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Amiodarone

CARDIOVASCULAR SYSTEM

ANTIARRHYTHMICS - [ CARDIOVASCULAR SYSTEM ]

Amiodarone is an anti-arrhythmic drug with multiple mechanisms of action. It inhibits the sodium channels, the potassium channels and the calcium channels and exerts a noncompetitive adrenergic blocking effect. So it is useful in a wide variety of arrhythmias.(1)

Treatment and prophylaxis of frequently recurring ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) in patients refractory to other therapy. (2)

Known hypersensitivity to any of the components of Amiodarone including iodine Cardiogenic shock Marked sinus bradycardia Second- or third-degree atrio-ventricular (AV) block unless a functioning pacemaker is available. Corneal Refractive Laser Surgery (2)

Fever Bradycardia, congestive heart failure, cardiac arrest, hypotension, ventricular tachycardia Nausea, liver impairment Arrhythmia Early onset pulmonary toxicity, adult respiratory distress syndrome, pulmonary fibrosis, vision loss, thyroid abnormalities, neonatal hypo- or hyperthyroidism, (2)

Protease inhibitors, loratadine, cimetidine, trazodone, grapefruit juice, : These drugs increase amiodarone levels Cyclosporine, statins, digoxin, quinidine, procainamide, warfarin, Dextromethorphan and phenytoin: Levels of these drugs is elevated Propranolol, verapamil, diltiazem: potentiation of bradycardia, sinus arrest, and AV block Clopidrogrel: decreased action of clopidogrel Rifampin, St. John's Wort, Cholestyramine: These drugs decrease levels of amiodarone Fentanyl: hypotension, bradycardia, and decreased cardiac output. Disopyramide, Fluoroquinolones, macrolide antibiotics, and azoles: QT prolongation is seen (2)

Amiodarone is excreted in human milk and can result in adverse effects in the nursing child. Safety and efficacy is not established in pediatric population Dosing in elderly patient should be cautious, since there is a greater frequency of decreased hepatic, renal or cardiac function and of concomitant disease or other drug therapy. (2)

Oral: 200 mg three times a day for one week, reduced to 200 mg twice daily for further one week. Maintenance 200 mg daily or reduced to minimum required to control arrhythmia. Intravenous infusion: Initially 5 mg/kg body weight over 20 to 120 min with ECG monitoring, subsequent infusion given if necessary according to response (up to max 1.2g in 24 h). (2)

1. Sampson KJ, Kass RS. Anti-arrhythmic drugs. In: Brunton L, Chabner B, Knollmann B eds. Goodman & Gilman’s The Pharmacological basis of Therapeutics. 12th ed. USA: McGraw Hill; 2011:815-48. 2. Nexterone [cited 2013 sept 9]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/label/2011/022325s002lbl.pdf 3. National Formulary of India. 4 th ed. Government of India, Ministry of Health and Family Welfare. India: Indian Pharmacopoeia Commission; 2011.