Low dose amiodarone pulmonary toxicity in a patient with a history of pneumonectomy

Abstract

A case of amiodarone pulmonary toxicity (APT) is described following a low dosage of amiodarone (200 mg/day) with serious respiratory insufficiency in a patient after right pneumonectomy. The patient was successfully treated by discontinuation of amiodarone, mechanical ventilation and prednisolone (40 mg/day). A literature study indicates that APT is a dose related toxicity. In our opinion a higher pulmonary drug concentration of amiodarone could exist from a change in pharmacokinetics because of a low fat storage in a thin patient and compensatory growth of the remaining lung which occurs after pneumonectomy. Given these findings we suggest that if amiodarone is indicated in such patients both loading and maintenance doses should be adapted.

A New Agent for Atrial Fibrillation: Electrophysiological Properties of Dronedarone

“…[12][13][14][15] Although AM is generally well tolerated, the adverse effects such as thyroid dysfunction, 16 hepatic toxicity, pulmonary fibrosis, and dermatological changes often limit the long-term use of AM in a significant number of patients. [16][17][18][19][20][21] Amiodarone hydrochloride (molecular weight [MW] ¼ 681.8) contains over 35% iodine by weight, which has been attributed to its major toxicity profile after long-term therapy. 6,17,19,20,22,23 The high iodine content in its molecule has been implicated in the development of ocular and serious pulmonary toxicity 24 or thyroid dysfunction 25 among others.…”

“…[16][17][18][19][20][21] Amiodarone hydrochloride (molecular weight [MW] ¼ 681.8) contains over 35% iodine by weight, which has been attributed to its major toxicity profile after long-term therapy. 6,17,19,20,22,23 The high iodine content in its molecule has been implicated in the development of ocular and serious pulmonary toxicity 24 or thyroid dysfunction 25 among others. For these adverse side effects, congeners of AM were developed.…”