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Amiodarone

Amiodarone [chemical/ingredient]


Presentation

  • Given the severity of his presentation and lack of any clinical or biochemical improvement, oral prednisolone 30 mg once daily was coadministered. His symptoms subsequently resolved and he became euthyroid.[ncbi.nlm.nih.gov]
  • It is known to cause pulmonary toxicity, which can manifest in a variety of presentations, ranging from asymptomatic to fatal.[ncbi.nlm.nih.gov]
  • In an effort to shed light on this syndrome, we present a stereotypical case study in amiodarone-induced pulmonary toxicity, as a prelude to a review of theorized pathophysiology, epidemiology, clinical presentation, diagnosis, therapeutics, monitoring[ncbi.nlm.nih.gov]
  • We present a report on a patient with pseudo-alcoholic cirrhosis with low dose amiodarone.[ncbi.nlm.nih.gov]
  • We present a case of a male patient who presented with chest discomfort and rapid atrial fibrillation. He was known to have paroxysmal atrial fibrillation, which did not respond to initial beta-blocker treatment.[ncbi.nlm.nih.gov]
Intravenous Administration
  • Intravenous administration is only appropriate in hospital with continuous ECG monitoring. Intravenous dosing Amiodarone can be given intravenously for supraventricular or ventricular arrhythmias, but should be reserved for urgent cases.[nps.org.au]
  • In clinical studies of 2 to 7 days, clearance of amiodarone after intravenous administration in patients with VT and VF ranged between 220 and 440 mL/hr/kg.[web.archive.org]
  • After intravenous administration in man, amiodarone relaxes vascular smooth muscle, reduces peripheral vascular resistance (afterload), and slightly increases cardiac index. Amiodarone prolongs phase 3 of the cardiac action potential.[drugbank.ca]
  • Amiodarone: haemodynamic profile during intravenous administration and effect on pacing-induced ischaemia in man. Drugs. 1985; 29(Suppl 3):11-22. 54. Schwartz A, Shen E, Morady F et al.[drugs.com]
Myxedema
  • Myxedema coma secondary to amiodarone use has been rarely reported in the literature.[ncbi.nlm.nih.gov]
  • Mazonson PD, Williams ML, Cantley LK, Dalldorf FG, Utiger RD, Foster JR "Myxedema coma during long-term amiodarone therapy." Am J Med 77 (1984): 751-4 147.[web.archive.org]
  • Myxedema coma during long-term amiodarone therapy. Am J Med. 1984; 77:751-4. 232. Burger A, Dinichert D, Nicod P et al.[drugs.com]
  • Myxedema coma during long-term amiodarone therapy. Am J Med. 1984; 77:751-4. [IDIS 191622] [PubMed 6486153] 232. Burger A, Dinichert D, Nicod P et al.[web.archive.org]
Camping
  • [HSA: 6331 ] [KO: K04838 ] SCN8A [HSA: 6334 ] [KO: K04840 ] SCN9A [HSA: 6335 ] [KO: K04841 ] SCN10A [HSA: 6336 ] [KO: K04842 ] SCN11A [HSA: 11280 ] [KO: K04843 ] Pathway hsa04020 Calcium signaling pathway hsa04022 cGMP-PKG signaling pathway hsa04024 cAMP[kegg.jp]
  • ] [KO: K04837 ] SCN5A [HSA: 6331 ] [KO: K04838 ] SCN8A [HSA: 6334 ] [KO: K04840 ] SCN9A [HSA: 6335 ] [KO: K04841 ] SCN10A [HSA: 6336 ] [KO: K04842 ] SCN11A [HSA: 11280 ] [KO: K04843 ] パスウェイ hsa04020 カルシウムシグナル伝達経路 hsa04022 cGMP-PKG シグナル伝達経路 hsa04024 cAMP[genome.jp]
  • Channel properties are modulated by cAMP and subunit assembly. Mediates the rapidly activating component of the ...[drugbank.ca]
Amyloidosis
  • Vincent Yi-Fong Su, Chia-Jen Liu, Yu-Wen Hu, Wei-Juin Su, Yuh-Min Chen, Shinn-Liang Lai, Tzeng-Ji Chen, Diahn-Warng Perng, Yu-Chin Lee, Cheng-Hwai Tzeng and Kun-Ta Chou, Amyloidosis and the risk of cancer: a nationwide population-based study, International[doi.org]
Quickening
  • […] amiodarone alone (RR 1.18; 95% CI: 1.05-1.33; P 0.004) and significantly decreased the time to cardioversion (SMD -10.35 h; 95% CI: -18.13 hours to -2.57 hours; P CONCLUSIONS: Ranolazine given orally at appropriate doses showed the property to significantly quicken[ncbi.nlm.nih.gov]
Peripheral Neuropathy
  • Peripheral neuropathy during longterm high-dose amiodarone therapy. Abstract Three patients developed peripheral neuropathy after taking amiodarone for more than 18 months.[doi.org]
  • Three patients developed peripheral neuropathy after taking amiodarone for more than 18 months.[ncbi.nlm.nih.gov]
  • neuropathy, constipation, anorexia, blood dyscrasias, pancreatitis; peripheral vein phlebitis (w. concentrated solutions; see full labeling).[empr.com]
  • Neuropathy [see WARNINGS AND PRECAUTIONS ] Photosensitivity and Skin Discoloration [see WARNINGS AND PRECAUTIONS ] Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the[rxlist.com]
  • neuropathy reported rarely with chronic administration; may resolve upon discontinuation of therapy Bradycardia, some requiring pacemaker insertion reported when ledipasvir/sofosbuvir or sofosbuvir with simeprevir initiated in patients on amiodarone;[reference.medscape.com]

Workup

  • A gallium scan also may be performed as part of the diagnostic workup. Fatalities, secondary to pulmonary toxicity, have occurred in approximately 10% of cases.[web.archive.org]
Dyslipidemia
  • Huan-Jui Yeh, Yiing-Jenq Chou, Nan-Ping Yang, Chi-Chia Cheng and Nicole Huang, Association Between Physical Therapy and Risk of Coronary Artery Disease and Dyslipidemia Among Osteoarthritis Patients: A Nationwide Database Study, Archives of Physical Medicine[doi.org]
Trypanosoma Cruzi
  • Past studies have shown that amiodarone exerts antiparasitic effects against Trypanosoma cruzi and Acanthamoeba castellanii.[ncbi.nlm.nih.gov]
Torsades De Pointes
  • Drug-induced prolongation of the corrected QT interval (QTc) may lead to serious and potentially life-threatening ventricular tachyarrhythmia, such as torsades de pointes (Tdp), which is worthy of clinical attention.[ncbi.nlm.nih.gov]
  • AIM: To define the incidence, presentation, and outcomes of drug-induced Torsades de Pointes (TdP) with intravenous (IV) amiodarone.[ncbi.nlm.nih.gov]
  • Female gender as a risk factor for torsades de pointes associated with cardiovascular drugs. JAMA. 1993;270:2590-7. Medline 5 . Kukla P, Slowiak-Lewinska T. Amiodarone-induced torsade de pointes. Five case report. Kardiol Pol. 2004;60:365-70.[revespcardiol.org]
  • AMD was described to prolong the QT interval and can lead to torsades de pointes.[ncbi.nlm.nih.gov]
  • A review with special reference to torsade de pointes tachycardia. Ann Intern Med 121: 529-535.[omicsonline.org]

Treatment

  • Amiodarone-induced hyperthyroidism is a known side effect of amiodarone treatment. In the pediatric population, long-term amiodarone treatment is rarely indicated because of its severe side effects including thyroid function impairment.[ncbi.nlm.nih.gov]
  • […] compared with either no treatment or treatment with other prophylactic or therapeutic agents.[ncbi.nlm.nih.gov]
  • Amiodarone is a highly effective treatment for supraventricular and ventricular tachyarrhythmia; however, it could be associated with several serious adverse effects, including liver injury.[ncbi.nlm.nih.gov]
  • Intrauterine antiarrhythmic treatment can reduce perinatal morbidity and mortality.[ncbi.nlm.nih.gov]
  • Amiodarone is an effective medication for the treatment of cardiac arrhythmias.[ncbi.nlm.nih.gov]

Prognosis

  • Amiodarone induced TdP has favorable prognosis if recognized and treated promptly, and these patients should not receive amiodarone by any route in future. Copyright 2017 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.[ncbi.nlm.nih.gov]
  • Nuclear medicine Gallium 67 scan: sensitive but nonspecific Treatment and prognosis Cessation of amiodarone and treatment with steroids arrests and often results in resolution of imaging findings over time 3 .[radiopaedia.org]
  • Prognosis is favorable, with a low mortality rate, except for patients who develop respiratory distress, whose mortality approaches 50 % (3) Treatment is based on drug discontinuation and administration of corticosteroids, which should be kept for several[escardio.org]
  • Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990; 142:523-528. ‎ Pagina 153 - MC, et al. Ventilator-associated pneumonia caused by potentially drug-resistant bacteria.[books.google.ro]
  • Patients with preexisting pulmonary disease have a poorer prognosis if pulmonary toxicity develops.[web.archive.org]

Etiology

  • Of the 25 published cases of amiodarone induced acute hepatotoxicity available for review, only 10 provide evidence to conclusively implicate parenteral amiodarone as the etiology.[ncbi.nlm.nih.gov]
  • When epididymitis does not seem to be caused by an infection or any other identifiable etiology, this should not be overlooked by the cardiologist, urologist or general practitioner.[ncbi.nlm.nih.gov]
  • Indications: Ventricular fibrillation/pulseless ventricular tachycardia Ventricular tachycardia without overt signs of shock (SBP 90) Wide complex tachycardia of unknown etiology Pediatric ventricular fibrillation/pulseless ventricular tachycardia Contraindications[orangecountyfl.net]
  • Major lab tests available aiming at topographic and etiologic diagnosis to be used in the preoperative period when there are questions about neuromuscular involvement are serum CK levels, electroneuromyography and muscle biopsy with histochemical study[scielo.br]
  • Etiology, warning signs and therapy of torsade de pointes. Circulation. 1981; 64:1167-74. 267. Meulendyk J. Anesthetic considerations with amiodarone: report of a case. J Am Osteopath Assoc. 1984; 83:585-8. 268. Palakurthy PR, Iyer V, Meckler RJ.[drugs.com]

Epidemiology

  • In an effort to shed light on this syndrome, we present a stereotypical case study in amiodarone-induced pulmonary toxicity, as a prelude to a review of theorized pathophysiology, epidemiology, clinical presentation, diagnosis, therapeutics, monitoring[ncbi.nlm.nih.gov]
  • He has since completed further training in emergency medicine, clinical toxicology, clinical epidemiology and health professional education.[lifeinthefastlane.com]
  • […] type 2 AIT shows involuted follicles filled with desquamated vacuolated epithelial cells, scattered inflammatory infiltrate composed of foamy macrophages and lymphocytes, and fibrosis ( Proc (Bayl Univ Med Cent) 2008;21:382 , Pathol Int 2008;58:55 ) Epidemiology[pathologyoutlines.com]
  • Beecher, W George, A Sole, M Leither, C Kapadious, Southern Baptist Hospital, New Orleans, Louisiana; WJ Brown, NRM Buist, HTC Gipson, RK Huston, NG Kennaway, Oregon Health Sciences University, Portland; Div of Drug Experience, Office of Biometrics and Epidemiology[web.archive.org]
Sex distribution
Age distribution

Pathophysiology

  • In an effort to shed light on this syndrome, we present a stereotypical case study in amiodarone-induced pulmonary toxicity, as a prelude to a review of theorized pathophysiology, epidemiology, clinical presentation, diagnosis, therapeutics, monitoring[ncbi.nlm.nih.gov]
  • This article reviews the pathophysiology, presentation, diagnosis, and treatment of amiodarone-induced pulmonary toxicity.[ncbi.nlm.nih.gov]
  • […] test may be helpful Monitoring amiodarone therapy, especially when amiodarone is coadministered with other drugs that may interact Evaluation of possible amiodarone toxicity Assessment of patient compliance Clinical Information Discusses physiology, pathophysiology[mayomedicallaboratories.com]
  • Int 2008;58:55 ) Epidemiology More frequent in males than in females (3:1) Occurs in 3% of patients treated with amiodarone in North America, increasing to 10% in countries with low iodine dietary intake ( NCBI - Amiodarone Induced Thyrotoxicosis ) Pathophysiology[pathologyoutlines.com]

Prevention

  • METHODS: Prospective randomized controlled trials (RCTs) that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included.[ncbi.nlm.nih.gov]
  • The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients.[ncbi.nlm.nih.gov]
  • Ranolazine was effective in preventing the occurrence of AF when compared to controls (RR 0.60; 95% CI: 0.43-0.83; P 0.002).[ncbi.nlm.nih.gov]
  • Amiodarone appears to be one of the most promising drugs for the possible prevention of ventricular fibrillation and sudden death.[ncbi.nlm.nih.gov]
  • The QT interval in pseudo-ECG was prolonged and the re-entry in tissue was prevented. This study provides further evidence that amiodarone may be a potential pharmacological agent for preventing arrhythmogenesis for SQT3 patients.[ncbi.nlm.nih.gov]

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