Deutsche Medizinische Wochenschrift... May 2001
Review
Topics: Amiodarone; Angina Pectoris; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Eye; Humans; Lung; Thyroid Gland
PubMed: 11413750
DOI: 10.1055/s-2001-14417 -
Ugeskrift For Laeger Jun 2015Amiodarone is an effective antiarrhythmic drug for supraventricular and ventricular arrhythmias. A majority of patients treated with amiodarone suffer from mild... (Review)
Review
Amiodarone is an effective antiarrhythmic drug for supraventricular and ventricular arrhythmias. A majority of patients treated with amiodarone suffer from mild adverse events, however, serious life-threatening adverse events caused by amiodarone are also seen. This review describes the pharmacology, interactions, side and adverse effects of amiodarone and highlights the importance of a systematic interdisciplinary follow-up protocol for outpatients treated with amiodarone.
Topics: Amiodarone; Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Drug Interactions; Drug Monitoring; Humans; Lung; Thyroid Gland
PubMed: 26554056
DOI: No ID Found