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Amiodarone

Molecule Description

Amiodarone is a medicine used to treat heart rhythm abnormalities. It belongs to a class of medications called ‘antiarrhythmic agents.’

Uses of Amiodarone

  • Rhythm disorders of the heart.
  • Rapid and abnormal heart rhythms (Tachyarrhythmias) that are associated with electrical pathway abnormalities (Wolf-Parkinson-White (WPW syndrome)).
  • Rapid and regular heartbeats (Atrial Flutter) or fast and irregular heartbeats (Atrial Fibrillation).
  • Sudden and violent, rapid, abnormal heartbeats (Paroxysmal Tachyarrhythmias), when there are no other alternatives that originate in the ventricles (ventricular), above the ventricles (supraventricular), from the sinoatrial node or atrioventricular node (nodal tachycardia - nodes are small areas of heart muscle that control the heartbeat) and rapid, erratic heartbeats which is usually life-threatening (ventricular fibrillation).
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  • Use with caution.
  • Medicines that can lengthen heartbeats (Clarithromycin, Ciprofloxacin).
  • Medicines used for heart diseases and high blood pressure (Propranolol, Diltiazem, Verapamil, Digoxin, Flecainide) for constipation (Bisacodyl, Senna), and to lower cholesterol (Simvastatin, Atorvastatin).
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  • Amphotericin (antifungal), immunosuppressants (Hydrocortisone, Betamethasone, Prednisolone, Cyclosporine, Tacrolimus), anaesthesia medicines (Midazolam, Lidocaine, Fentanyl), Ergotamine (for migraine), Colchicine (for gout) and blood thinning agents (Warfarin, Dabigatrine).
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Contraindications of Amiodarone

When should one not use Amiodarone

  • Allergy to Amiodarone or its components or Iodine.
  • History or signs of severe allergic reactions such as swelling of face, lips, throat, or tongue with swallowing or breathing problems and with or without rashes, itching.
  • Slow heart rate (Bradycardia), due to blockage of signals from one of the heart nodes (sinoatrial heart block). Nodes are areas in the heart which control heartbeat.
  • Similar problems with your nodes and you do not have a pacemaker (an artificial device that is used to replace heart nodes).
  • Past or present thyroid problems.

Side effects of Amiodarone

Common side effects of this drug are:

  • Jaundice (yellowing of eyes or skin), feeling sick, decreased hunger, pain the stomach, or high temperature (signs of liver damage).
  • Breathing difficulty, chest tightness, cough, wheeze (whistling sound while breathing), weight loss, fever (signs of lung disease, can be severe).
  • Irregular or erratic heartbeats (uncommon, but serious) – requires immediate medical attention.
  • Severe allergic reactions such as swelling of face, lips, throat or tongue with swallowing or breathing problems, even with or without rashes, itching, blistering or peeling of skin, fever, chills, high temperature, increased liver enzymes in blood test (angioedema or toxic epidermal necrolysis – can be severe, but rare).
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Precautions and Warnings of Amiodarone

Pregnancy

Q:
Can I take Amiodarone during pregnancy?
A:
Amiodarone is not given during pregnancy as it has the potential to affect the thyroid of the unborn baby.

Breast Feeding

Q:
Can I take Amiodarone while breastfeeding?
A:
Do not take if you are breastfeeding or plan to breastfeed; this is because Amiodarone is secreted well into the breast milk and may harm the baby.

Driving

Q:
Can I drive if I have consumed Amiodarone?
A:
You can drive while taking Amiodarone. But if you experience any vision problems (Blurry eyesight is one of the side effects of Amiodarone), you are advised not to drive.

Alcohol

Q:
Can I consume alcohol with Amiodarone?
A:
Amiodarone is helpful for delicate heart conditions, and alcohol is not suitable for the heart. This medicine should be used with caution if you have any liver problems. Because alcohol also damages the liver and you are advised not to consume alcohol.

Other General Warnings

Talk to your doctor if
  • Heart, liver, or lung problems (asthma)
  • Vision problems (including due to damaged optic nerve - optic neuritis)
  • Elderly patients
  • Any artificial inserted devices in the heart (pacemaker – which controls heart rate, Implantable Cardioverted Defibrillator (ICD) – a device which detects any abnormal heart rate or rhythm)
  • Allergic skin reactions

Mode of Action of Amiodarone

How Does It Work?

Balanced potassium levels are mandatory for normal heart rhythm. High potassium levels cause abnormal heart rhythms, which can be fatal. Amiodarone primarily acts by a dual mechanism of reducing potassium levels in the heart and by creating the heart to beat slowly.
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Interactions of Amiodarone

Interactions with other medicines

  • Medicines used to correct heart rhythm abnormalities (Sotalol, Quinidine, Procainamide, Disopyramide, or Bretylium).
  • Anti-infectives (injectable Erythromycin, Cotrimoxazole, Moxifloxacin or Pentamidine).
  • Medicines used to treat mental or behavioural disorders (Thioridazine, Chlorpromazine, Fluphenazine, Haloperidol, Pimozide, Amisulpiride, Lithium, Doxepin, Maprotiline, Sertindole,
  • or Amitriptyline).
  • Anti- malarials (Guinine, Mefloquine, Chloroquine or Halofantrine).
  • Anti-allergics (Terfenadine, Astemizole or Mizolastine).
  • Hepatitis C medications (Sofosbuvir, Simeprevir, Daclatasvir, or Ledispasvir).

Interactions with food items

Amiodarone does not interact with food, and one can take this medicine before or after meals with a glass of water.

Dietary Restrictions of Amiodarone

Grapefruit juice inhibits the breakdown of Amiodarone in the intestine. It is better to avoid grapefruit and its juice while on Amiodarone.

Dosage of Amiodarone

Overdose

An overdose with Amiodarone can be fatal. Care should be taken to avoid any overdose with this medicine. Overdose symptoms may include weakness, slow heart rate, feeling light-headed, or loss of consciousness and require immediate medical attention.
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Missed a Dose

If you miss a dose of Amiodarone, take it as soon as you remember. However, if it is less than 8 hours for your next dosage, skip the missed dose and follow the regular dosing schedule. Do not take extra medicine or double dose to compensate for the missed dose.
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Frequently Asked Questions (FAQs)

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Q: Amiodarone is a Class III Antiarrhythmic agent. What does this mean?

A: Antiarrhythmic agents are classified into four classes based on their mechanism of action and the targets they act. Class III Antiarrhythmic agents primarily work by decreasing potassium levels and controlling abnormal heart rhythms. Other medicines in this class are Dronedarone, Sotalol, Dofetilide, etc.

Q: What else should I know before taking Amiodarone?

  • Amiodarone stays in your blood for a long time. It can have some potency and protective action on your heart for up to 1 month after stopping the tablet, this should be remembered, especially if you are planning pregnancy because you are advised not to try for at least 30 days after stopping to take Amiodarone. Treatment with Amiodarone should be given in a hospital setting or under strict medical supervision. Self-medication and self-adjusting the dose can be harmful.
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  • Amiodarone can cause skin problems and increases your sensitivity to light.
  • You are advised to stay away from direct sunlight, use protective clothing and sunscreen lotions during treatment and up to 1 month after stopping Amiodarone.
Last Updated on: 05 Oct 2020 | 10:47 PM (IST)

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Disclaimer
The information provided herein is accurate, updated and complete as per the best practices of the Company. Please note that this information should not be treated as a replacement for physical medical consultation or advice. We do not guarantee the accuracy and the completeness of the information so provided. The absence of any information and/or warning to any drug shall not be considered and assumed as an implied assurance of the Company. We do not take any responsibility for the consequences arising out of the aforementioned information and strongly recommend you for a physical consultation in case of any queries or doubts. Please click here for detailed T&C.
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