CHF and arrhythmias:
Indications for: Amiodarone
Documented, life-threatening recurrent ventricular fibrillation or hemodynamically unstable ventricular tachycardia.
Give consistently with regard to meals. Individualize. Loading dose (initiate in hospital with cardiac monitoring): 800–1600mg/day in divided doses with meals for 1–3 weeks. After control achieved, 600–800mg/day for 1 month then reduce to maintenance dose, usually 400mg/day.
Cardiogenic shock. Sick sinus syndrome. 2nd- or 3rd-degree AV block. Bradycardia with syncope unless paced.
Be experienced with the treatment and monitoring of life-threatening arrhythmias before prescribing this medication. Correct potassium, magnesium and calcium deficiencies prior to initiation. Monitor for pulmonary and liver toxicity; reduce dose or discontinue if either occurs. Perform baseline pulmonary function tests at initiation, then every 3–6 months. Do liver function tests regularly. Surgery. Monitor thyroid function and signs of thyrotoxicosis. Assess implantable cardiac devices. Do regular ophthalmic exams. Withdraw cautiously. Elderly. Neonatal injury (monitor). Labor & delivery. Pregnancy (increased risk for fetal toxicity). Nursing mothers: not recommended.
Class III antiarrhythmic.
Interactions may persist months after discontinuing. Increased risk of torsade de pointes with QT prolonging drugs (eg, class I or III antiarrhythmics, lithium, certain phenothiazines, tricyclic antidepressants, certain fluoroquinolones or macrolides, azole antifungals, halogenated inhalation anesthetics); avoid. Potentiated by CYP3A4 inhibitors (eg, certain fluoroquinolones or macrolides, azole antifungals, grapefruit juice, cimetidine); avoid. Potentiates antiarrhythmics (eg, quinidine, procainamide, flecainide); reserve concomitant use for those who are unresponsive to a single agent; reduce their doses by 30–50% for several days after transitioning to oral amiodarone. Potentiates cyclosporine, digoxin (reduce digoxin dose by ½ or discontinue), warfarin (reduce anticoagulant dose by ⅓ to ½ and monitor INR), phenytoin, lidocaine, fentanyl; monitor. Myopathy with statins metabolized by CYP3A4; limit simvastatin dose to 20mg daily or lovastatin dose to 40mg daily. Additive bradycardia, sinus arrest, and AV block with β-blockers, digoxin, verapamil, diltiazem, ivabradine, clonidine; monitor heart rate. Exacerbation of arrhythmias with antiarrhythmics. Symptomatic bradycardia when co-administered with sofosbuvir. Antagonized by St. John’s wort, cholestyramine. May affect thyroid function tests. See full labeling.
Nausea, vomiting, constipation, anorexia, CHF, pulmonary inflammation or fibrosis, malaise, fatigue, thyroid disorders, flushing, abnormal taste/smell, edema; post-op adult respiratory distress syndrome, exacerbation of arrhythmias, heart block or failure, sinus bradycardia, hepatotoxicity, corneal deposits, optic neuropathy/neuritis (reevaluate if occurs), photosensitivity, skin pigmentation, peripheral neuropathy.
Formerly known under the brand name Cordarone.