Amiodarone

Amiodarone Brand Names

Cordarone | Nexterone | Pacerone

What is Amiodarone

Amiodarone is a class III antiarrhythmic agent used for the treatment of tachyarrhythmias.

Although amiodarone is FDA-approved only for the treatment of ventricular arrhythmias, it is widely used for supraventricular arrhythmias, especially for the pharmacological cardioversion of atrial fibrillation and maintenance of normal sinus rhythm.

Amiodarone and sotalol are equally efficacious in converting atrial fibrillation to sinus rhythm; however, amiodarone is superior to sotalol for maintaining sinus rhythm.

Amiodarone is also more effective than propafenone and other class I agents for the maintenance of sinus rhythm.

Amiodarone may be considered during cardiac arrest when ventricular fibrillation or pulseless ventricular tachycardia is unresponsive to cardiopulmonary resuscitation (CPR), defibrillation, and vasopressor therapy.

Amiodarone may also be considered for stable wide-complex tachycardia or polymorphic ventricular tachycardia.

Guidelines suggest amiodarone as an alternative treatment for the prevention of atrial fibrillation after cardiac surgery in patients for whom first-line therapy (e.g., beta-blockers) is contraindicated.

Atrial tachyarrhythmias occurred significantly less often in patients receiving oral amiodarone compared to those receiving placebo (16.1% vs. 29.5%, respectively) after nonemergent coronary artery bypass graft (CABG) surgery and/or valve replacement or repair in the PAPABEAR trial.

Although amiodarone is associated with several potentially significant and sometimes fatal adverse effects, it has not been associated with proarrhythmias as frequently as other antiarrhythmics.

Indications

  1. atrial fibrillation
  2. atrial fibrillation prophylaxis
  3. atrial flutter
  4. cardiac surgery
  5. cardiopulmonary resuscitation
  6. heart failure
  7. ventricular fibrillation
  8. ventricular tachycardia

For the treatment of life-threatening recurrent ventricular fibrillation or hemodynamically unstable (symptomatic) sustained ventricular tachycardia, including post-myocardial infarction (MI) patients

Side Effects

  1. abdominal pain
  2. acute respiratory distress syndrome (ARDS)
  3. agranulocytosis
  4. akinesia
  5. alopecia
  6. anaphylactic shock
  7. anaphylactoid reactions
  8. angioedema
  9. anorexia
  10. aplastic anemia
  11. arrhythmia exacerbation
  12. arthralgia
  13. ataxia
  14. atrial fibrillation
  15. AV block
  16. bleeding
  17. blurred vision
  18. bradycardia
  19. bronchiolitis obliterans
  20. bronchospasm
  21. cardiac arrest
  22. cholestasis
  23. cirrhosis
  24. confusion
  25. constipation
  26. corneal deposits
  27. cough
  28. cyanosis
  29. delirium
  30. diarrhea
  31. dizziness
  32. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
  33. dyspnea
  34. ecchymosis
  35. edema
  36. elevated hepatic enzymes
  37. eosinophilia
  38. eosinophilic pneumonia
  39. epididymitis
  40. erythema
  41. erythema multiforme
  42. exfoliative dermatitis
  43. fatigue
  44. fever
  45. flushing
  46. goiter
  47. hallucinations
  48. headache
  49. heart failure
  50. hemolytic anemia
  51. hemoptysis
  52. hepatic failure
  53. hepatitis
  54. hepatotoxicity
  55. hyperhidrosis
  56. hyperthyroidism
  57. hypoesthesia
  58. hypotension
  59. hypothyroidism
  60. hypoxia
  61. impotence (erectile dysfunction)
  62. injection site reaction
  63. insomnia
  64. involuntary movements
  65. libido decrease
  66. lupus-like symptoms
  67. malaise
  68. myopathy
  69. nausea
  70. neutropenia
  71. optic neuritis
  72. pancreatitis
  73. pancytopenia
  74. paresthesias
  75. periarteritis
  76. peripheral neuropathy
  77. phlebitis
  78. photosensitivity
  79. pleural effusion
  80. pneumonitis
  81. pruritus
  82. pseudotumor cerebri
  83. pulmonary edema
  84. pulmonary fibrosis
  85. pulmonary toxicity
  86. QT prolongation
  87. rash
  88. renal failure (unspecified)
  89. respiratory arrest
  90. rhabdomyolysis
  91. SIADH
  92. skin discoloration
  93. skin necrosis
  94. Stevens-Johnson syndrome
  95. thrombocytopenia
  96. thrombosis
  97. thrombotic thrombocytopenic purpura (TTP)
  98. thyrotoxicosis
  99. torsade de pointes
  100. toxic epidermal necrolysis
  101. tremor
  102. urticaria
  103. vasculitis
  104. ventricular fibrillation
  105. ventricular tachycardia
  106. visual impairment
  107. vomiting
  108. weakness
  109. wheezing
  110. xerostomia

Monitoring Parameters

  • CBC
  • chest x-ray
  • ECG
  • LFTs
  • ophthalmologic exam
  • pulmonary function tests (PFTs)
  • thyroid function tests (TFTs)

Contraindications

  • amiodarone-induced liver toxicity
  • Amiodarone-induced lung toxicity
  • apheresis
  • arrhythmia exacerbation
  • AV block
  • bradycardia
  • breast-feeding
  • cardiogenic shock
  • cardiomyopathy
  • celiac disease
  • children
  • chronic obstructive pulmonary disease (COPD)
  • diarrhea
  • electrolyte imbalance
  • females
  • fever
  • geriatric
  • goiter
  • halothane anesthesia
  • heart failure
  • hepatic disease
  • hepatitis
  • hepatotoxicity
  • human immunodeficiency virus (HIV) infection
  • hyperparathyroidism
  • hyperthyroidism
  • hypocalcemia
  • hypokalemia
  • hypomagnesemia
  • hypotension
  • hypothermia
  • hypothyroidism
  • hypovolemia
  • infants
  • infertility
  • iodine hypersensitivity
  • long QT syndrome
  • myocardial infarction
  • neonates
  • neurological disease
  • ocular surgery
  • optic neuritis
  • peripheral neuropathy
  • pheochromocytoma
  • pneumonitis
  • pregnancy
  • pulmonary disease
  • pulmonary fibrosis
  • QT prolongation
  • requires an experienced clinician
  • respiratory distress syndrome
  • respiratory insufficiency
  • rheumatoid arthritis
  • sick sinus syndrome
  • sickle cell disease
  • sleep deprivation
  • stroke
  • sunlight (UV) exposure
  • surgery
  • systemic lupus erythematosus (SLE)
  • thyroid disease
  • thyrotoxicosis
  • ventricular dysfunction
  • visual disturbance

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  • Quinidine
  • Quinine
  • Ramelteon
  • Ranolazine
  • Rasagiline
  • Red Yeast Rice
  • Repaglinide
  • Ribociclib
  • Ribociclib; Letrozole
  • Rifabutin
  • Rifampin
  • Rifapentine
  • Rifaximin
  • Rilpivirine
  • Riluzole
  • Rimegepant
  • Risperidone
  • Ritonavir
  • Rivaroxaban
  • Rofecoxib
  • Romidepsin
  • Ropinirole
  • Rufinamide
  • Ruxolitinib
  • Salmeterol
  • Saquinavir
  • Saxagliptin
  • Segesterone Acetate; Ethinyl Estradiol
  • Selpercatinib
  • Selumetinib
  • Sertraline
  • Sevoflurane
  • Short-acting beta-agonists
  • Sildenafil
  • Simeprevir
  • Simvastatin
  • Simvastatin; Sitagliptin
  • Siponimod
  • Sirolimus
  • Sofosbuvir
  • Sofosbuvir; Velpatasvir
  • Sofosbuvir; Velpatasvir; Voxilaprevir
  • Solifenacin
  • Sonidegib
  • Sorafenib
  • Sotalol
  • St. John’s Wort, Hypericum perforatum
  • Sufentanil
  • Sulfonylureas
  • Sunitinib
  • Suvorexant
  • Tacrine
  • Tacrolimus
  • Tadalafil
  • Talazoparib
  • Tamoxifen
  • Tamsulosin
  • Tazemetostat
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Telotristat Ethyl
  • Temsirolimus
  • Tenofovir Alafenamide
  • Tenofovir, PMPA
  • Terbinafine
  • Terbutaline
  • Tetrabenazine
  • Tezacaftor; Ivacaftor
  • Thalidomide
  • Theophylline, Aminophylline
  • Thiazide diuretics
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Thyroid hormones
  • Ticagrelor
  • Timolol
  • Tiotropium; Olodaterol
  • Tipranavir
  • Tizanidine
  • Tolterodine
  • Tolvaptan
  • Topotecan
  • Toremifene
  • Torsemide
  • Tramadol
  • Trandolapril; Verapamil
  • Trazodone
  • Tretinoin, ATRA
  • Triamcinolone
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trimipramine
  • Triptorelin
  • Tucatinib
  • Ubrogepant
  • Ulipristal
  • Umeclidinium; Vilanterol
  • Valdecoxib
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venetoclax
  • Venlafaxine
  • Verapamil
  • Verteporfin
  • Vinblastine
  • Vincristine
  • Vincristine Liposomal
  • Vinorelbine
  • Vorapaxar
  • Voriconazole
  • Vorinostat
  • Warfarin
  • Zanubrutinib
  • Zileuton
  • Ziprasidone
  • Zolpidem
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