Optimal management of amiodarone therapy

Efficacy and side effects

Daniel E. Hilleman, Mary Ann Miller, Robert Parker, Paul Doering, John A. Pieper

Research output: Contribution to journalArticle

81 Citations (Scopus)

Abstract

Objectives. To review management and dosing guidelines for amiodarone therapy, and discuss the drug's adverse event profile. Methods. Review of relevant studies and reports. Results. Amiodarone is a highly effective antiarrhythmic drug, but is associated with adverse effects involving several organs. Amiodarone-induced arrhythmia is rare, with frequency of 0.3% in one study. Pulmonary toxicity is the most serious noncardiac side effect (2-17% of patients). Hypersensitivity pneumonitis can appear early in the course of therapy. Interstitial pneumonitis is a more common but insidious pulmonary reaction characterized by cough, low-grade fever, and dyspnea that occurs after months or years of therapy. Clinically important hypothyroidism and hyperthyroidism occur in 2-10% of patients. Optic neuritis or neuropathy in which patients experience decreased or blurred vision may progress to permanent blindness. Abnormalities in liver function tests, especially elevated aminotransferase and alkaline phosphatase levels, are seen in 4-25% of patients. Neurologic side effects were reported in 20-40% of patients, at times associated with tremor, ataxia, peripheral neuropathy, malaise or fatigue, sleep disturbances, dizziness, and headaches. Several types of dermatologic reactions have been reported, including allergic rash, photosensitivity, and blue-gray skin discoloration. The best strategy for early detection of pulmonary toxicity is vigilant clinical follow-up with monitoring of cardiac status and liver and thyroid function, and prescription of the lowest effective dosage. After an initial loading dose, 200 mg/day in many patients maintains arrhythmia control and minimizes the frequency of side effects. Conclusion. Amiodarone is a safe and efficacious antiarrhythmic agent when lower dosages are given to patients who are closely monitored and subject to careful follow-up.

Original languageEnglish
JournalPharmacotherapy
Volume18
Issue number6 II
StatePublished - Nov 1998
Externally publishedYes

Fingerprint

Amiodarone
Lung
Therapeutics
Cardiac Arrhythmias
Extrinsic Allergic Alveolitis
Optic Neuritis
Optic Nerve Diseases
Liver Function Tests
Anti-Arrhythmia Agents
Interstitial Lung Diseases
Dizziness
Peripheral Nervous System Diseases
Tremor
Hyperthyroidism
Ataxia
Blindness
Hypothyroidism
Transaminases
Exanthema
Drug-Related Side Effects and Adverse Reactions

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Hilleman, D. E., Miller, M. A., Parker, R., Doering, P., & Pieper, J. A. (1998). Optimal management of amiodarone therapy: Efficacy and side effects. Pharmacotherapy, 18(6 II).

Optimal management of amiodarone therapy : Efficacy and side effects. / Hilleman, Daniel E.; Miller, Mary Ann; Parker, Robert; Doering, Paul; Pieper, John A.

In: Pharmacotherapy, Vol. 18, No. 6 II, 11.1998.

Research output: Contribution to journalArticle

Hilleman, DE, Miller, MA, Parker, R, Doering, P & Pieper, JA 1998, 'Optimal management of amiodarone therapy: Efficacy and side effects', Pharmacotherapy, vol. 18, no. 6 II.
Hilleman DE, Miller MA, Parker R, Doering P, Pieper JA. Optimal management of amiodarone therapy: Efficacy and side effects. Pharmacotherapy. 1998 Nov;18(6 II).
Hilleman, Daniel E. ; Miller, Mary Ann ; Parker, Robert ; Doering, Paul ; Pieper, John A. / Optimal management of amiodarone therapy : Efficacy and side effects. In: Pharmacotherapy. 1998 ; Vol. 18, No. 6 II.
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