AMIODARONE Flashcards
Amiodarone indication
Treatment of arrhythmias
Specialist
Class
3
Amiodarone - loading dose
LOADING DOSE:
200mg TDS for 7 days →
200mg BD for 7 days →
200mg OD maintenance
Administration route
IV infusion
- rapid
- little or no myocardial depression
PO
Administration
OD
- long half life
- can extend to several weeks
- may take months of weeks to ready SS
CI
General C/I:
- Thyroid dysfunction
- sino-atrial block
Specific to IV amiodarone:
- Avoid bolus injection in Congestive Heart failure
SEs
- Corneal Microdeposits
- Brady
- Thyroid Disorders
- Photosensitivity Reaction
- Hepatotoxicity
- Pulmonary Toxicity
- Peripheral neuropathy
Amiodarone - Corneal Microdeposits
Reversible when treatment ends - if vision is impaired: STOP
Thyroid Disorders
Can cause hypo or hyperthyroidism due to iodine content
Hepatotoxicity
Stop if patient develops signs of liver disease
- dark urine
- yellow skin, jaundice
- N + V
Pulmonary Toxicity
Report in cases of new / progressive shortness of breath or coughs
Peripheral neuropathy
- new neurological symptoms
- numbness, tingling
Amiodarone - Driving and Skilled Tasks
Microdeposits may lead to blurred vision
Interactions
- Drugs that cause hypokalaemia
- Drugs that cause QT prolongation
- CYP450 Enzyme substrates (Amiodarone = inhibitor)
- Other enzyme inhibitors (grapefruit) and inducers will affect amiodarone too
- Drugs that cause bradycardia
- Beta-blockers or RL-CCBs
Monitoring
- TFTs - before, every 6m
- LFTs - before, every 6m
- Serum K+ - before
- Chest x-ray - before
- IV - ECG + liver transanimase
Counselling
- Photosensitivity - shield from sun during treatment and several months after
Patients who have stopped amiodarone within the last few months and need to start sofosbuvir and daclatasvir, simeprevir and sofosbuvir, or sofosbuvir
and ledipasvir
should be monitored → risk of severe heart block
