Amiodarone

The anti-arrhythmic drug, Amiodarone, is used to treat life-threatening problems with heart rhythm, known as ventricular arrhythmias.

Overview

Amiodarone is an anti-arrhythmic medication that is used in the treatment of a number of serious and potentially fatal ventricular arrhythmias, such as fibrillation or tachycardia. The medication works effectively and quickly by restoring the heart’s normal rhythm so that a steady, regular heartbeat is maintained. The drug acts by slowing down certain electrical nerve impulses to the heart muscle that can cause the heart to beat erratically.

Amiodarone is only used in patients who have already been treated with other medication that has not been effective in resolving their condition.

In the US, Amiodarone is available under the brand names Cordarone and Pacerone. This medication is only available on prescription from your doctor and it comes in tablet form.

Conditions treated

  • ventricular arrhythmia

Type of medicine

  • anti-arrhythmic medication
  • tablet

Side-effects

Together with the many benefits that Amiodarone can bring, some people may experience some unwanted or unpleasant side-effects. Most of these side-effects may not occur, but if you do suffer from any unusual or unpleasant effects, you should consult your doctor, as you may need medical attention.

The following side-effects are quite common in people taking Amiodarone and should be reported to your doctor immediately.

You should tell your doctor if you begin to feel a slight fever, develop a cough, or have pain when breathing. Shortness of breath, dizziness, fainting or feeling lightheaded are experienced by some patients taking this medication, as is shaking or trembling of the hands, and problems with coordination, movement, and walking. Patients taking Amiodarone can sometimes find that their skin becomes more sensitive to sunlight. You may also find that you begin to feel weakness in your legs and arms.

Less commonly, some people experience visual disturbance, including blurred vision, green-blue halos around objects, increased sensitivity to light, and their eyes may feel dry. Your skin may appear blue-gray around your face, arms, and neck, and can become dry and puffy. Some patients report feeling cold or unusually sensitive to heat, with excessive sweating. Your heartbeat may feel unusually fast or irregular, or too slow. Feelings of unusual tiredness sometimes occur, together with uncharacteristic nervousness, agitation, and problems sleeping. You may find that you lose or gain weight unexpectedly. Swelling of the lower legs, scrotum, and feet are also reported by some people.

In rare cases, jaundice can occur, and a skin rash might be seen.

There are many other side-effects that can occur in people taking Amiodarone, however the incidence of the following effects is not known.

  • bleeding gums
  • blistering, loosening, or peeling of the skin
  • bloating
  • chest pain
  • blood in the urine
  • bloody, black, or tarry stools
  • clay-colored stools
  • confusion
  • dry cough, coughing or spitting up blood
  • coma
  • cracking of the skin
  • dark urine, decreased urine output, difficult or painful urination
  • joint or muscle pain
  • depression, hostility
  • diarrhea
  • indigestion
  • itching
  • swelling of the face, eyelids, lips, tongue, throat, feet, hands, legs, or genitals
  • lethargy
  • loss in sexual drive or performance
  • muscle spasms or cramps
  • nosebleeds
  • pain in the groin, or scrotum
  • pains in the stomach possibly radiating to the back
  • pale skin
  • pinpoint red spots on the skin
  • hallucinations
  • seizures
  • sneezing
  • sore throat
  • sores or ulcers on the lips or in the mouth
  • swollen glands
  • bad breath
  • unusual bruising or bleeding
  • unusual feelings of nervousness or restlessness
  • vomiting up blood
  • wheezing

There are a few side-effects that sometimes occur in patients who are taking Amiodarone that do not usually need medical attention. These effects often resolve themselves during your treatment as your body becomes acclimatized to the medicine. Your doctor may be able to give you some advice on how to prevent or reduce many of these unpleasant side-effects if they are persistent or particularly bothersome.

The side-effects include headaches, loss of appetite, nausea or vomiting, constipation, loss of interest in sex, dizziness, hot flushes, metallic or bitter taste.

This list of side-effects is not all-inclusive. If you experience any other unusual effects, you should report them to your doctor or cardiologist straight away.

Dosage

This medication will initially be given to you while you are under observation in a hospital or clinic. This will allow your treating physician to watch your reaction to the medication to be sure that you do not suffer any serious side-effects. You must take Amiodarone exactly as prescribed and as instructed by your doctor, even though you may initially begin to feel unwell after taking it.

You may take Amiodarone with or without food, as long as you take it in the same way each time. You should swallow each tablet whole, without crunching, chewing or splitting it. Do not try to dissolve the tablets in water.

You will be given a Medication Guide when you are initially prescribed this medication. Be sure to read the Guide thoroughly so that you understand how to take the medicine and to gain an understanding of how it works and the side-effects that you may experience. If you have any questions, just ask your doctor or pharmacist.

You must only take this medication exactly as instructed by your doctor. Do not take more than the prescribed dose. Do not increase the frequency of the dose you have been prescribed, and do not continue taking the drug for longer than directed by your doctor. Do not miss any doses. To do so could increase the likelihood of you suffering unpleasant side-effects. Note that it might take a couple of weeks for your body to begin to respond to the medication.

For the oral (tablet) form of Amiodarone in the treatment of ventricular arrhythmias:

  • adults should initially take 800 mg to 1600 mg each day, taking in divided doses
  • the dose for children will be determined by your child’s doctor or specialist

Your doctor may deem it necessary to adjust the dose of your medication in the future, depending on how your body responds to and tolerates its effects.

If you miss a dose of your medication, you should try to take it as soon as possible. If it is nearly time for your next dose, skip this one and revert to your usual dosing schedule. Do not double doses.

The dose of Amiodarone prescribed will vary among patients. You must follow your doctor’s orders or the directions given on the medication packaging. The dosage levels outlined here are based on the average dose. If the dose you are prescribed is different, do not change it, unless your doctor tells you to. The dose of this medication that you are prescribed will depend on the strength of the tablet, as will the number of doses you should take each day, and the duration of your course of treating, depending on the condition that you are being treated for.

Do not share this medication with anyone else.

If you find that your condition gets worse or fails to improve while you are taking this medication, consult your doctor or cardiologist promptly.

In the event that you overdose, you may experience breathing problems or have fainting episodes. If you think you may have overdosed, seek your doctor’s advice immediately or call 911.

Major drug interactions

Some types of medication should not be used concurrently, as this may change how your medications work and could increase the risk of you suffering serious side-effects. However, in some cases, two or more different medications may be used together, even though an interaction may occur. If this is the case, your doctor may decide to alter the dose of one of your medicines. Alternatively, your doctor may be able to suggest some precautions that you can take to negate the effect of any interactions.

You should make a list of all medications that you use, including prescription and over-the-counter drugs, herbal remedies, and vitamin supplements. Show this list to your doctor before you begin taking Amiodarone. Do not change the dose or frequency of any of your prescribed or non-prescription medications without first consulting your doctor.

There are a number of products that may interact with Amiodarone. These include fingolimod, sofosbuvir, and ledipasvir, used in the treatment of hepatitis c.

There are other drugs besides Amiodarone that can affect your heart’s rhythm. The following drugs should not be used in conjunction with Amiodarone unless your doctor instructs you to the contrary.

  • dofetilide
  • pimozide
  • procainamide
  • quinidine
  • sotalol
  • macrolide antibiotics, including clarithromycin and erythromycin
  • quinolone antibiotics, including levofloxacin

There are a number of medications that can affect the efficient removal of Amiodarone form the body, and this can influence the way in which the medication works and its efficacy. Such medications include the following:

  • azole antifungals, including itraconazole, cimetidine, and cobicistat
  • protease inhibitors, including fosamprenavir, and indinavir
  • rifamycins, including rifampin, and St. John's Wort

Amiodarone can retard the removal of other drugs from the body, potentially affecting their efficacy and how they work. Drugs that may be affected in this way include the following:

  • clopidogrel and phenytoin
  • some statin drugs, including atorvastatin and lovastatin
  • trazodone
  • warfarin

Warnings

While you are taking this medication, you must attend your doctor or cardiologist for regular progress checks. These check-ups are very important as they allow your doctor to check that the medication is working as it should be. You will also have the chance to discuss any troublesome side-effects that you may be experiencing and to air any concerns that you may have about your new medication. Your doctor may carry out blood tests to check for any unwanted effects that the medication is causing.

You must tell your doctor if you are already taking any other form of medicine, including over-the-counter products, herbal remedies, or vitamin supplements. You should also tell your doctor if you know that you are allergic to food colorings, certain foodstuffs, preservatives, or animal derivatives.

You must not eat grapefruit or drink grapefruit juice while you are using Amiodarone unless your medical specialist tells you that it is safe to do so. Grapefruit can cause the quantity of medication circulating in your bloodstream to increase, which may cause you to accidentally overdose. For more information on this phenomena, consult your doctor or your pharmacist.

If you think you might be pregnant, tell your doctor immediately. Taking Amiodarone while you are pregnant can seriously harm the unborn baby. You should use an effective form of birth control to avoid becoming pregnant for the duration of your treatment with this medication. This medication passes into breast milk and can have unpleasant side-effects on a nursing infant. You should not breast-feed while you are using this drug, nor should you express milk to feed it with. Ask your doctor or midwife for more advice on alternatives for feeding your baby.

If you experience shortness of breath, tightening of your chest, wheezing or any other form of breathing difficulties while using this medication, tell your doctor immediately.

Amiodarone can cause changes in the heart rhythm, including a condition called QT prolongation. This condition can cause serious side effects in some patients, including fainting. If you experience irregular heartbeats, a faster than usual heartbeat, or a sensation that your heart is pounding, these could be symptoms of QT prolongation, and you should consult your doctor immediately. Elderly patients are particularly susceptible to QT prolongation, especially if there is a history of cardiac arrest.

Low levels of magnesium and potassium in the blood can increase the risk of QT prolongation. If you are taking diuretics (water pills), or if you suffer from severe sweating, vomiting, or diarrhea, your risk of developing QT prolongation may increase. Always drink plenty of water to reverse the effects of dehydration.

Some people can develop liver problems while taking Amiodarone. If you experience more than one of the following symptoms, you should stop taking the medication right away and see your doctor as soon as possible as a matter of urgency:

  • clay-colored stools
  • dark urine
  • abdominal pain or tenderness
  • fever
  • itching
  • decreased or complete loss of appetite
  • nausea and vomiting
  • headaches
  • skin rashes
  • jaundice (yellowing of the skin or eyes)
  • swelling in the lower legs or feet
  • feeling unaccountably tired or weak

This medication can interfere with your vision. If you find that your vision is blurred, you have problems when reading, or you experience any other visual disturbances during or after treatment with this medication, you should seek your doctor’s advice. Your doctor may refer you to an ophthalmologist to have your eyes checked.

If you experience feelings of burning, tingling, numbness or discomfort in your feet, legs, hands or arms, you could be developing a serious condition called peripheral neuropathy. Under these circumstances, you should contact your doctor right away.

It is a good idea to wear a medical alert bracelet or carry a medical identification card in your handbag or wallet if you are taking this medication. Emergency services will need to know about your condition in the event that you are admitted to hospital as the result of an accident.

If you are scheduled to have surgery, including dental surgery or any form of emergency treatment, you must tell your treating physician or dentist in charge that you are taking this medication. It may be necessary for you to stop taking the medicine a few days before having surgery or any medical tests, and your doctor will advise you on this.

This medication can cause your skin to develop an increased sensitivity to sunlight, which may continue for several months following the cessation of your treatment. Too much exposure to direct sunlight can cause serious sunburn. For the duration of your treatment with Amiodarone and for a few months afterward, be sure to use a good-quality sunblock or sunscreen product while you are out of doors. Do not sunbathe. Wear clothing that covers your arms and legs, and use a hat to protect your face. Do not use tanning beds or sunlamps.

If you are a long-term user of this medication, you may notice that your skin takes on a blue-gray hue, especially in areas that have been exposed to the sun, for example on your face, neck, and arms. Once the treatment with Amiodarone has ended, the color should fade and return to normal, although you should be prepared to wait a few months for your complexion to return to normal. If your skin fails to return to its usual color, you should check with your doctor.

Before you begin your course of treatment with Amiodarone, be sure to discuss your medical history with your treating physician. This is especially important if you have a history of lung disease, thyroid problems, or liver disease.

This medication can make you feel dizzy. For this reason, you should not use machinery, drive or carry out any form of activity that requires you to be alert, until such time as you can perform these activities safely.

Amiodarone can interact with alcohol. For the duration of your treatment with this medication, it is advisable to limit your consumption of alcohol.

Storage

You should always keep your supply of Amiodarone in a sealed, airtight container. This medication should be stored at room temperature. Do not freeze the medication. You should not expose the medication to sources of extreme heat or direct sunlight. Do not allow the medication to get wet.

Always keep the medication where it cannot be reached by children or pets. If a pet does consume Amiodarone, you should seek immediate veterinary advice.

Do not keep any unwanted Amiodarone tablets. Do not use any drugs that have exceeded their use-by date. Do not dispose of any unwanted medicine by flushing it down the toilet or drain. Do not discard unused medication with your trash; Amiodarone tablets may be mistaken for candy and consumed by a child. Seek the advice of your doctor or pharmacist if you need to dispose of any unused or unwanted medicines.

Summary

In the US, Amiodarone is available under the brand names, Cordarone and Pacerone.

The medication is used in the treatment of serious and potentially fatal ventricular arrhythmias, such as fibrillation or tachycardia. Amiodarone is an anti-arrhythmic drug that slows down the electrical nerve impulses of the heart muscle, effectively restoring the correct, regular rhythm. Amiodarone may be used exclusively or in conjunction with other cardiac medication, under the direction of your doctor or cardiologist.

This medication can have a number of unpleasant side-effects, including slight fever, a cough, or pain when breathing. Shortness of breath, dizziness, and fainting can also occur in some patients. Amiodarone can also cause changes in the heart’s normal rhythm, including a condition called QT prolongation, which can cause some serious side-effects, most commonly in elderly patients or those with a history of heart attack.

There are a number of commonly prescribed and non-prescription drugs that can interact adversely with this medication. In addition, you should not eat grapefruit or drink grapefruit juice when taking Amiodarone. Grapefruit can affect the body’s efficiency in removing the drug from your body, potentially leading to a dose that is too high or even an overdose.

Amiodarone is extremely effective in controlling and managing the symptoms of ventricular arrhythmias. If you are to enjoy the best results of treatment with this drug, you should work closely with your cardiologist or doctor to determine the correct dose and dosage schedule for the medication. This process will require that you attend your specialist for regular check-ups and blood tests. These tests and discussions are necessary in order to make sure that the medication is working effectively, and that there are no unwanted side-effects.

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Last Reviewed:
December 10, 2017
Last Updated:
February 09, 2018