Drug information of Amiodarone


Amiodarone

Drug group:

Amiodarone affects the rhythm of your heartbeats. It is used to help keep the heart beating normally in people with life-threatening heart rhythm disorders of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). Amiodarone is used to treat ventricular tachycardia or ventricular fibrillation. Amiodarone is for use only in treating life-threatening heart rhythm disorders. You will receive your first few doses in a hospital setting, where your heart rhythm can be monitored using an electrocardiograph or ECG

Mechanism of effect

The antiarrhythmic effect of amiodarone may be due to at least two major actions. It prolongs the myocardial cell-action potential (phase 3) duration and refractory period and acts as a noncompetitive a- and b-adrenergic inhibitor.

Pharmacodynamic

Amiodarone belongs to a class of drugs called Vaughan-Williams Class III antiarrhythmic agents.

Pharmacokinetics

Following oral administration in man, Amiodarone is slowly and variably absorbed. The bioavailability of Amiodarone is approximately 50%. the onset of action may occur in 2 to 3 days, but more commonly takes 1 to 3 weeks, Food increases the rate and extent of absorption of Amiodarone. Amiodarone has a very large but variable volume of distribution, averaging about 60 L/kg. Amiodarone is eliminated primarily by hepatic metabolism and biliary excretion.

Dosage

Usual Adult Dose for Arrhythmias Initial dose (IV): 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: 150 mg over the first 10 minutes (15 mg/min), followed by 360 mg over the next 6 hours (1 mg/min). Maintenance infusion: 540 mg over the remaining 18 hours (0.5 mg/min). Initial dose (PO): Loading doses of 800 to 1600 mg/day are required for 1 to 3 weeks (occasionally longer) until initial therapeutic response occurs. When adequate arrhythmia control is achieved, or if side effects become prominent, the dose should be reduced to 600 to 800 mg/day for one month and then to the maintenance dose, usually 400 mg/day. Some patients may require up to 600 mg/day. Amiodarone may be administered as a single daily dose, or in patients with severe gastrointestinal intolerance, as a twice daily dose.

Interactions

Atenolol , Azithromycin , Ipratropium bromide , isosorbide dinitrate , Propafenone , Promethazine , Pitolisant , Lopinavir and Ritonavir , Troleandomycin , Gadofosveset , Methyl aminolevulinate , Pimavanserin , Betrixaban , lenvatinib , Apalutamide , Flibanserin , Edoxaban , Abarelix , Asenapine , Alfuzosin , Amisulpride , Paliperidone , Bendroflumethiazide , Halofantrine , aminolevulinic acid oral , Aminolevulinic acid topical , cobicistat , Sofosbuvir and velpatasvir , Terfenadine , Chlorthalidone , Arsenic trioxide , Efavirenz , Tipranavir , Etravirine , Panitumumab , Anagrelide , Promazine , Torasemide , probucol , Vasopressin , Pirfenidone , Procainamide , Mefloquine , Indapamide , Ibutilide , Inotuzumab‎ , Goserelin , vandetanib , boceprevir , Droperidol , Osimertinib , Indinavir , Mesoridazine , nelfinavir , Ivabradine , Phenindione , Pindolol , Afatinib , Palonosetron , propoxyphene , protriptyline , Axitinib , ISOPROTERENOL , ritonavir , saquinavir , Prochlorperazine , Quinidine , Dabigatran , Ziprasidone , Histrelin , teriflunomide , Rifabutin , Ranolazine , Pentamidine , Methazolamide , Buprenorphine , Toremifene , Disulfiram , Bisoprolol , Daclatasvir , Sofosbuvir , ledipasvir and sofosbuvir , fentanyl , Nitroglycerin , Nilotinib , Vardenafil , Chlorpromazine , Flecainide , Rivaroxaban , Lovastatin , Levofloxacin , Lidocaine , Mefenamic acid , Mexiletine , Moxifloxacin , Simvastatin , Cyclosporine , Phenylephrine , Fingolimod , Loperamide , Loratadin , Daunorubicin , Diltiazem , Ranitidine , Salbutamol , Sevo flurane , Cisapride , Pimozide , Tamsulosin , Tetrabenazine , Trazodone , Topotecan , Tolterodine

Alerts

1- Amiodarone is intended for use only in patients with the indicated life-threatening arrhythmias because its use is accompanied by substantial toxicity. 2- Pulmonary Toxicity, Worsened Arrhythmia, Impairment of Vision, peripheral neuropathy , Photosensitivity, Thyroid Abnormalities may occure. 3- The safety and effectiveness of Amiodarone hydrochloride tablets in pediatric patients have not been established.

Points of recommendation

1-Elevations in liver enzymes (aspartate aminotransferase and alanine aminotransferase) can occur. Liver enzymes in patients on relatively high maintenance doses should be monitored on a regular basis. 2-Amiodarone alters the results of thyroid-function tests, causing an increase in serum T4 and serum reverse T3, and a decline in serum T3 levels. Despite these biochemical changes, most patients remain clinically euthyroid. 3-Patients should receive a baseline chest X-ray and pulmonary function tests including diffusion capacity prior to initiation of therapy and ever 3 to 6 months thereafter.

Pregnancy level

D

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