Amiodarone 200mg

Class III Antiarrhythmic Agent

“ALERT: US Boxed Warning

Life-threatening arrhythmias (tablet):

Amiodarone is intended for use only in patients with indicated life-threatening arrhythmias because its use is accompanied by substantial toxicity.

Pulmonary toxicity (tablet):

Amiodarone can cause pulmonary toxicity (hypersensitivity pneumonitis or interstitial/alveolar pneumonitis) that has resulted in clinically manifest disease at rates as high as 17% in some series of patients. Pulmonary toxicity has been fatal about 10% of the time. Obtain a baseline chest X-ray and pulmonary function tests, including diffusion capacity, when amiodarone therapy is initiated. Repeat history, physical exam, and chest X-ray every 3 to 6 months.

Hepatotoxicity:

Amiodarone can cause hepatotoxicity, which can be fatal. Obtain baseline and periodic liver transaminases and discontinue or reduce dose if the increase exceeds 3 times normal or doubles in a patient with an elevated baseline. Discontinue amiodarone if the patient experiences signs or symptoms of clinical liver injury.

Worsened arrhythmia (tablet):

Amiodarone can exacerbate arrhythmias. Initiate amiodarone in a clinical setting where continuous ECGs and cardiac resuscitation are available.”

CSA NA – FDA Approved – REMS (N) – Can Ship

Amiodarone/Pacerone/Cordarone inhibits both alpha- and beta-adrenergic receptors, and has action on sodium, calcium, and potassium channels, decreases AV conduction and sinus node function, prolongs action potential and refractory period in myocardial tissue.  All these actions result in adjusted heart rate and electrical activity to correct the arrhythmia.

Amiodarone/Pacerone/Cordarone is officially indicated for use in life threatening recurrent ventricular arrythmias when responses to other agents fail.  It is also prescribed off-label for use in refractory atrial fibrillation, for pharmacological cardioversion, prevention of post cardiothoracic surgery atrial fibrillation/flutter, rate control as an alternate agent, and other scenarios related to various arrhythmia.  

Before starting Amiodarone/Pacerone/Cordarone make sure your physician is aware of any allergies (especially hypersensitivity to iodine) or medications you currently take, if you have kidney disease, liver disease, thyroid disease, sick sinus syndrome, bradycardia with no pacemaker, atrioventricular block, pulmonary interstitial abnormalities, implanted cardiac device, electrolyte imbalances, history of heart attack, Wolff-Parkinson-White syndrome, are pregnant or breastfeeding. 

Average of 100-400mg daily divided into one or two dosages for maintenance therapy.  Significantly higher dosages may be used initially to cardiovert patient into normal sinus rhythm before starting maintenance.  

How to Take: Follow instructions provided by physician/pharmacy label, take consistently at same times each day and consistently with or without food unless otherwise directed, store at room temperature.

You Need to Avoid: This medication has many drug interactions so ask your pharmacist before starting any over the counter medications or supplements. Do not consume grapefruit juice with this medication.

Hypotension, phospholipidemia, nausea, vomiting, epithelial keratopathy, pulmonary toxicity, skin photosensitivity, hypothyroidism, bradycardia, anorexia, constipation, abnormal gait, ataxia (uncoordinated movements), tremor, QT prolongation

Note this is not a complete list of side effects, only common ones

1. This medication has a lot of scary side effects, is it safe?
   This medication is highly effective for controlling arrhythmias however due to risk of some serious side effects and its many drug interactions, it is usually only used in emergency scenarios or when other agents have been ineffective.  Many people use this medication with no issues, but due to potential risk other agents are generally attempted first.  If prescribed this medication, your physicians concern about the risks of arrhythmia which can be fatal, outweigh the risks of adverse reaction.