Users

amiodarone

Affected Drug

• C01BD01 Amiodarone

Baseline

Baseline: ECG, CXR, PFT’s, LFT’s, TSH/FT4, and eye exam if baseline visual impairment

Follow-up

Follow-up: Q6mo- AST, ALT, TSH, FT4; Yearly-ECG, CXR; PRN for symptoms- PFT’s, ophthalmology exam

Important Interactions

• Drugs: C01AA05 Digoxin
  Interaction increases digoxin concentrations – reduce dose by 50% and monitor levels
• Drugs: J01FA01 Erythromycin
  Interaction can prolong QT
• Drugs: J01FA10 Azithromycin
  Interaction can prolong QT
• Drugs: J01FA09 Clarithromycin
  Interaction can prolong QT
• Drugs: J01FA15 Telithromycin
  Interaction can prolong QT
• Drugs: J01MA02 Ciprofloxacin
  Interaction can prolong QT
• Drugs: J01MA12 Levofloxacin
  Interaction can prolong QT
• Drugs: J01MA14 Moxifloxacin
  Interaction can prolong QT
• Drugs: J01MA06 Norfloxacin
  Interaction can prolong QT
• Drugs: J01MA01 Ofloxacin
  Interaction can prolong QT
• Drugs: C07AG01 Labetalol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AB04 Acebutolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AA03 Pindolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07CA03 Pindolol And Other Diuretics
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AB04 Acebutolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AB03 Atenolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07CB03 Atenolol And Other Diuretics
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AB07 Bisoprolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AB09 Esmolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AB02 Metoprolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AA03 Pindolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: S01ED03 Levobunolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: S01ED53 Levobunolol, Combinations
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AA12 Nadolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AA05 Propranolol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C07AA07 Sotalol
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C08CA05 Nifedipine
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C08DA01 Verapamil
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C09BB10 Trandolapril And Calcium Channel Blockers
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C08DB01 Diltiazem
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C08CA01 Amlodipine
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C10BX03 Atorvastatin And Amlodipine
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C08CA02 Felodipine
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: C09BB05 Ramipril And Calcium Channel Blockers
  Interaction may act synergistically to cause symptomatic bradyarrhythmia
• Drugs: B01AA03 Warfarin
  Interaction amiodarone potentiates effect of warfarin – decrease dose by 25% and follow INR

Details

Conditions	System	Monitoring		ADE	Incidence	Recommendation
		Baseline	Follow-up
	Cardiac	EKG (baseline and prn if IV loading)	yearly EKG	prolonged qt (torsades des pointes)	<1%:	reduce amiodarone dose or d/c use
				symptomatic bradycardia or avb	3-5%	reduce amiodarone dose or d/c use
	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 (TSH+T4)	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: PFTs	Yearly: PRN for signs/symptoms	pulmonary toxicity (cough, fever, dyspnea)	1-2% (at maint dose < 400 mg/d)	Discontinue amiodarone immediately ; consider steroid treatment

References

• Vassallo, P et al. Prescribing amiodarone: an evidence-based review of clinical indications. J Am Med Assoc 2007;298:1312
• Goldschlager, N et al. Practical guidelines for clinicians who treat patients with amiodarone. Arch Intern Med 2000;160:1741
• Giardina, EG. Clinical use of amiodarone. In: UpToDate, Basow, DS (Ed) UpToDate, Waltham, MA, 2010.