Amiodarone

Generic Name: amiodarone (oral) (A mi OH da rone)
Brand Names: Cordarone, Pacerone

What is amiodarone?

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 (sometimes called an EKG).

Important information

Amiodarone is for use only in treating life-threatening heart rhythm disorders.

You should not take this medicine if you are allergic to amiodarone or iodine, or if you have a serious heart condition such as "AV block" (unless you have a pacemaker), a history of slow heart beats, or if your heart cannot pump blood properly.

 Prednisone: 12 Things You Should Know

SLIDESHOW

Prednisone: 12 Things You Should Know

This medicine can cause dangerous side effects on your liver or your lungs.

Call your doctor at once if you have: chest pain, trouble breathing, upper stomach pain, dark urine, jaundice (yellowing of the skin or eyes), or if you cough up blood.

Do not use amiodarone without telling your doctor if you are pregnant. It could harm the unborn baby. Use effective birth control, and tell your doctor if you become pregnant during treatment.

To be sure this medication is not causing harmful effects, your blood may need to be tested on a regular basis. Your thyroid and liver function may also need to be tested, and you may need eye exams and chest x-rays. Do not miss any scheduled appointments.

Before taking this medicine

You should not use this medicine if you are allergic to amiodarone or iodine, or if you have:

certain serious heart conditions, especially "AV block" (unless you have a pacemaker);

a history of slow heart beats that have caused you to faint; or

if your heart cannot pump blood properly.

Amiodarone can cause dangerous side effects on your heart, liver, lungs, or thyroid.

To make sure amiodarone is safe for you, tell your doctor if you have:

asthma or another lung disorder;

liver disease;

a thyroid disorder;

vision problems;

high or low blood pressure;

an electrolyte imbalance (such as low levels of potassium or magnesium in your blood); or

if you have a pacemaker or defibrillator implanted in your chest.

Do not use amiodarone if you are pregnant. Taking amiodarone during pregnancy can harm the unborn baby or cause thyroid problems or abnormal heartbeats after the baby is born. Amiodarone may also affect the child's growth or development (speech, movement, academic skills) later in life. Use effective birth control to prevent pregnancy during treatment.

Amiodarone can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

How should I take amiodarone?

Take amiodarone exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

If you have been taking another heart rhythm medicine, you may need to gradually stop taking it when you start using amiodarone. Follow your doctor's dosing instructions very carefully.

You may take this medicine with or without food, but take it the same way each time.

It may take up to 2 weeks before your heart rhythm improves. Keep using the medicine as directed even if you feel well.

While using amiodarone, you will need frequent medical tests and chest x-rays to check your thyroid, vision, lungs, and liver function. Amiodarone can have long lasting effects on your body. You may need medical tests for several months after you stop using this medicine.

If you need surgery (including laser eye surgery), tell the surgeon ahead of time that you are using amiodarone. You may need to stop using the medicine for a short time.

Amiodarone can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using this medicine.

Store at room temperature away from moisture, heat, and light.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of amiodarone can be fatal.

Overdose symptoms may include weakness, slow heart rate, feeling light-headed, or loss of consciousness.

What should I avoid while taking amiodarone?

Grapefruit and grapefruit juice may interact with amiodarone and lead to unwanted side effects. Avoid the use of grapefruit products while taking amiodarone.

Avoid exposure to sunlight or tanning beds. Amiodarone can make you sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

This medicine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Amiodarone side effects

Get emergency medical help if you have signs of an allergic reaction to amiodarone: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Amiodarone takes a long time to completely clear from your body. You may continue to have side effects after you stop using it. It could take up to several months for the medicine to completely clear from your body.

Call your doctor at once if you have any of these side effects, even if they occur up to several months after you stop using amiodarone:

wheezing, cough, chest pain, coughing up blood, breathing problems that get worse;

a new or a worsening irregular heartbeat pattern (fast, slow, or pounding heartbeats);

a light-headed feeling, like you might pass out;

blurred vision, vision loss, headache or pain behind your eyes, sometimes with vomiting;

liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);

signs of overactive thyroid--weight loss, thinning hair, feeling too hot or too cold, increased sweating, irregular menstrual periods, swelling in your neck (goiter); or

signs of underactive thyroid--extreme tired feeling, dry skin, joint pain or stiffness, muscle pain or weakness, hoarse voice, feeling more sensitive to cold temperatures, weight gain.

Common amiodarone side effects may include:

dizziness, vision problems, seeing halos around lights;

loss of coordination, feeling weak or tired;

nausea, vomiting, constipation;

numbness or tingling;

tremors; or

abnormal liver function tests.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Amiodarone dosing information

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.

Usual Pediatric Dose for Supraventricular Tachycardia:

less than 1 month:

Limited data available: oral loading dose: 10 to 20 mg/kg/day orally in 2 divided doses for 7 to 10 days; dosage should then be reduced to 5 to 10 mg/kg/day once daily and continued for 2 to 7 months; this protocol was used in 50 infants (less than 9 months of age) and neonates (as young as 1 day of life); intravenous loading dose: 5 mg/kg given over 60 minutes; Note: Bolus infusion rates should generally not exceed 0.25 mg/kg/minute unless clinically indicated; most studies used bolus infusion time of 60 minutes to avoid hypotension; may repeat initial loading dose to a maximum total initial load: 10 mg/kg; do not exceed total daily bolus of 15 mg/kg/day.

less than 1 year: Initial dose: 600 to 800 mg/1.73 m²/day orally for 4 to 14 days given in 1 to 2 divided doses/day.

Maintenance dose: 200 to 400 mg/1.73 m²/day orally given once a day.

greater than 1 year: Initial dose: 10 to 15 mg/kg/day orally for 4 to 14 days given in 1 to 2 divided doses/day.

Maintenance dose: 5 to 10 mg/kg/day orally given once a day.

What other drugs will affect amiodarone?

Many drugs can interact with amiodarone. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

an antibiotic - azithromycin, ciprofloxacin, clarithromycin, erythromycin, levofloxacin, moxifloxacin, pentamidine, rifampin, and others;

an antidepressant - amitriptyline, citalopram, desipramine, doxepin, imipramine, nortriptyline, trazodone, and others;

a blood thinner - warfarin, Coumadin, Jantoven;

cancer medicines;

a diuretic or "water pill";

"statin" cholesterol medicine - atorvastatin, lovastatin, simvastatin, Lipitor, Zocor, Vytorin, and others;

heart or blood pressure medication - atenolol, carvedilol, clonidine, digoxin, disopyramide, dofetilide, flecainide, ivabradine, metoprolol, nebivolol, procainamide, propranolol, quinidine, sotalol, verapamil, and many others;

hepatitis C medication - ledipasvir, simeprevir, sofosbuvir, Harvoni, Olysio, Sovaldi;

HIV or AIDS medication - indinavir, nelfinavir, rilpivirine, ritonavir, saquinavir; or

medicine to treat mental illness - chlorpromazine, fluphenazine, haloperidol, lithium, pimozide, promethazine, thioridazine, ziprasidone, and others.

This list is not complete and many other drugs can interact with amiodarone. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Amiodarone takes a long time to completely clear from your body, and drug interactions are possible for up to several months after you stop using amiodarone. Talk to your doctor before taking any medication during this time. Keep track of how long it has been since your last dose of amiodarone.