Acute respiratory failure on a low dose of amiodarone – is it an underdiagnosed and undertreated condition?

Meter, Mijo; Prusac, Ivana Kuzmić; Glavaš, Duška; Meter, Diana

doi:10.1016/j.rmcr.2021.101500

Cited by 3 publications

(2 citation statements)

References 23 publications

(28 reference statements)

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“…Amiodarone-induced interstitial lung damage includes varying forms of presentation, from mild to moderate/severe [ 40 ]. These include organizing pneumonia, interstitial pneumonitis or respiratory failure.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Fibrosis Related to Amiodarone—Is It a Standard Pathophysiological Pattern? A Case-Based Literature Review

et al. 2022

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Amiodarone hydrochloride is an antiarrhythmic drug, with proven efficacy in prevention and treatment of numerous arrhythmias, atrial fibrillation especially, or ventricular arrhythmias, with a long half-life (55–60 days). The increased risk of developing amiodarone-induced pulmonary fibrosis is directly related to the dose and the duration of the intake. Amiodarone-induced pulmonary toxicity is conditioned by dose, patient’s age, and pre-existent pulmonary pathologies. The pattern for drug-induced lung injury may vary in many forms, but the amiodarone can cause polymorphous injuries such as diffuse alveolar damage, chronical interstitial pneumonia, organizing pneumonia, pulmonary hemorrhage, lung nodules or pleural disease. The pathological mechanism of pulmonary injury induced by amiodarone consists of the accumulation of phospholipid complexes in histocytes and type II pneumocytes. Differential diagnosis of pulmonary fibrosis induced by amiodarone is made mainly with idiopathic pulmonary fibrosis, left ventricular failure or infectious disease. Before starting treatment with amiodarone, patients should be informed of potential adverse effects and any new respiratory symptoms should promptly be reported to their family physician or attending physician. The assessment carried out at the initiation of amiodarone treatment should include at least chest X-ray and respiratory function tests and extrapulmonary evaluation.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Fibrosis Related to Amiodarone—Is It a Standard Pathophysiological Pattern? A Case-Based Literature Review

et al. 2022

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“…Even though the adverse effects of amiodarone are well-documented, physicians and patients do not often follow the guidelines for monitoring the therapy. For instance, the serum levels of amiodarone, which can be measured in specific medical centers and indicate toxicity if above 2.5 mg/L, are not regularly measured [14].…”

Section: Discussionmentioning

confidence: 99%

Amiodarone-Induced Lung Toxicity: A Case Initially Not Correctly Framed

Scaramozzino¹,

Sapone²,

Plastina³

et al. 2023

Cureus

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Amiodarone-induced pulmonary toxicity (AIPT) is one of the most serious adverse effects of amiodarone and is one of the leading causes of death associated with its use. The onset of AIPT depends on dosage, patient's age, and pre-existing pulmonary pathologies; typically, the adverse effects stop progressing when a cumulative dose higher than 150 mg is reached. The risk of developing amiodarone-induced pulmonary fibrosis is directly related to the dosage and duration of administration. In this case report, the effect of a prolonged overdose of amiodarone taken at doses of 200 mg/day for two years is reported, with symptoms and instrumental evidence of respiratory pathology induced by amiodarone drug toxicity. Comorbidities, oxygen therapy, invasive procedures, and surgical interventions can trigger pulmonary symptoms. Despite significant advances in understanding AIPT, its etiology and pathogenesis remain poorly understood. The role of steroids in the treatment of AIPT is still under debate as most reports of improvement after amiodarone withdrawal differ little from those in which concomitant steroid therapy was used. In clinical practice, therapeutic doses of corticosteroids may be indicated for patients with AIPT; usually, a starting dose of prednisone from 40 to 60 mg daily, which is then gradually reduced, is prescribed. The pharmacodynamics of amiodarone determines a treatment period of four to 12 months.The patient with AIPT in this case report, who markedly improved after treatment with prednisone at a starting dose of 50 mg/day, which was then gradually tapered. At the end of the therapy, the computed tomography (CT) scan revealed the disappearance of most of the scattered ground-glass opacities and of the thickening indicating bi-apical pulmonary fibrosis.The case report is unique because: 1) Bronchoalveolar lavage (BAL)/transbronchial biopsy was not used for diagnosis.2) The case was framed based on the patient's laboratory and clinical data.3) The pathology is normally prevalent in men rather than women.

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Amiodarone

2021

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Acute respiratory failure on a low dose of amiodarone – is it an underdiagnosed and undertreated condition?

Cited by 3 publications

References 23 publications

Pulmonary Fibrosis Related to Amiodarone—Is It a Standard Pathophysiological Pattern? A Case-Based Literature Review

Pulmonary Fibrosis Related to Amiodarone—Is It a Standard Pathophysiological Pattern? A Case-Based Literature Review

Amiodarone-Induced Lung Toxicity: A Case Initially Not Correctly Framed

Amiodarone

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