Adverse Effects of Low Dose Amiodarone: A Meta-Analysis

Vorperian, Vicken R.; Havighurst, Thomas C.; Miller, Stephen D.; January, Craig T.

doi:10.1016/s0735-1097(97)00220-9

Cited by 379 publications

(277 citation statements)

References 45 publications

Supporting

Mentioning

254

Contrasting

Unclassified

Order By: Relevance

“…Although available evidence suggests that amiodarone is effective for maintenance of sinus rhythm in patients with AF, its use is limited by potentially severe extracardiac side effects, 5 even at low doses. 20 Therefore, amiodarone should be used as second-line treatment, except in patients with HF, in whom amiodarone appears to offer advantages regarding relative risks and benefits, and in patients with substantial LVH. 5 Numerous possible reasons exist regarding the extensive use of amiodarone.…”

Section: Guidelines Versus Clinical Practice: Why the Difference?mentioning

confidence: 99%

Antiarrhythmic drug therapy for atrial fibrillation: Are the guidelines guiding clinical practice?

Reiffel

Naccarelli

2006

Clin Cardiol

View full text Add to dashboard Cite

Summary:The AFFIRM study showed no clear survival advantage for a rhythm versus rate control strategy in patients with atrial fibrillation (AF). However, rhythm control with antiarrhythmic drugs (AADs) is appropriate in a large number of patients with AF. The American College of Cardiology/ American Heart Association/European Society of Cardiology AF management guidelines include a safety-based algorithm for selection of AAD therapy. Class 1C agents are recommended as first-line therapy in patients without or with minimal structural heart disease. However, market research and clinical study data indicate a growing use of class III agents (mainly amiodarone) despite long-term safety and tolerability concerns, suggesting that clinical practice does not adhere to current guidelines.

show abstract

Section: Guidelines Versus Clinical Practice: Why the Difference?mentioning

confidence: 99%

Antiarrhythmic drug therapy for atrial fibrillation: Are the guidelines guiding clinical practice?

Reiffel

Naccarelli

2006

Clin Cardiol

View full text Add to dashboard Cite

show abstract

“…3 Higher daily doses are associated with a greater incidence of pulmonary toxicity but may occur in patients taking lower doses (Յ200 mg/d). [6][7][8] Amiodarone and its metabolite desethylamiodarone are cationic amphiphilics that accumulate in organs with high lipid content, including the lungs. 5 Both can be toxic to lung tissue even at therapeutic serum levels.…”

Section: Discussionmentioning

confidence: 99%

48-Year-Old Woman With Dyspnea, Cough, and Weight Loss

Duello

Louh

Burger

2012

Mayo Clinic Proceedings

View full text Add to dashboard Cite

A 48-year-old woman presented to our emergency department with progressive dyspnea, cough with clear sputum, and a 9-kg weight loss. Evaluation at an outside emergency department 6 months previously had revealed a right middle lobe infiltrate on chest radiography (CXR), and she was treated with a 10-day course of levofloxacin for presumed community-acquired pneumonia. Her symptoms continued, and 1 month later, she went to an outside pulmonologist who found bilateral alveolar infiltrates on chest computed tomography (CT).On presentation to our emergency department, the patient reported no orthopnea, fevers, chills, or night sweats. Her medical history was notable for nonischemic dilated cardiomyopathy that was treated with cardiac resynchronization therapy and an automatic implantable cardioverter-defibrillator (AICD), atrial fibrillation, and myelodysplastic syndrome. She had a 10-pack-year smoking history but had quit smoking 1 year previously. Her medications included furosemide, losartan, digoxin, coumadin, amiodarone, and spironolactone. No new medications had been added to her treatment regimen during the past 10 years.On admission, the patient's vital signs were as follows: temperature, 37.0 o C; blood pressure, 101/64 mm Hg; respiratory rate, 18 breaths/min; and oxygen saturation, 94% while the patient breathed room air. She was in no acute distress. Her sclera had a blue-grey discoloration. Cardiac examination revealed a regular rhythm, grade 1/6 systolic murmur heard at the left upper sternal border, no gallops, no jugular venous distention, and no peripheral edema. Pulmonary examination revealed crackles over the right middle lobe but otherwise normal results. Abdominal, musculoskeletal, and neurologic examination findings were unremarkable.Chest radiography showed bilateral dense consolidations that were greater on the right with clear costophrenic angles, an AICD, and cardiomegaly. Chest CT revealed asymmetric bilateral, multilobar alveolar consolidations without pleural effusions or engorgement of the intralobar space, 4-chamber cardiomegaly, and an AICD.Laboratory studies yielded the following results (reference ranges shown parenthetically): hemoglobin, 10.1 g/dL (12.0-15.5 g/dL; previous level, 10.0 g/dL); white blood cell count, 1.6 ϫ 10 9 /L (3.5-10.5 ϫ 10 9 /L); 10% segmented neutrophils; 59% lymphocytes with an absolute neutrophil count of 2.0 ϫ 10 9 /L (0.9-2.9 ϫ 10 9 /L); platelet count, 125 ϫ 10 9 /L (150-450 ϫ 10 9 /L); erythrocyte sedimentation rate, 64 mm/h (Ͻ29 mm/h); international normalized ratio, 1.7 (0.8-1.2); brain naturietic peptide (BNP), 1260 pg/mL (Ͻ71 pg/mL); digoxin, 1.59 ng/mL (0.5-2.0 ng/mL); thyroid stimulating hormone, 0.52 mIU/L (0.3-5.0 mIU/L); and human immunodeficiency virus antibody, negative. The patient was admitted to the hospital for evaluation of new neutropenia, progressive dyspnea, and undiagnosed pulmonary infiltrate.

show abstract

“…Clinical use of amiodarone is associated with concerns about adverse effects, particularly APTwhich reportedly occurs in 0.8 to 17%of the treated patients, and has a high mortality rate (1,2). In managing patients treated with amiodarone, clinicians closely monitor symptoms, laboratory data, and DLco (5).…”

Section: Discussionmentioning

confidence: 99%

“…Amiodarone is used increasingly to treat life-threatening arrhythmias (1,2). However, use of this drug is restricted due to concerns of adverse effects, especially pulmonarytoxicity (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

“…However, use of this drug is restricted due to concerns of adverse effects, especially pulmonarytoxicity (1)(2)(3)(4). Although the pulmonary carbon monoxide diffusion capacity (DLco) has been measured to detect amiodarone-induced pulmonary toxicity (APT) (5), the sensitivity, specificity and applicability to acutely ill patients remain unclarified.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

SP-D as a Marker of Amiodarone-induced Pulmonary Toxicity.

et al. 2002

View full text Add to dashboard Cite

Twopatients with amiodarone-induced pulmonary toxicity (APT) showed abnormally increased serum SP-D concentrations, although their KL-6 level was within the normal range. In a 59-year-old man with ischemic heart disease, APTprogressed rapidly and required steroid pulse therapy. During the clinical course, SP-D was as high as 375 ng/ml, although the KL-6 level was only 289 U/ml. In a 58-year-old man treated for dilated cardiomyopathy, SP-D increased to 289 ng/ml, while KL-6 remained at less than 500 U/ml. These cases indicate that SP-D is a useful and early diagnostic marker for APTeven when KL-6 is not elevated. (Intrenal Medicine 41: 709-712, 2002)

show abstract

Adverse Effects of Low Dose Amiodarone: A Meta-Analysis

Abstract: Compared with placebo, there is a higher likelihood of experiencing several amiodarone-related adverse effects with exposure to low daily doses of the drug. Thus, although low dose amiodarone may be well tolerated, it is not free of adverse effects.

Cited by 379 publications

References 45 publications

Antiarrhythmic drug therapy for atrial fibrillation: Are the guidelines guiding clinical practice?

Antiarrhythmic drug therapy for atrial fibrillation: Are the guidelines guiding clinical practice?

48-Year-Old Woman With Dyspnea, Cough, and Weight Loss

SP-D as a Marker of Amiodarone-induced Pulmonary Toxicity.

Contact Info

Product

Resources

About