Presentation
It is known to cause pulmonary toxicity, which can manifest in a variety of presentations, ranging from asymptomatic to fatal. [ncbi.nlm.nih.gov]
Entire Body System
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Fatigue
You may feel fatigued, lethargic, have poor exercise tolerance, and may experience dizziness and fainting. [a-fib.com]
Neurologic Common : Malaise and fatigue, tremor/abnormal involuntary movements, lack of coordination, abnormal gait/ataxia, dizziness, paresthesias, decreased libido, insomnia, headache, sleep disturbances. Ophthalmic Common : Visual disturbances. [rxlist.com]
Tremors; lack of coordination or difficulty walking; dizziness, weakness or fatigue; trouble sleeping or sleep disturbances; headache; sexual disturbances; weight loss; abnormal taste or smell; vision problems such as blurred vision, halos around objects [my.clevelandclinic.org]
Symptoms of simvastatin liver injury include: Unusual fatigue Loss of appetite Right upper abdominal discomfort Dark urine Yellowing of the skin or whites of the eyes Simvastatin Amiodarone Memory Loss Side Effects Also in the February 2012 update, the [rotlaw.com]
IP usually has an insidious and gradual onset, with slowly progressing dyspnea, cough, and rapid fatigue. [verywellhealth.com]
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Intravenous Administration
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/h/kg. [globalrph.com]
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]
However, published experience with intravenous administration of amiodarone to surgical patients in the United States is minimal. [anesthesiology.pubs.asahq.org]
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]
Amiodarone is widely distributed in the body after intravenous administration, and a three-compartment model best explains its distribution kinetics ( [17] ). [onlinejacc.org]
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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]
Gastrointestinal
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Nausea
Common side effects include: nausea, vomiting, and loss of appetite. What is amiodarone? Amiodarone affects the rhythm of your heartbeats. [drugs.com]
Possible symptoms of an overdose with this medication may include: Nausea Vomiting Constipation Loss of appetite Heart rhythm problems A slow heart rate (bradycardia) Low blood pressure (hypotension) Liver damage Jaundice (yellowing of the skin and whites [heart.emedtv.com]
SIDE EFFECTS Adverse reactions include fever, bradycardia, CHF, cardiac arrest, hypotension, ventricular tachycardia, nausea, and abnormal liver function. [jointemsprotocols.com]
Gastrointestinal Very common : Nausea, vomiting. Common : Constipation, anorexia, abdominal pain. Dermatologic Common : Solar dermatitis/photosensitivity. [rxlist.com]
Nausea, vomiting, constipation, loss of appetite, shaking, or tiredness may occur. If any of these effects persist or worsen, tell your doctor promptly. [webmd.com]
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Abdominal Pain
Common : Constipation, anorexia, abdominal pain. Dermatologic Common : Solar dermatitis/photosensitivity. [rxlist.com]
Nausea, vomiting, constipation, loss of appetite, abdominal pain (about 25 percent of patients). Take amiodarone with meals. [my.clevelandclinic.org]
Your pharmacist may be able to advise you on managing side effects. abdominal pain bad taste constipation diarrhea difficulty sleeping dizziness or lightheadedness nausea sensitivity of skin to sunlight tremor vomiting Although most of the side effects [medbroadcast.com]
More severe cases can result in liver failure signaled by jaundice, abdominal pain, and distension. Read our 5-star custom reviews SKIN: Amiodarone increases sensitivity to the sun and sun burning. [a-fib.com]
Jaw & Teeth
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Bleeding Gums
unusual nosebleeds, bruising, blood in urine, coughing blood, bleeding gums, cuts that don’t stop bleeding) signs of liver problems, e.g.: abdominal pain or swelling dark urine fever itchy skin loss of appetite nausea and vomiting pale or clay-coloured [medbroadcast.com]
Musculoskeletal
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Fracture
The patient was noted to have a subdural hematoma, multiple rib fractures, sternal body fracture, abdominal wall injury, left clavicle fracture, right humerus fracture, and vertebral fractures. [ncbi.nlm.nih.gov]
Skin
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Dermatitis
Dermatologic Common : Solar dermatitis/photosensitivity. [rxlist.com]
Visual field defect, blurred vision [ Ref ] Dermatologic Very common (10% or more): Photosensitivity (up to 10%) Common (1% to 10%): Slate-gray or bluish pigmentations of light-exposed skin Very rare (less than 0.01%): Erythema, rash, exfoliative dermatitis [drugs.com]
Exfoliative dermatitis, toxic epidermal necrolysis, skin cancer, and pruritus have been reported in postmarketing experience. [web.archive.org]
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Pruritus
[…] and Subcutaneous Tissue Disorders : urticaria, toxic epidermal necrolysis (sometimes fatal), erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, bullous dermatitis, drug rash with eosinophilia and systemic symptoms (DRESS), eczema, pruritus [rxlist.com]
[…] dermatitis, alopecia, sweating Frequency not reported : Granuloma, angioedema, urticaria, Stevens-Johnson syndrome, spontaneous ecchymosis, pustular psoriasis enhanced Postmarketing reports : Toxic epidermal necrolysis, erythema multiforme, skin cancer, pruritus [drugs.com]
Exfoliative dermatitis, toxic epidermal necrolysis, skin cancer, and pruritus have been reported in postmarketing experience. [web.archive.org]
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Alopecia
Uncommon : Blue skin discoloration, rash, spontaneous ecchymosis, alopecia, hypotension, and cardiac conduction abnormalities. Postmarketing Experience The following adverse reactions have been identified during post-approval use of CORDARONE. [rxlist.com]
Rarely, cases of toxic epidermal necrolysis, exfoliative dermatitis, reversible alopecia, bullous dermatosis, linear IgA disease, cutaneous vasculitis, and pustular psoriasis have been reported. [web.archive.org]
[…] field defect, blurred vision [ Ref ] Dermatologic Very common (10% or more): Photosensitivity (up to 10%) Common (1% to 10%): Slate-gray or bluish pigmentations of light-exposed skin Very rare (less than 0.01%): Erythema, rash, exfoliative dermatitis, alopecia [drugs.com]
Side effects Amiodarone can cause the following side effects: nausea, vomiting, taste changes, vision disturbances, photosensitivity ( increased sensitivity to sunlight ), alopecia ( hair loss ), thyroid gland disorders ( because Amiodaron contains iodine [pharmacybook.net]
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Eczema
Skin and Subcutaneous Tissue Disorders : urticaria, toxic epidermal necrolysis (sometimes fatal), erythema multiforme, Stevens-Johnson syndrome, exfoliative dermatitis, bullous dermatitis, drug rash with eosinophilia and systemic symptoms (DRESS), eczema [rxlist.com]
Stevens-Johnson syndrome, spontaneous ecchymosis, pustular psoriasis enhanced Postmarketing reports : Toxic epidermal necrolysis, erythema multiforme, skin cancer, pruritus, bullous dermatitis, drug rash with eosinophilia and systemic symptoms (DRESS), eczema [drugs.com]
Additional postmarketing reports have included urticaria and eczema. [ Ref ] A retrospective study of 44 patients found by univariate analysis that patients who experienced dermatologic side effects were younger than patients who did not (mean age 48 [web.archive.org]
Psychiatrical
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Delusion
Delusions resolved one week after amiodarone was stopped. The patient subsequently did well after substitution with flecainide. [ Ref ] Genitourinary side effects have been reported rarely. [web.archive.org]
Urogenital
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Anuria
The broken-down muscle mass can cause other problems throughout the body such as: Electrolytic disturbances; Nausea; Vomiting; Confusion; Coma; Cardiac arrhythmia; Dark urine; Oligura or Anuria (decreased or non-existent urine production, respectively [rotlaw.com]
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Sexual Dysfunction
Ahmad S "Amiodarone and sexual dysfunction." Am Heart J 130 (1995): 1320-1 113. [web.archive.org]
Neurologic
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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]
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Headache
Neurologic Common : Malaise and fatigue, tremor/abnormal involuntary movements, lack of coordination, abnormal gait/ataxia, dizziness, paresthesias, decreased libido, insomnia, headache, sleep disturbances. Ophthalmic Common : Visual disturbances. [rxlist.com]
Tremors; lack of coordination or difficulty walking; dizziness, weakness or fatigue; trouble sleeping or sleep disturbances; headache; sexual disturbances; weight loss; abnormal taste or smell; vision problems such as blurred vision, halos around objects [my.clevelandclinic.org]
[…] 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, seeing halos around lights, vision loss, headache [uofmhealth.org]
Tell your doctor if any of these symptoms are severe or do not go away: constipation loss of appetite headache decreased sex drive difficulty falling asleep or staying asleep flushing changes in ability to taste and smell changes in amount of saliva Some [nlm.nih.gov]
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Papilledema
An amiodarone-associated neuropathy was suspected, and amiodarone was discontinued with the approval of the cardiologist, with complete regression of the papilledema and a stabilization of visual symptoms. [ncbi.nlm.nih.gov]
[…] respiratory distress syndrome [ Ref ] Ocular Very common (10% or more): Corneal microdeposits (up to 90% or more) Common (1% to 10%): Visual disturbance Very rare (less than 0.01%): Optic neuropathy/ neuritis Frequency not reported : Permanent blindness, papilledema [drugs.com]
[…] professional: Ocular side effects have been reported the most frequently and have included corneal microdeposits (up to 98%) which only rarely caused visual halos or blurred vision, corneal opacities, lenticular changes, loss of eyelashes or eyebrows, papilledema [web.archive.org]
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Altered Mental Status
A 79-year-old woman admitted with atrial flutter was being treated with intravenous (IV) amiodarone when she abruptly developed coagulopathy, altered mental status and liver enzyme derangement. [ncbi.nlm.nih.gov]
mental status, hallucinations, and delirium have been reported in postmarketing experience. [ Ref ] A 66-year-old male with refractory ventricular tachycardia developed psychotic delusions 17 days after beginning amiodarone therapy. [web.archive.org]
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]
Rhythm
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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]
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]
A review with special reference to torsade de pointes tachycardia. Ann Intern Med 121: 529-535. [omicsonline.org]
Biopsy
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Liver Biopsy
We emphasize the importance of close monitoring of liver enzymes and evaluation of liver computed tomographic imaging as well as liver biopsy during treatment with amiodarone, and discontinuation should be considered when amiodarone-induced hepatotoxicity [ncbi.nlm.nih.gov]
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]
ACUTE TREATMENT Intravenously administered amiodarone is effective for the emergency treatment of ventricular tachyarrhythmias. [aafp.org]
We suggest that euthyroidism be restored before total thyroidectomy or RAI treatment, unless definitive treatment is urgent (2, ØØOO). Recommendation 11. [doi.org]
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]
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]
[…] to cardiopulmonary bypass. [ 57 ] However, studies linking postoperative ARDS to preoperative oral amiodarone and procedures not involving cardiopulmonary bypass, such as AICD placement under general anesthesia, [ 52,53,57 ] suggest a multifactorial etiology [anesthesiology.pubs.asahq.org]
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 [cdc.gov]
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]
[…] 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]