AMIODARONE

Dr Patrick Peng

CLASSES OF ANTI ARRHYTHMIC

Class

Mechanism

Na+ channel blocker

II

blocker

III

K+ channel blocker

IV

Ca++ channel blocker

amiodarone

AMIODARONE
Structurally related to thyroxine.
Net effect:
Increases refractoriness
Depresses sinus node automaticity
Slows conduction.
Long half-life (14100 days) risk of toxicity

USES
Management of life-threatening recurrent ventricular fibrillation (VF) or
hemodynamically-unstable ventricular tachycardia (VT) refractory to
other antiarrhythmic agents
Pharmacologic conversion of AF to and maintenance of normal sinus
rhythm
Prevention of postoperative AF associated with cardiothoracic surgery

APD & RP by
blocking the K+
channels

DOSAGE ( MR DAVIDS
PROTOCOL)
Loading

IV amiodarone 300mg for 1 hour

Maintenance

IV amiodarone 900mg for 23 hours

Oral
T amiodarone 400mg BD x 3/7T amiodarone 200mg BD x 3/7T amiodarone 200mg OD x
6/52

ADVERSE EFFECT
The most worrying long-term side effect is lung toxicity. This is be significant
in 3 to 9% of patients (possibly even up to 17%), and may kill the patient if
missed. There may be:

Interstitial pneumonitis
Lung fibrosis
Hypersensitivity pneumonitis
Bronchiolitis obliterans organising pneumonia (BOOP)

Neurotoxicity has been reported in up to 40%, manifesting mainly as

peripheral neuropathy with proximal motor weakness(!) or distal sensory
disturbance. Sleep disturbance, ataxia, vivid dreams and fine resting tremor
are said to be common, and worse in the elderly.

 Phototoxicity is common,Blue-grey skin discolouration may occur. Nonspecific

rashes and even itch, petechiae and erythema nodosum have been seen.
Hyper- and hypo-thyroidism have been reported, in 1 to 10%, but possibly
more commonly in older persons. Free T3 levels are often low, with high rT3.
Eye involvement may include corneal infiltrates which are commonly
asymptomatic, but may result in visual blurring / haloes around lights in about
2% of patients. Optic neuritis, macular degeneration and blindness have been
reported. Most patients on amiodarone for over 3 months get corneal
microdeposits visible on slit-lamp examination.

 Asymptomatic, mild sinus bradycardia is common but symptomatic

bradycardia occurs in only 2-4% of patients. Hypotension may occur,
more related to theintravenous preparation.
Hepatitis may occur. Elevated aminotransferase and alkaline phosphatase
levels occur in 4-25% of cases
Mild but common reported side effects include constipation, nausea, loss
of appetite

INTERACTIONS
There is an erratic interaction with oral anticoagulants (warfarin) - if the two must
be given together, perhaps halve the warfarin dose and watch the INR carefully
Any drugs that cause bradycardia may be potentiated:beta blockers, calcium
channel blockers
Amiodarone increasesdigoxinlevels (markedly reduce the digoxin dose and watch
levels; or stop it)
Drugs that deplete the body of potassium (e.g.diuretics) should be avoided, or
the potassium should be monitored and replaced

THANK YOU~~