Document Actions
Amiodarone
Amiodarone Monitoring:
| System | Monitoring | ADE | Incidence | Recommendation | |
| Baseline | Follow-up | ||||
| Cardiac | ECG (baseline & during load) | Yearly | Prolonged QT; tdP | <1% | Reduce amiodarone dose or discontinue use |
| Symptomatic bradycardia or AVB | 3-5% | ||||
| Derm | Physical Exam | PRN for signs/symptoms | Photosensitivity | 25-75% | Avoid sunlight; use sunscreen |
| Blue-gray discoloration | 4-9% | Reduce dose or discontinue | |||
| Endocrine | Thyroid fxn (TSH + T4) | Every 6 months | Hypothyroidism | 6% | Tx w/ levothyroxine |
| Hyperthyroidism | 1-2% | Discontinue amiodarone; refer to endocrinologist | |||
| Hepatic | LFT’s | AST & ALT
Every 6 months |
AST, ALT >2x ULN | 15-30% | Reduce amiodarone dose or discontinue |
| Hepatitis/cirrhosis | <3% | Discontinue amiodarone | |||
| Neurologic | Physical Exam | PRN for signs/symptoms | Most commonly tremor/ataxia | 3-35% | Reduce amiodarone dose or discontinue |
| Ophtho | Eye exam (if baseline visual impairment) | PRN for signs/symptoms | Corneal deposits | >90% | Continue amiodarone treatment |
| Optic neuropathy | <1-2% | Discontinue amiodarone | |||
| Resp | CXR | Yearly | Pulmonary toxicity (cough, fever, dyspnea) | 1-2% (at maint dose < 400 mg/d) | Discontinue amiodarone immediately ; consider CS treatment |
| PFTs | PRN for signs/symptoms | ||||
References:
Vassallo, P, Trohman, RG. Prescribing Amiodarone: an evidence-based review of clinical indications. JAMA 2007; 298:1312
Goldschlager, N, Epstein, AE, Naccarelli, G et al. Practical guidelines for clinicians who treat patients with amiodarone. Arch Intern Med 2000; 160: 1741
Up to Date
Amiodarone Monitoring:
Baseline: ECG, CXR, PFT’s, LFT’s, TSH/T4, and eye exam if baseline visual impairment
Follow-up:
Q6mo: AST, ALT, TSH, T4
Yearly; ECG, CKR
PRN for symptoms: PFT’s, ophthalmology exam
Important interactions:
Antiobiotics (macrolides and quinolones can prolong QT)
Digoxin (increases digoxin concentrations – reduce dose by 50% and monitor levels)
B-blockers (may act synergistically w/ amiodarone to cause symptomatic bradyarrhythmia)
CCB (may act synergistically w/ amiodarone to cause symptomatic bradyarrhythmia)
Warfarin (amiodarone potentiates effect of warfarin – decrease dose by 25% and follow INR)