Amiodarone

As an antiarrhythmic agent, amiodarone restores natural heart rhythm and helps patients maintain a normal, steady heartbeat.

Overview

Amiodarone treats life-threatening heart rhythm problems, such as ventricular arrhythmias and tachycardia. Typically used in patients who have already been treated with other medications that didn't work, amiodarone slows the nerve impulses in the heart, helping keep the heart rhythm normal. Known as an anti-arrhythmic drug, it blocks the electrical signals in the heart that cause irregular heartbeat.

Other medications can interact with amiodarone, therefore, it's important to discuss the medications you're taking with your doctor. Patients should also discuss any medical conditions they have with their doctor, as certain conditions can also interact with this drug. Amiodarone can be administered intravenously and may also be known by its brand name, Cardarone IV.

Condition(s) treated

  • Tachycardia
  • Irregular heartbeat
  • Persistent ventricular fibrillation

Type of Medicine

  • Antiarrhythmic

Side Effects

Some medications, along with treating problems, can cause unwelcome side effects. Not all side effects mentioned will occur, but if they do, they may require medical attention. If any of the following common side effects occur, check with your doctor right away.

  • Shortness of breath
  • Cough
  • Trembling or shaking of the hands
  • Fainting, lightheadedness, dizziness
  • Slight fever
  • Trouble walking
  • Tingling or numbness in the toes or fingers
  • Painful breathing
  • Weakness of the arms or legs
  • Sensitivity of the skin to sunlight
  • Unusual and uncontrolled movements of the body

Less common side effects include:

  • Nervousness
  • Blue-gray coloring of the skin on the arms, face and neck
  • Dry eyes
  • Blurred vision or blue-green halos seen around objects
  • Coldness
  • Dry, puffy skin
  • Trouble sleeping
  • Fast or irregular heartbeat
  • Pain and swelling in the scrotum
  • Swelling of the feet or lower legs
  • Slow heartbeat
  • Sweating
  • Sensitivity to light
  • Sensitivity to heat
  • Weight gain or loss
  • Unusual tiredness

Rare side effects include:

  • Skin rash
  • Yellow skin or eyes

The incidence of the following side effects is unknown:

  • Abdominal or stomach pain
  • Blue lips, fingernails, or skin
  • Agitation
  • Leg, back, or stomach pains
  • Blurred or double vision
  • Cracks in the skin
  • Bleeding gums
  • General body swelling
  • Blistering, peeling, or loosening skin
  • Bloating
  • Blood in the urine
  • Chest pain
  • Bloody, black, or tarry stools
  • Chills
  • Fatigue
  • Clay-colored stools
  • Coma
  • High fever
  • Confusion
  • Fast heartbeat
  • Lower back or side pain
  • Red, irritated eyes
  • Stupor
  • Confusion as to time, place or person
  • Mood or mental change
  • Holding false beliefs that cannot be changed by fact
  • Coughing or spitting up blood
  • Dark urine
  • Itching
  • Decreased urine output
  • Joint or muscle pain
  • Sores, ulcers, or white spots in the mouth or on the lips
  • Nosebleeds
  • Unusual bruising or bleeding
  • Red skin lesions, usually with a purple center
  • Depression
  • Muscle cramps or spasms
  • Pain in the abdomen, scrotum, or groin
  • Loss of heat from the body
  • Sore throat
  • Pains in the side, stomach or abdomen, possibly traveling to the back
  • Hostility
  • Muscle pain or stiffness
  • Diarrhea
  • Irritability
  • Difficulty or labored breathing
  • Pain or burning with urination
  • Rash
  • Large, hive-like swelling on the lips, face, eyelids, tongue, feet, legs, hands, throat, or sex organs
  • Unusual nervousness, excitement, restlessness
  • Difficult urination
  • Sneezing
  • Inability to have or keep an erection
  • Dry cough
  • Unpleasant breath odor
  • Muscle twitching
  • Eye pain
  • Red, swollen skin
  • Indigestion
  • Swelling on the ankles, hands, or face
  • Irregular, fast or slow, or shallow breathing
  • Lethargy
  • Wheezing
  • Pale skin
  • Noisy breathing
  • Vomiting blood
  • Severe headache
  • Troubled breathing
  • Loss in sexual ability, drive, desire, or performance
  • No breathing
  • Scaly skin
  • Pinpoint red spots on the skin
  • Swelling of the scrotum
  • Rapid weight gain
  • Swollen or painful glands
  • Hearing, seeing, or feelings that aren't there
  • Seizures
  • Tightness in the chest
  • Unusual weakness or tiredness

Some side effects are common and usually go away during treatment. These side effects do not require medical attention. Your body just needs time to adjust to the medication. Your healthcare provider may be able to give you some tips on how to prevent or reduce some of these side effects. Talk to your doctor if they become too bothersome or if you have questions about them.

  • Constipation
  • Headache
  • Loss of appetite
  • Nausea and vomiting

Less common side effects of this nature include:

  • Flushing of the face
  • Dizziness
  • Bitter or metallic taste
  • Decrease in sexual ability in men
  • Decrease in sexual interest

Side effects not listed may also occur in some patients. If you develop any other side effects, contact your healthcare provider immediately.

Dosage

To treat ventricular arrhythmias, adults should take between 800 and 1600 milligrams (mg) per day of divided doses. Your doctor may need to adjust your dose as necessary in order for your body to tolerate the drug properly.

To treat ventricular arrhythmias, children must have their dosage determined by their doctor.

Typically, you'll receive your first dose of this medication intravenously in the hospital. After this, your doctor may switch you to the oral medication.

If you miss a dose, take it as soon as you remember, unless it's almost time for your next dose. If that's the case, skip the missed dose and resume your normal dosing schedule. Never double up on doses to make up for a missed dose.

Interactions

Certain medications should not be combined, as an interaction may occur, and your doctor might have to change your dosage of amiodarone. The following medications are not recommended with amiodarone:

  • Nelfinavir
  • Amifampridine
  • Pimozide
  • Amisulpride
  • Bepridil
  • Cisapride
  • Sparfloxacin
  • Colchicine
  • Dronedarone
  • Posaconazole
  • Fingolimod
  • Terfenadine
  • Fluconazole
  • Grepafloxacin
  • Piperaquine
  • Ritonavir
  • Indinavir
  • Thioridazine
  • Ketoconazole
  • Vernakalant
  • Levomethadyl
  • Mesoridazine
  • Saquinavir
  • Tipranavir
  • Ziprasidone

The following medications are usually not supposed to be taken in combination with amiodarone, but in some cases, could be necessary. If both medications are prescribed together, your doctor might adjust the dosage or frequency of one or both of the medications. These medications include:

  • Ebastine
  • Abiraterone
  • Deslorelin
  • St John's Wort
  • Pazopanib
  • Nefazodone
  • Quinidine
  • Ospemifene
  • Ivabradine
  • Lumefantrine
  • Octreotide
  • Quetiapine
  • Probucol
  • Goserelin
  • Fluoxetine
  • Acecainide
  • Digoxin
  • Afatinib
  • Fluvoxamine
  • Cilostazol
  • Pasireotide
  • Etravirine
  • Lovastatin
  • Spiramycin
  • Moxifloxacin
  • Lacidipine
  • Ofloxacin
  • Agalsidase Alfa
  • Desipramine
  • Itraconazole
  • Efavirenz
  • Alfuzosin
  • Amiodarone
  • Sulfamethoxazole
  • Protriptyline
  • Nafarelin
  • Sotalol
  • Ondansetron
  • Paroxetine
  • Gonadorelin
  • Sulpiride
  • Loratadine
  • Olanzapine
  • Formoterol
  • Degarelix
  • Quinine
  • Prilocaine
  • Iloperidone
  • Amitriptyline
  • Delamanid
  • Amlodipine
  • Pentamidine
  • Famotidine
  • Manidipine
  • Ranitidine
  • Granisetron
  • Nicardipine
  • Paritaprevir
  • Sultopride
  • Delavirdine
  • Lopinavir
  • Flunarizine
  • Eliglustat
  • Morphine Sulfate Liposome
  • Isradipine
  • Ombitasvir
  • Ciprofloxacin
  • Sorafenib
  • Ranolazine
  • Propafenone
  • Diltiazem
  • Perflutren Lipid Microsphere
  • Lapatinib
  • Amprenavir
  • Disopyramide
  • Mefloquine
  • Sunitinib
  • Papaverine
  • Halofantrine
  • Fosamprenavir
  • Solifenacin
  • Idelalisib
  • Regorafenib
  • Pimavanserin
  • Anagrelide
  • Nifedipine
  • Lidoflazine
  • Procainamide
  • Clomipramine
  • Rifampin
  • Imipramine
  • Felbamate
  • Methadone
  • Apomorphine
  • Encainide
  • Mifepristone
  • Triptorelin
  • Dofetilide
  • Foscarnet
  • Tacrolimus
  • Perhexiline
  • Cobicistat
  • Risperidone
  • Goldenseal
  • Aripiprazole
  • Indecainide
  • Sodium Phosphate, Monobasic
  • Dolasetron
  • Prochlorperazine
  • Vandetanib
  • Tamoxifen
  • Mizolastine
  • Salmeterol
  • Cyclobenzaprine
  • Oxycodone
  • Sofosbuvir
  • Domperidone
  • Ibutilide
  • Arsenic Trioxide
  • Perphenazine
  • Vadenafil
  • Sematilide
  • Fosphenytoin
  • Topotecan
  • Crizotinib
  • Vorinostat
  • Paliperidone
  • Tedisamil
  • Nilotinib
  • Artemether
  • Pranidipine
  • Sodum Phosphate, Dibasic
  • Methotrimeprazine
  • Iohexol
  • Enflurane
  • Promethazine
  • Vasopressin
  • Clozapine
  • Sodium Phosphate
  • Sertindole
  • Telaprevir
  • Asenapine
  • Tocainide
  • Moricizine
  • Galantamine
  • Sevoflurane
  • Warfarin
  • Ledipasvir
  • Metronidazole
  • Panobinostat
  • Felodipine
  • Nilvadipine
  • Voriconazole
  • Escitalopram
  • Vemurafenib
  • Simeprevir
  • Tolterodine
  • Donepezil
  • Conivaptan
  • Fentanyl
  • Astemizole
  • Telavancin
  • Doxepin
  • Mexiletine
  • Zileuton
  • Venetoclax
  • Trimipramine
  • Eribulin
  • Clarithromycin
  • Atazanavir
  • Doxorubicin
  • Pipamperone
  • Simvastatin
  • Lercanidipine
  • Azimilide
  • Telithromycin
  • Doxorubicin Hydrochloride Liposome
  • Azithromycin
  • Bedaquiline
  • Tizanidine
  • Morphine
  • Venlafaxine
  • Gallopamil
  • Hydroquinidine
  • Nisoldipine
  • Dabigatran Etexilate
  • Bicalutamide
  • Mibefradil
  • Sirolimus
  • Tetrabenazine
  • Daclatasvir
  • Gatifloxacin
  • Nitrendipine
  • Erythromycin
  • Vinflunine
  • Boceprevir
  • Toremifene
  • Miconazole
  • Hydroxychloroquine
  • Haloperidol
  • Verapamil
  • Zolmitriptan
  • Citalopram
  • Isoflurane
  • Trimethoprim
  • Ticagrelor
  • Pitolisant
  • Norfloxacin
  • Zotepine
  • Droperidol
  • Vincristine Sulfate Liposome
  • Bretylium
  • Vilanterol
  • Leuprolide
  • Dabrafenib
  • Buserelin
  • Ceritinib
  • Halothane
  • Gemifloxacin
  • Dasabuvir
  • Levofloxacin
  • Hydroxyzine
  • Chloral Hydrate
  • Chloronique
  • Zuclopenthixol
  • Isoniazid
  • Dasatinib
  • Chloropromazine
  • Flecainide
  • Trazodone
  • Vincristine
  • Ginkgo Biloba
  • Histrelin
  • Lidocaine
  • Pixantrone
  • Trifluoperazine

Using the following medications along with amiodarone can cause an increase in side effects, but both drugs may be determined to be best for your treatment. If both medications are prescribed together, your doctor might change how often you use one or both of the medications, or the dosage. These medications include:

  • Abarelix
  • Acebutolol
  • Acenocoumarol
  • Aplrenolol
  • Atorvastatin
  • Betaxolol
  • Bevantolol
  • Bisoprolol
  • Bucindolol
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Cholestyramine
  • Clonazepam
  • Cyclosporine
  • Dicumarol
  • Digitoxin
  • Dilevalol
  • Esmolol
  • Labetalol
  • Levobunolol
  • Mepindolol
  • Methotrexate
  • Metipranolol
  • Metoprolol
  • Nadolol
  • Nebevolol
  • Nevirapine
  • Oxprenolol
  • Penbutolol
  • Phenytoin
  • Pindolol
  • Propranolol
  • Rifapentine
  • Rosuvastatin
  • Talinolol
  • Tertatolol
  • Theophylline
  • Timolol

Certain foods and other substances can cause interactions, such as grapefruit juice. Using alcohol and tobacco can cause interactions as well. Some medical conditions can also cause interactions. If you have any of the following medical problems, tell your doctor.

  • AV block (abnormal heart rhythm), with no pacemaker
  • Cardiogenic shock
  • Eye or vision problems
  • Heart rhythm problems (e.g. QT prolongation)
  • Hypomagnesemia (low magnesium in blood)
  • Lung disease or other breathing problems (e.g. interstitial pneumonitis)
  • Bradycardia (slow heartbeat)
  • Sick sinus syndrome (type of abnormal heart rhythm), with no pacemaker
  • Heart disease (e.g. congestive heart failure)
  • Hypokalemia (low potassium in the blood)
  • Hypotension (low blood pressure)
  • Thyroid problems

Warnings

Before taking amiodarone, you and your doctor must decide whether the risks are worth the good the medication will do for you. Consider the following information before taking amiodarone.

Take amiodarone exactly as your doctor prescribed. Follow all of the directions on the label, as well as any instructions given to you by your doctor.

Avoid taking amiodarone in smaller or larger amounts than suggested by your doctor. Typically, you'll receive your first dose of amiodarone in the hospital, where your heart can be monitored.

If you're currently taking another medicine to treat heart rhythms, you might need to stop taking it gradually when you start taking amiodarone. Be sure to follow your doctor's instructions about dosing carefully.

Talk to your doctor about any other allergies you might have to this medication and any other medications. Also, tell your doctor whether you have allergies to certain foods, animals, dyes, or preservatives.

You should not take this medication if you're allergic to iodine or amiodarone, or if you have 2nd- or 3rd-degree "AV block" (unless you have a pacemaker). Tell your doctor if you have a history of slow heartbeats, or if your heart isn't able to pump blood properly.

Do not take this medication if you have an allergy to iodine, as it contains iodine.

Amiodarone can cause dangerous side effects on your thyroid, lungs, heart, and liver.

Elderly patients are more likely to have heart, liver, or kidney problems that may require a dosage adjustment. Elderly patients should take amiodarone with caution. More of amiodarone may stay in your body and increase your risk of side effects if you are over the age of 60.

Tell your doctor if you have signs of a thyroid problem, like dry skin, weight changes, feeling too hot or cold, thinning hair, extreme tiredness, swelling in your neck (goiter), and irregular menstrual periods.

Call your doctor right away if you develop: jaundice (yellowing of the eyes or skin), dark urine, trouble breathing, chest pain, upper stomach pain, fast or pounding heartbeats, or if you cough up blood.

Avoid grapefruit juice while taking amiodarone.

Do not use this medication if you have neurological diseases such as Parkinson's disease, epilepsy, peripheral neuropathy, or muscular dystrophy. Taking amiodarone can cause these conditions to worsen.

Do not use this medication if you're pregnant. Taking amiodarone while pregnant can harm the baby or cause thyroid problems or abnormal heartbeats after birth. This medication can also affect the child's growth and development, such as speech, movement and academic skills. Using birth control during treatment to prevent pregnancy is recommended.

Amiodarone is known to pass into breast milk and can harm your nursing baby. Do not breastfeed while taking this medication.

Children should not take this medication (anyone under 18 years old), as its effectiveness has not yet been determined.

This medication can be taken with or without food, but make sure to take it the same way each time.

It can take up to 2 weeks before your heart rhythm improves so don't expect immediate results. Keep using the medication throughout the course of treatment, even if you start feeling better.

Amiodarone can interfere with certain medical tests; therefore, it's important to tell any healthcare professional who treats you that you're taking it.

While taking amiodarone, you may need regular medical tests and chest x-rays to monitor your vision, thyroid, lungs and liver function. This medication is known to have long lasting effects on your body. Medical tests may be required for several months after you stop taking amiodarone. Drug interactions are a possibility for up to several months after you stop taking this medication.

If you're planning to have surgery, tell the surgeon beforehand that you're taking amiodarone. You may need to stop taking amiodarone for a limited time.

In case of an accidental overdose, seek emergency medical attention immediately, or contact a poison control center. Signs of an overdose include lightheadedness, weakness, loss of consciousness, or slow heart rate.

Do not share this medication with anyone; it's also important that you don't take someone else's medication.

This medication can cause dizziness; do not drive, use heavy machinery, or perform any activity that requires alertness until you're sure you can perform such actions safely. Limit your alcohol consumption while taking amiodarone.

Low levels of magnesium or potassium in the blood can increase your risk of QT prolongation. The risk of QT prolongation is increased if you're taking other drugs that can cause QT prolongation. Talk to your doctor about any medical conditions you have.

Do not use lidocaine with amiodarone, as this may cause seizures and a slower heart rate.

Storage

Store this medication in a closed container away from extreme moisture, heat, and direct light. Store at room temperature and avoid freezing.

Keep this medication out of the reach and sight of children. If you're using weekly pill reminders, make sure they're locked, as they're usually not child resistant.

Dispose of any outdated or unused medication, however, do not throw it in the trash or flush this medication down the toilet. Prescription medications should always be disposed of in accordance with state and federal regulations. Ask your doctor or pharmacist how you should dispose of any medication you don't use. Your community may have a take-back program that takes any unused or expired medication. Ask your local garbage or recycling department about such programs.

Summary

While amiodarone is a greatly beneficial drug, it can also increase the risk of potentially fatal medical conditions when they're not reported to a healthcare professional. As a treatment designed to alleviate irregular heartbeat, amiodarone slows the nerve impulses in the heart, helping keep the heart rhythm normal. By slowing down the heart rhythm, this medication can treat conditions such as ventricular tachycardia and ventricular fibrillation. This medication is typically given when other medications to treat heart rate problems haven't worked.

When taken correctly, amiodarone treats and prevents abnormal heartbeats by working inside cells to regulate muscle contractions in the heart. In addition to treating life-threatening heart rate problems, amiodarone can help improve the quality of life in some patients.

Resources
Last Reviewed:
December 10, 2017
Last Updated:
December 22, 2017