Amiodarone‐Induced Pulmonary Toxicity

Abstract

Amiodarone-induced pulmonary toxicity (AIPT) is one of the most serious adverse effects of amiodarone therapy and can be fatal. Therefore, vigilant monitoring is advised. Baseline chest radiograph and pulmonary function tests and follow-up chest films at 3-month intervals are advocated. However, since abnormalities on these two examinations do not always precede symptoms, patient self-reports of respiratory symptoms appear to be the best method for early detection of AIPT.

Hyperglobulinemia in Amiodarone-induced Pneumonitis

“…Indeed in a few single case reports, hyperglobulinemia is mentioned in APT [15,16]. The issue of monitoring patients on amiodarone therapy to identify pulmonary toxicity at an early stage is currently under discussion [5,14]. The use of serum globulin measurement may be considered as a part of such a vigilant monitoring.…”

“…Immunologic mechanisms are among the mechanisms proposed for amiodarone induced pulmonary toxicity. Diagnostic laboratory data for amiodarone pulmonary toxicity are not specific and include elevated erythrocyte sedimentation rate (ESR), but the etiology and diagnostic criteria for amiodarone pulmonary toxicity remain unclear [13,14]. Hyperglobulinemia is mentioned in a few case reports of amiodarone-induced pulmonary disease [15,16], but is not addressed directly.…”

Amiodarone pulmonary toxicity: a report on two cases

“…11, 15 The clinical presentation of amiodarone pulmonary toxicity is very nonspecific. Common symptoms are shortness of breath, dry cough, fever, respiratory distress, and fatigue; sometimes it can mimic acute respiratory distress syndrome.…”

Amiodarone Lung Injury: Another Heart Failure Mimic?

“…Pharmacology of amiodarone. Amiodarone is an amphophilic, iodinated benzofurane derivative that binds avidly to plasma proteins and tissues 2 . The drug has a delayed onset of action and requires high initial loading doses because of its variable bioavailability and biphasic pattern of uptake and distribution.…”

“…Macrophages obtained from patients without clinical toxicity who were receiving amiodarone demonstrate similar degrees of macrophage phospholipidosis and have similar bronchoalveolar and biopsy findings. Thus, intracellular phospholipidosis is not specific for amiodarone toxicity, and other mechanisms may be important 2 …”