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Updated 11 February 2013

Amiodarone

Amiodarone is indicated for the treatment of abnormal heart rhythms.

1

Amiodarone is the active ingredient of Cordarone, Hexarone, AryCor and Bio-Amiodarone.

General Information

Amiodarone is indicated for the treatment of abnormal heart rhythms. Other than beta blocker drugs, this medication is considered to be the safest oral anti-arrhythmic dug available. It is, however, still recommended that treatment should be started under specialist supervision.

Amiodarone is stored in body tissue, and to load the body with the drug, tissue needs to be saturated. As a result of this, adverse effects with amiodarone may take several weeks to appear and may continue for months after withdrawal. This is because the drug is not metabolised by the liver or kidneys, but only when tissue cells containing amiodarone are shed – it may remain in the body for a very long time.

Sun exposure should be avoided while taking amiodarone and also for several weeks after stopping treatment as the drug can cause severe discoloration of the skin, generally in areas of sun exposure. It may furthermore sensitise the skin to sunlight which can result in sunburn.

Amiodarone has caused a condition known as halo-vision in several patients. This is when the drug causes deposits on the cornea of the eye. Bright light at night will appear as a foggy illumination.

How does it work?

Amiodarone slows nerve impulses in heart muscle, thereby affecting and restoring rhythm.

Fast facts

Drug schedule: Schedule 4

Available as: Tablets and injection

What does it do? Stabilises abnormal heart rhythm

Overdose risk: Medium

Dependence risk: Low

Available as a generic? Yes (tablets)

Available on prescription only? Yes

User information

Onset of effect: It may take several months to achieve the full benefit of this drug.

Duration of action: Effects may persist for as long as 5 months after withdrawal.

Stopping this medicine: If this drug is stopped suddenly, symptoms of the condition being treated may recur. It should not be discontinued without consulting your doctor.

Prolonged use: The need for prolonged use should be reassessed at regular intervals as adverse effects on the liver, lungs, thyroid gland and eyes have been reported with long-term use.

Special precautions

Consult your doctor before using this drug if:

  • you are sensitive to iodine,
  • you have a thyroid disorder,
  • you have a lung disease, like asthma or bronchitis,
  • you have a heart disease,
  • you have an eye disease, or
  • you are taking other medications.

Pregnancy: Avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant. Note that because amiodarone stays in the body so long, it should be stopped several months before conception.

Breastfeeding: Avoid. This medication is passed through breast milk and may affect your baby adversely. Consult your doctor before use.

Porphyria: Avoid. This medication may cause serious adverse effects. Consult your doctor before use.

Infants and children: This medication is not intended for use in children.

Elderly: Caution is advised in the elderly as side effects may be more severe. A dosage adjustment may be needed.

Driving and hazardous work: Caution is advised as use of this medication may affect your vision. Avoid such activities until you know how it affects you.

Alcohol: No special precautions need to be taken.

Possible side effects

Side effect

Frequency

Consult your doctor

Common

Rare

Only if severe

In all cases

Nausea/ vomiting

x

x

Headache

x

x

Photosensitivity

x

x

Altered thyroid function

x

x

Visual disturbance

x

x

Changes in heart rate

x

x

Fatigue

x

x

Grey skin

x

x

Shortness of breath/cough

x

x

Rash/ itchy skin

x

x

Numb/ tingling fingers/toes

x

x

Interactions

Drug interactions

Anaesthetic agents

Increased risk of complications

Warfarin

Increased risk of bleeding

Drugs for malaria

Increased risk of heart rhythm disturbance

Antipsychotic drugs

Increased risk of heart rhythm disturbance

Beta blockers

Increased risk of low blood pressure and heart rhythm disturbance

Nifedipine, Diltiazem, etc

Increased risk of serious low blood pressure and heart rhythm disturbance

Cholestyramine

Lowered effect of amiodarone

Ciclosporin

Increased risk of kidney damage

Cimetidine

Increased risk of amiodarone toxicity

Co-trimoxazole

Increased risk of heart rhythm disturbance

Digoxin

Increased risk of amiodarone toxicity

Ritonavir

Increased risk of amiodarone toxicity

Lithium

Risk of lower thyroid function

Erythromycin

Increased risk of heart rhythm disturbance

Phenytoin

Risk of phenytoin toxicity

Tropisetron

Increased risk of heart rhythm disturbance

Overdose action

A small overdose is no cause for concern. In case of intentional large overdose, seek emergency medical attention.

Recommended dosage

Adults: A maintenance dose of 100-200mg daily (maximum 600mg/day) is generally prescribed. Your doctor may start your treatment with what is known as a loading dose: a high dose that is gradually lowered.

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.

 
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