Pneumonitis and pulmonary fibrosis associated with amiodarone treatment: a possible complication of a new antiarrhythmic drug.

Sobol, Samuel M.; Rakita, Louis

doi:10.1161/01.cir.65.4.819

Cited by 182 publications

(42 citation statements)

References 7 publications

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“…The antiarrhythmic drug amiodarone produces lung fibrosis in humans (183) and animals (28). Some data suggest a role for oxidative stress in amiodarone-induced lung fibrosis.…”

Section: Fibrogenic Drugs Antioxidants and Oxidative Stressmentioning

confidence: 99%

Antioxidants as Potential Therapeutics for Lung Fibrosis

Day

2008

Antioxidants & Redox Signaling

124

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Interstitial lung disease encompasses a large group of chronic lung disorders associated with excessive tissue remodeling, scarring, and fibrosis. The evidence of a redox imbalance in lung fibrosis is substantial, and the rationale for testing antioxidants as potential new therapeutics for lung fibrosis is appealing. Current animal models of lung fibrosis have clear involvement of ROS in their pathogenesis. New classes of antioxidant agents divided into catalytic antioxidant mimetics and antioxidant scavengers are being developed. The catalytic antioxidant class is based on endogenous antioxidant enzymes and includes the manganese-containing macrocyclics, porphyrins, salens, and the non-metal-containing nitroxides. The antioxidant scavenging class is based on endogenous antioxidant molecules and includes the vitamin E analogues, thiols, lazaroids, and polyphenolic agents. Numerous studies have shown oxidative stress to be associated with many interstitial lung diseases and that these agents are effective in attenuating fibroproliferative responses in the lung of animals and humans.

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“…The antiarrhythmic drug amiodarone produces lung fibrosis in humans (183) and animals (28). Some data suggest a role for oxidative stress in amiodarone-induced lung fibrosis.…”

Section: Fibrogenic Drugs Antioxidants and Oxidative Stressmentioning

confidence: 99%

Antioxidants as Potential Therapeutics for Lung Fibrosis

Day

2008

Antioxidants & Redox Signaling

124

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“…In 1980, Rotmensch et al [6] re- ported the first association between am iodarone therapy and interstitial lung dis ease. Since then, several reports of amiod arone pulmonary toxicity, whose preva lence in our area has been estimated to be around 4-5%, have ben published [7][8][9][10][11][12][13][14], In some of these patients, the diagnosis of interstitial lung disease can be difficult, because of the presence of associated left sided heart failure [15]. In this situation, the demonstration of an inflammatory process in the lower respiratory tract may be useful in order to differentiate between pulmonary manifestations of pneumonitis and those of left-sided heart failure.…”

Section: Introductionmentioning

confidence: 99%

Bronchoalveolar Lavage Cellular Analysis and Gallium Lung Scan in the Assessment of Patients with Amiodarone-Induced Pneumonitis

Xaubet

Roca²,

Rodríguez-Roisin³

et al. 1987

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Seven patients suffering from amiodarone-induced pneumonitis were followed after diagnosis over a period of 16 ± 6 months. All of them showed clinical, radiographic and functional manifestations of interstitial lung disease. Bronchoalveolar lavage was performed on 6 of them and disclosed lymphocytosis in 2 cases (associated to eosinophilia in 1 of them), neutrophilia in 1 and normal differential count in 2. In 1 case there were abundant hemosiderin-laden macrophages. In addition, all patients evidenced an increased ⁶⁷Ga lung scan uptake. After discontinuation of amiodarone therapy (with or without corticosteroid therapy), ⁶⁷Ga lung uptake normalized in 3 cases, but remained increased in 3. Bronchoalveolar lavage was repeated only in 2 cases, showing disappearance of lymphocytosis in one and abundant hemosiderin-laden macrophages in the other. Our results suggest that (1) hemosiderin-laden macrophages can be found in bronchoalveolar lavage in patients with amiodarone-induced pneumonitis, probably related to subclinical chronic left-sided heart failure; (2) ⁶⁷Ga lung scan appears to be a sensitive marker of amiodarone pneumonitis, although it can remain abnormal after pulmonary clinical, radiographic and functional normalization

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“…Amiodarone has been associated with radiological evidence of interstitial pulmonary changes, and in some patients this progresses to an alveolitis with patchy consolidation.4 [20][21][22] These changes are usually but not invariably associated with high doses (over 600 Gastrointestinal complaints-constipation, nausea, and vomiting-are uncommon and seldom a problem; they occur particularly during the loading period and respond to a reduction in the dose. Abnormalities in liver function values, with an increase in aminotransferase activity (two to three times normal), are observed in about 15% of patients and often resolve spontaneously without the dose being decreased.7…”

Section: Pharmacokineticsmentioning

confidence: 99%