Amiodarone side effects from the cardiovascular system Review article
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Published:
Dec 31, 2012
Keywords:
amiodarone, side effects, circulatory system
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Abstract
Amiodarone is a most commonly used drug in pharmacotherapy of ventricular and supraventricular arrhythmias. Side effects affecting circulatory system are quite rare. Hypotension occurred in about 10% pts. is the most common side effect of amiodarone during iv. use. Chronic use of amiodarone may lead to development of new cases of heart failure or exacerbation of existing one. Proarrhythmic effect is observed in pts. with prolong QT interval, hypokalemia, previously treated with other antiarrhythmic drugs, female, congestive heart failure, and is dose and time of use dependent. Most threaten arrhythmia seen Turing chronic amiodarone intake is Torsade de Pointes, which occurred In 0.5% pts. Conduction disturbance, elevated pacing threshold, and impaired pacemaker function are seen rare.
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Kosior , D. A., Postuła , M., Brodowski , K., & Żylińska , E. (2012). Amiodarone side effects from the cardiovascular system. Cardiology in Practice, 6(2), 24-28. Retrieved from https://journalsmededu.pl/index.php/kwp/article/view/1582
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References
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2. Gil J.: Amiodarone: an overview of its pharmacological properties, and review of its therapeutic use in cardiac arrhythmias. Drugs 1992; 43: 69-110.
3. Podrid P.J.: Amiodarone: reevaluation of an old drug. Ann. Intern. Med. 1995; 122: 689-720.
4. Green H.L., Graham E.L., Werner J.A. et al.: Toxic and therapeutic effects of amiodarone in the treatment of cardiac arrythmias. J. Am. Coll. Cardiol. 1984; 2: 1114-1128.
5. Harris L., McKenna W.J., Rowland E. et al.: Side effects and possible contraindications and amiodarone use. Am. Heart J. 1983; 106: 916-923.
6. Mason J.W.: Amiodarone. N. Engl. J. Med. 1987; 316: 455-466.
7. Gough W.B., Zeiler R.H., Barreca P. et al.: Hypotensive action of commercial intravenous amiodarone and polysorbate 80 in dogs. J. Cardiovasc. Pharmacol. 1982; 4: 375-380.
8. Wyeth Laboratories. Cordarone® Intravenous (amiodarone hydrochloride) prescribing information. Philadelphia, PA; 2002 Jan 24.
9. Gallik D.M., Singer I., Meissner M.D. et al.: Hemodynamic and surface electrocardiographic effects of a new aqueous formulation of intravenous amiodarone. Am. J. Cardiol. 2002; 90: 964-968.
10. Anastasiou-Nana M.I., Nanas J.N., Alexopoulos G. et al.: Amiodarone concentration in human myocardium after rapid intravenous administration. Cardiovasc. Drugs Ther. 1999; 13: 265-270.
11. Mahmarian J.J., Smart F.W., Moye L.E. et al.: Exploring the minimal dose of amiodarone with antiarrhythmic and hemodynamic activity. Am. J. Cardiol. 1994; 74: 681-686.
12. DePaola A.A.V., Horowitz L.N., Spielman S.R. et al.: Development of congestive heart failure and alterations in left ventricular function in patients with sustained ventricular tachyarrhythmias treated with amiodarone. Am. J. Cardiol. 1987; 60: 276-80.
13. Kosinski E.J., Albin J.B., Young E. et al.: Hemodynamic effects of amiodarone. J. Am. Coll. Cardiol. 1984; 4: 565-570.
14. Doval H.C., Nul D.R., Grancelli H.O. et al.: Randomized trial of low-dose amiodarone in severe congestive heart failure (GESICA trial). Lancet 1994; 344: 493-498.
15. Deedewania P.C., Singh B.N., Ellenbogen K. et al.; for the Department of Veteran Affairs CHF-STAT Investigators. Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). Circulation 1998; 98: 2574-2579.
16. Hamer A.W.F., Arkles B., Johns J.A.: Beneficial effects of low dose amiodarone in patients with congestive heart failure: a placebo controlled trial. J. Am. Coll. Cardiol. 1989; 14: 1768-1774.
17. Cleland J.G., Dargie H.J., Findlay I.N. et al.: Clinical, hemodynamic and antiarrhythmic effects of long term treatment with amiodarone of patients in heart failure. Br. Heart J. 1987; 57: 436-445.
18. Singh B.N., Vaughan Williams E.M.: The effect of amiodarone, a new anti-anginal drug, on cardiac muscle. Br. J. Pharmacol. 1970; 39: 657-667.
19. Herre J.M., Sauve M.J., Malone P. et al. : Long term results of amiodarone therapy in patients with reccurent sustained ventricular tachycardia or ventricular fibrillation. J. Am. Coll. Cardiol. 1989; 13: 442-449.
20. Weinberg B.A., Miles W.M., Klein S. et al.: Five-year follow-up of 589 patients treated with amiodarone. Am. Heart J. 1993; 125: 109-120.
21. Fogoros R.N., Anderson K.P., Winkle R.A. et al.: Amiodarone: clinical efficacy and toxicity in 96 patients with reccurent drug-refractory arrythmias. Circulation 1983; 63: 88-94.
22. Haffaje C.I., Love J.C., Canada A.T. et al.: Clinical pharmacokinetics and efficacy of amiodarone for refractory tachyarrhythmias. Circulation 1983; 67: 45-51.
23. Harris L., McKenna W.J., Rowland E. et al.: Side effects of long-term amiodarone therapy. Circulation 1983; 67: 45-51.
24. McGovern B., Garan H., Kelly E. et al.: Adverse reactions during treatment with amiodarone hydrochloride. Br. Med. J. 1983; 287: 175-180.
25. Morady F., Sauve M.J., Malone P. et al.: Long-term efficacy and toxicity of high-dose amiodarone therapy for ventricular tachycardia or ventricular fibrillation. Am. J. Cardiol. 1983; 52: 975-979.
26. Kou C.S., Reddy C.P., Paciotti M.V.: Asystole during treatment with amiodarone in a patient with persistent atrial tachycardia. J. Electrocardiol. 1985; 18: 105-110.
27. Rady M.Y., Ryan T., Start N.J.: Perioperative therapy with amiodarone and the incidence of acute organ dysfunction after cardiac surgery. Anesth. Analg. 1997; 85: 489-497.
28. The Cardiac Arrhythmia Suppresion Trial (CAST) Invetigators. Effect of encainide and flecainide on mortality in infarction. N. Engl. J. Med. 1989; 321: 406-412.
29. Brown M.A., Smith W.M., Lubbe W.F. et al.: Amiodarone-induced torsade de points. Eur. Heart J. 1986; 7: 234-239.
30. Leroy G., Haiat R., Barthelemy M. et al.:Torsade de points during loading with amiodarone. Eur. Heart J. 1987; 8: 541-543.
31. Rotmensch H.H., Belhassen B., Swanson B.N. et al.: Steady-state serum amiodarone concentrations: relationships with antiarrhythmic efficacy and toxicity. Ann. Intern. Med. 1984; 101: 462-469.
32. Raehl C.L., Patel A.K., LeRoy M.: Drug-induced torsade de points. Clin. Pharm. 1985; 4: 675-690.
33. Makkar R.R., Fromm B.S., Steinman R.T. et al.: Female gender as a risk factor for torsade de points associated with cardiovascular drugs. JAMA 1993; 270: 2590-2597.
34. Leatham E.W., Holt D.W., McKeanna W.J. et al.: Class III antiarrhythmic in overdose. Presenting features and management principles. Drug Safe. 1993; 9: 450-462.
35. Rae A.P., Kay H.R., Horowitz L.N. et al.: Proarrhythmic effect of antiarrhythmic drugs in patients with malignant ventricular arrhythmias evaluated by electrophysiologic testing. J. Am. Coll. Cardiol. 1988; 12: 131-139.
36. Kadish A.H., Buxton A.E., Waxman H.L. et al.: Usefulness of electrophysiologic study to determine the clinical tolerance of arrythmia reccurrens during amiodarone therapy. J. Am. Coll. Cardiol. 1987; 10: 90-96.
37. Forgos R.N.: Amiodarone-induced refractoriness to cardioversion. Ann. Inter. Med. 1984; 100: 699-700.
38. Levick C.E., Mizgala H.F., Kerr C.R.: Failure to pace following high dose aniarrhythmic therapy – reversal with isoproterenol. Pacing Clin. Electrophysiol. 1984; 7: 252-256.
39. Julian D.G., Camm A.J., Fragin G. et al.; for the EMIAT investigators. Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet 1997; 349: 667-674.
40. Carins J.A., Connolly S.J., Roberts R.S. et al.; for the CAMIAT investigators. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Lancet 1997; 349: 675-682.
41. Amiodarone Trials Meta-Analysis Investigators. Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomized trials. Lancet 1997; 350: 1417-1424.
2. Gil J.: Amiodarone: an overview of its pharmacological properties, and review of its therapeutic use in cardiac arrhythmias. Drugs 1992; 43: 69-110.
3. Podrid P.J.: Amiodarone: reevaluation of an old drug. Ann. Intern. Med. 1995; 122: 689-720.
4. Green H.L., Graham E.L., Werner J.A. et al.: Toxic and therapeutic effects of amiodarone in the treatment of cardiac arrythmias. J. Am. Coll. Cardiol. 1984; 2: 1114-1128.
5. Harris L., McKenna W.J., Rowland E. et al.: Side effects and possible contraindications and amiodarone use. Am. Heart J. 1983; 106: 916-923.
6. Mason J.W.: Amiodarone. N. Engl. J. Med. 1987; 316: 455-466.
7. Gough W.B., Zeiler R.H., Barreca P. et al.: Hypotensive action of commercial intravenous amiodarone and polysorbate 80 in dogs. J. Cardiovasc. Pharmacol. 1982; 4: 375-380.
8. Wyeth Laboratories. Cordarone® Intravenous (amiodarone hydrochloride) prescribing information. Philadelphia, PA; 2002 Jan 24.
9. Gallik D.M., Singer I., Meissner M.D. et al.: Hemodynamic and surface electrocardiographic effects of a new aqueous formulation of intravenous amiodarone. Am. J. Cardiol. 2002; 90: 964-968.
10. Anastasiou-Nana M.I., Nanas J.N., Alexopoulos G. et al.: Amiodarone concentration in human myocardium after rapid intravenous administration. Cardiovasc. Drugs Ther. 1999; 13: 265-270.
11. Mahmarian J.J., Smart F.W., Moye L.E. et al.: Exploring the minimal dose of amiodarone with antiarrhythmic and hemodynamic activity. Am. J. Cardiol. 1994; 74: 681-686.
12. DePaola A.A.V., Horowitz L.N., Spielman S.R. et al.: Development of congestive heart failure and alterations in left ventricular function in patients with sustained ventricular tachyarrhythmias treated with amiodarone. Am. J. Cardiol. 1987; 60: 276-80.
13. Kosinski E.J., Albin J.B., Young E. et al.: Hemodynamic effects of amiodarone. J. Am. Coll. Cardiol. 1984; 4: 565-570.
14. Doval H.C., Nul D.R., Grancelli H.O. et al.: Randomized trial of low-dose amiodarone in severe congestive heart failure (GESICA trial). Lancet 1994; 344: 493-498.
15. Deedewania P.C., Singh B.N., Ellenbogen K. et al.; for the Department of Veteran Affairs CHF-STAT Investigators. Spontaneous conversion and maintenance of sinus rhythm by amiodarone in patients with heart failure and atrial fibrillation: observations from the veterans affairs congestive heart failure survival trial of antiarrhythmic therapy (CHF-STAT). Circulation 1998; 98: 2574-2579.
16. Hamer A.W.F., Arkles B., Johns J.A.: Beneficial effects of low dose amiodarone in patients with congestive heart failure: a placebo controlled trial. J. Am. Coll. Cardiol. 1989; 14: 1768-1774.
17. Cleland J.G., Dargie H.J., Findlay I.N. et al.: Clinical, hemodynamic and antiarrhythmic effects of long term treatment with amiodarone of patients in heart failure. Br. Heart J. 1987; 57: 436-445.
18. Singh B.N., Vaughan Williams E.M.: The effect of amiodarone, a new anti-anginal drug, on cardiac muscle. Br. J. Pharmacol. 1970; 39: 657-667.
19. Herre J.M., Sauve M.J., Malone P. et al. : Long term results of amiodarone therapy in patients with reccurent sustained ventricular tachycardia or ventricular fibrillation. J. Am. Coll. Cardiol. 1989; 13: 442-449.
20. Weinberg B.A., Miles W.M., Klein S. et al.: Five-year follow-up of 589 patients treated with amiodarone. Am. Heart J. 1993; 125: 109-120.
21. Fogoros R.N., Anderson K.P., Winkle R.A. et al.: Amiodarone: clinical efficacy and toxicity in 96 patients with reccurent drug-refractory arrythmias. Circulation 1983; 63: 88-94.
22. Haffaje C.I., Love J.C., Canada A.T. et al.: Clinical pharmacokinetics and efficacy of amiodarone for refractory tachyarrhythmias. Circulation 1983; 67: 45-51.
23. Harris L., McKenna W.J., Rowland E. et al.: Side effects of long-term amiodarone therapy. Circulation 1983; 67: 45-51.
24. McGovern B., Garan H., Kelly E. et al.: Adverse reactions during treatment with amiodarone hydrochloride. Br. Med. J. 1983; 287: 175-180.
25. Morady F., Sauve M.J., Malone P. et al.: Long-term efficacy and toxicity of high-dose amiodarone therapy for ventricular tachycardia or ventricular fibrillation. Am. J. Cardiol. 1983; 52: 975-979.
26. Kou C.S., Reddy C.P., Paciotti M.V.: Asystole during treatment with amiodarone in a patient with persistent atrial tachycardia. J. Electrocardiol. 1985; 18: 105-110.
27. Rady M.Y., Ryan T., Start N.J.: Perioperative therapy with amiodarone and the incidence of acute organ dysfunction after cardiac surgery. Anesth. Analg. 1997; 85: 489-497.
28. The Cardiac Arrhythmia Suppresion Trial (CAST) Invetigators. Effect of encainide and flecainide on mortality in infarction. N. Engl. J. Med. 1989; 321: 406-412.
29. Brown M.A., Smith W.M., Lubbe W.F. et al.: Amiodarone-induced torsade de points. Eur. Heart J. 1986; 7: 234-239.
30. Leroy G., Haiat R., Barthelemy M. et al.:Torsade de points during loading with amiodarone. Eur. Heart J. 1987; 8: 541-543.
31. Rotmensch H.H., Belhassen B., Swanson B.N. et al.: Steady-state serum amiodarone concentrations: relationships with antiarrhythmic efficacy and toxicity. Ann. Intern. Med. 1984; 101: 462-469.
32. Raehl C.L., Patel A.K., LeRoy M.: Drug-induced torsade de points. Clin. Pharm. 1985; 4: 675-690.
33. Makkar R.R., Fromm B.S., Steinman R.T. et al.: Female gender as a risk factor for torsade de points associated with cardiovascular drugs. JAMA 1993; 270: 2590-2597.
34. Leatham E.W., Holt D.W., McKeanna W.J. et al.: Class III antiarrhythmic in overdose. Presenting features and management principles. Drug Safe. 1993; 9: 450-462.
35. Rae A.P., Kay H.R., Horowitz L.N. et al.: Proarrhythmic effect of antiarrhythmic drugs in patients with malignant ventricular arrhythmias evaluated by electrophysiologic testing. J. Am. Coll. Cardiol. 1988; 12: 131-139.
36. Kadish A.H., Buxton A.E., Waxman H.L. et al.: Usefulness of electrophysiologic study to determine the clinical tolerance of arrythmia reccurrens during amiodarone therapy. J. Am. Coll. Cardiol. 1987; 10: 90-96.
37. Forgos R.N.: Amiodarone-induced refractoriness to cardioversion. Ann. Inter. Med. 1984; 100: 699-700.
38. Levick C.E., Mizgala H.F., Kerr C.R.: Failure to pace following high dose aniarrhythmic therapy – reversal with isoproterenol. Pacing Clin. Electrophysiol. 1984; 7: 252-256.
39. Julian D.G., Camm A.J., Fragin G. et al.; for the EMIAT investigators. Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet 1997; 349: 667-674.
40. Carins J.A., Connolly S.J., Roberts R.S. et al.; for the CAMIAT investigators. Randomised trial of outcome after myocardial infarction in patients with frequent or repetitive ventricular premature depolarisations: CAMIAT. Lancet 1997; 349: 675-682.
41. Amiodarone Trials Meta-Analysis Investigators. Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomized trials. Lancet 1997; 350: 1417-1424.