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Author: Admin | 2025-04-28
Amiodarone, a class III antiarrhythmic, has become the drug of choice for the management of supraventricular and ventricular arrhythmias.1,2 Although not an FDA- approved indication, the use of amiodarone to treat atrial fibrillation is supported by practice guidelines from the American College of Cardiology/ American Heart Association (AHA) and the European Society of Cardiology.Amiodarone, a class III antiarrhythmic, has become the drug of choice for the management of supraventricular and ventricular arrhythmias.1,2 Although not an FDA- approved indication, the use of amiodarone to treat atrial fibrillation is supported by practice guidelines from the American College of Cardiology/ American Heart Association (AHA) and the European Society of Cardiology.3 The AHA 2005 Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care suggest that amiodarone may be considered--before other antiarrhythmic therapy is given--for treatment of recurrent ventricular fibrillation and pulseless ventricular tachycardia that is resistant to CPR, precordial shocks, and vasopressors.4A HIGH-RISK AGENTAlthough amiodarone is widely used, it must be considered a high-risk agent. The drug has an extensive adverse-effect profile, including thyroid, hepatic, and pulmonary toxicities.5,6 Before therapy is initiated, baseline thyroid, liver, and pulmonary function tests are recommended. In addition, a baseline chest radiograph and eye examination should be performed. Because of the extremely long half-life of amiodarone, its effects can persist long after it has been discontinued.Furthermore, amiodarone is associated with significant drug interactions, which require prudent monitoring and dosage adjustments. Our emphasis here is on the clinically relevant interactions; in Tables 1 through 5, we provide strategies to minimize risk.Table 1 - Amiodarone and CV agents: examples of clinically significant interactions*WarfarinSignificant increase in INR. Onset may be seen within 1 to 2 weeks. Peak effect is at 7 weeks.Decrease warfarin dose by 20% to 30%. Higher maintenance doses of amiodarone may require even greater reductions in warfarin dose. Closely
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