Amiodarone: What is it? Side Effects, How to Use? Interactions and Precautions

This drug belongs to the family of medications known as Antiarrhythmics. It is used to treat certain types of abnormal heart rhythms (arrhythmias).

It works by changing the way electrical impulses affect the heart muscle and beating more regularly.

The effects of this medicine can be observed 3 days after starting the treatment, and generally beneficial effects are observed from 1 to 3 weeks.

How to use Amiodarone?

The recommended starting dose for adults is generally 800 mg to 1,600 mg daily during the first 3 weeks in divided doses. The dose is eventually reduced from 200 mg to 400 mg once a day as prescribed by your doctor and according to the circumstances.

This medicine can be taken with or without meals, but always in the same way every day. Do not drink grapefruit juice during treatment with Amiodarone because blood levels may increase.

The injectable form of the drug can be used in hospitals in specific circumstances. The recommended dose varies according to each patient and their conditions.

Many things can affect the dose of medication a person needs, such as body weight, other medical conditions and other medications.

If your doctor has recommended a different dose from the ones listed here, do not change the way you are taking the medication without consulting your doctor.

If you miss a dose, skip the dose and continue your regular dosing schedule. Do not take a double dose to make up for the forgotten dose.

Who should NOT take this medicine?

Do not use this medicine if you:

  • You are allergic to Amiodarone, iodine, or any ingredient in this medicine.
  • It has a very low heart rate.
  • You have certain lung problems.
  • He has hepatitis.
  • It has a second or third degree AV block (except when used with a pacemaker).
  • You have thyroid disease.
  • Do not give this medicine to people with cardiogenic shock.

Side effects

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be controlled, and some may go away on their own over time.

Contact your doctor if you experience these side effects and are severe or bothersome. Your pharmacist can advise you on the management of side effects:

  • Abdominal pain.
  • Bad taste in the mouth.
  • Constipation.
  • Difficulty to sleep.
  • Dizziness or lightheadedness
  • Nausea.
  • Sensitivity of the skin to sunlight.
  • Vomiting

Although most of the side effects listed below do not happen very often, they could cause serious problems if you do not seek medical attention.

Serious side effects:

  • Blue-gray coloration on the skin, face, neck or arms.
  • Blurry vision or greenish blue halos around the objects.
  • Confusion.
  • Dizziness or fainting
  • Goiter (lump in the neck).
  • Hair loss.
  • Inability to concentrate.
  • Low blood pressure .
  • Numbness or tingling in the fingers and toes.
  • Sensitivity to light.
  • Signs of coagulation problems (unusual nosebleeds, bruises, blood in the urine, coughing up blood, bleeding gums, cuts that do not stop bleeding).
  • Signs of liver problems (abdominal pain or swelling, dark urine, fever, itchy skin, loss of appetite, nausea and vomiting).
  • Pale or clay-colored stools
  • Yellowing of the skin or the whites of the eyes.
  • Acne.
  • Slow heartbeat.
  • Perspiration.
  • Swelling of the feet or lower legs.
  • Symptoms of overactive thyroid gland (nervousness, accelerated heart rate, hand tremor, weight loss and trouble sleeping).
  • Symptoms of underactive thyroid gland (dry skin, constipation, weight gain, fatigue, pain, pain and stiffness, cold intolerance, depression, memory problems).
  • Problems to walk.
  • Unusual and uncontrolled body movements.
  • Sight loss.
  • Weightloss.

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • Signs of irregular heartbeat (fainting, dizziness, lightheadedness, weakness or pain in the chest).
  • Rapid or irregular heartbeat.
  • Signs of a severe skin reaction such as blisters, peeling, rash that covers a large area of ​​the body.
  • Signs of a severe allergic reaction (hives, difficulty breathing, swelling of the lips, tongue or throat).
  • Signs of lung problems (coughing up blood, difficult breathing, fever, difficulty breathing).

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptoms that bother you while taking this medicine.

Precautions

Abnormal heart rhythm: Amiodarone can cause a disturbed heart rhythm called QT prolongation. It can also worsen or trigger an irregular heartbeat (arrhythmia).

Your doctor will monitor your heart rate regularly while taking this medicine with a test called an electrocardiogram (ECG).

Certain medications (Sotalol, quinidine, thioridazine, chlorpromazine, droperidol, pimozide) may increase the risk of a type of abnormal heart rhythm called QT prolongation, and should only be used in combination with Amiodarone if the benefit of receiving both medications outweighs the risk of secondary

You are more at risk for this type of abnormal heart rhythm and its complications if you:

  • She is a woman.
  • He is over 65 years old.
  • You have a family history of sudden cardiac death.
  • Have a history of heart disease or abnormal heart rhythms.
  • It has a slow heart rate.
  • It has congenital prolongation of the QT interval.
  • You have diabetes.
  • He has had a stroke.
  • It has low levels of potassium, magnesium or calcium.
  • It has nutritional deficiencies.

Levels of potassium and magnesium in the blood: people with low levels of potassium or magnesium should have these conditions corrected before starting to take Amiodarone, as it can worsen abnormal heart rhythms.

Congestive heart failure: Amiodarone can worsen congestive heart failure.

If you have congestive heart failure, talk to your doctor about how this medicine can affect your medical condition, how your medical condition may affect the dosage, and if any special monitoring is needed.

Liver disease: It can cause liver problems, so your doctor should check your liver function regularly.

If you have liver disease, talk with your doctor about how this medicine can affect your medical condition and if any special control is needed. People with hepatitis should not take Amiodarone.

Pulmonary problems: Amiodarone can cause lung problems (pulmonary fibrosis , permanent scarring of the lungs) that, in some cases, can be fatal.

If you experience any difficulty breathing, fever, difficulty breathing, coughing or coughing up blood, accompanied by weakness and weight loss while taking Amiodarone, tell your doctor immediately.

Skin: This medicine can make your skin more sensitive to the sun. Use sunscreen and protective clothing while taking Amiodarone.

Some people who use it for long-term treatment may develop a bluish-gray discoloration of the exposed skin.

Surgery: If you are scheduled for surgery, tell all doctors involved in your care that you are taking Amiodarone.

Thyroid disease: This medicine can cause thyroid problems. Your doctor will perform regular tests to check your thyroid function before and during treatment with Amiodarone, especially if you are an older person or if you have a history of thyroid problems.

Vision problems: Amiodarone can cause vision problems that can be severe or permanent. Regular eye exams are recommended during treatment with Amiodarone. If you notice any change in vision or problems, contact your doctor as soon as possible.

Pregnancy: This medicine can harm a developing baby if the mother takes it during pregnancy. In particular, it has been observed to cause thyroid problems in the baby.

This medicine should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Amiodarone, contact your doctor immediately.

Breast-feeding: This medicine passes into breast milk. If you are a nursing mother and are taking Amiodarone, it can affect your baby. Talk to your doctor about whether you should continue breastfeeding.

Children: The safety and efficacy of Amiodarone for use in children has not been established.

Interaction with other medications

There may be an interaction between Amiodarone and any of the following drugs:

  • Alpha blockers (Alfuzosin, Doxazosin, Tamsulosin).
  • Angiotensin receptor blockers (Candasartan, Irbesartan, Losartan.)
  • Antiarrhythmics (Disopyramide, Flecainide, Procainamide, Quinidine).
  • Anti-cancer drugs (Cabazitaxel, Docetaxel, Doxorubicin, Etoposide, Ifosfamide, Irinotecan, Vincristine).
  • Antihistamines (Cetirizine, doxylamine, diphenhydramine, hydroxyzine , loratadine).
  • Antipsychotics (Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Quetiapine, Risperidone).
  • “Azole” antifungals (Fluconazole, Ketoconazole, Itraconazole , Voriconazole).
  • Barbiturates (Phenobarbital, Secobarbital).
  • Betabloqueantes (Propranolol, Metoprolol).
  • Bosentan.
  • Brentuximab.
  • Blockers of calcium channels (amlodipine, diltiazem, nifedipine, verapamil).
  • Certain anesthetics.
  • Chloral hydrate.
  • Medications for diabetes (Plorpropamide, Glipizide, Gliburide, Insulin, Metformin , Nateglinide, Rosiglitazone).

If you are taking any of these medications, talk to your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • Stop taking one of the medications.
  • Change one of the medications for another.
  • Change the way you are taking one or both medications.
  • Leave everything as is.

An interaction between two medications does not always mean you should stop taking one of them. Talk to your doctor about how drug interactions are handled or controlled.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription and over-the-counter medications you are taking.

Also tell him about any supplement you are taking, because the caffeine, alcohol, nicotine in cigarettes or illegal drugs can affect the action of Amiodarone.

General considerations

Because of the possibility of serious side effects, Amiodarone should only be given by a doctor who is experienced in the treatment of abnormal heart rhythms.

Storage

Store this medication at room temperature, protect it from light and moisture and keep it out of the reach of children.

Do not dispose of medications in wastewater (for example, in the sink or in the toilet) or in household waste. Ask your pharmacist how to get rid of medications that are no longer needed or have expired