Amiodorone

[tobagotwo]

Despite our leeriness of it, Amiodorone is now working itself into first position as an antiarrhythmic for a variety of heart rhythm problems.

I ran across this in an article about treatments for ventricular tachycardia. It's practically a manifesto for its use.

In general on this site, it's been considered a dangerous drug with many side effects. It's been depicted as a convenience for doctors at the expense of the overall well-being of the patient ("my part of this person's problems is fixed"). It has been noted to take six months or more to leave a person's body after they stop taking it.

However, it has also been agreed that this can be a miracle-working drug when the chips are really down.

I guess we're going to find out over the next several years what the overall value and price of using amiodorone will be for a wide variety of patients. When it's gotten this far in recognition, it's very likely to become commonly prescribed for much more commonplace issues.

Amiodarone (Cordarone)
Newest of the antiarrhythmics used in treating VT, generally is considered a class III antiarrhythmic, yet it has pharmacologic characteristics of all 4 classes.
Now is considered a class I intervention by the American College of Cardiology's practice guidelines for managing acute MI. DOC in treatment of refractory, hemodynamically unstable VT. Prehospital studies suggest amiodarone is safe for use in prehospital setting, and its adoption in the new ACLS guidelines will increasingly lead EMS authorities to adopt it as their first-line antiarrhythmic. This change already is well underway in Europe.

Interactions
Increases effect and blood levels of theophylline, quinidine, procainamide, phenytoin, methotrexate, flecainide, digoxin, cyclosporine, beta-blockers, and anticoagulants; ritonavir, sparfloxacin, and disopyramide increase cardiotoxicity; coadministration with calcium channel blockers may cause additive effects, further decreasing myocardial contractility; cimetidine may increase amiodarone levels

Best wishes,

 

[Ross]

Now this is disturbing. Very disturbing.

 

[Lionheart]

My experience with Amiodorone

My experience with Amiodorone

From what I have read, it seems like heart arrhythmia is fairly common after OHS. My surgeon from Cleveland Clinic prescribed me to start taking it about 3 days prior to my AVR surgery. I had told him during my consultation that I had experienced about 3 tachycardia events (1/year) in the past. I was never able to determine whether my tachy heart rate was regular or irregular and they only lasted about an hour each.

So I don't know if he prescribes it to all his patients or did it based my past history.
Within a few days? I developed a side-effect: SEVERE constipation. Graphic medical description follows - cover your eyes if faint of heart. It is hard to describe but I will for science- it was as though my sphincter muscle would not close. This eventually resolved itself but it was extremely miserable for maybe 12 hours.

I think the amiodorone was suppose to prevent me from going into Atrial fibrillation, but in the hospital post-op I went into A-fib 3 times. They electrically cardioverted me twice but I quickly went back into A-fib and the final time I self converted. Was my self-conversion due to the amiodorone? I don't know.

During recovery at home I went into a tachycardia (A-fib?) about 2 weeks after surgery but I self converted after about an hour. At about 4 weeks post op, I went into a tachycardia that was diagnosed as Atrial flutter. I was in it for about 6 weeks until they electrically cardioverted me. So from what I can see, Amiodorone did not prevent me from going into an arrhythmia.

It is interesting that when I went into A-Flutter that my local cardio spoke to a local electrophysiologist who suggested an ablation. Checking with my surgeon at CC, he suggested that I let my heart recover from the surgery for about 3 months before I do any treatments such as a cardio-version for the A-flutter. He thought that an ablation so early after surgery was too aggressive and that I should first try less invasive procedure such as gaining rate control with meds and eventually trying a cardio version no sooner than 3-months post-op.
I waited and had a cardioversion at about 2 1/2 months post op and have now been in a sinus rhythm for about 8 months. I was on amiodorone until mid December, for a total of 10 months post op. During that time I had two eye exams to monitor for potential problems-there were none and several blood chemistry tests (I think CMP panels) to monitor for liver (and maybe thyroid?) problems. There were none.

I was very leary of taking this medicine based on what I had read here, but I must say that I had to assume that a world-class surgeon was doing the right thing in prescribing it. I also must say that I would take it again if it would help prevent returning to A-flutter. A-flutter had a huge impact on my quality of life because physical activity like walking more than 100 ft without resting would cause my heart to race to over 200 bpm, shortness of breath, and a horrible feeling of helplessness. I hated being in A-flutter!

I really don't know if the Amiodorone prevented even greater problems or not. I am just happy now that I am really feeling great, that I am off amiodorone (Yea!) and that I have been in a good sinus rhythm for many months.
I hope this was useful.
John

 

[hensylee]

Now this is disturbing. Very disturbing.

I am sure it has its place. There are lots of other meds to try first, I am told.

Liohheart, glad to know you have gotten through your problems and have a good outcome. Sounds like your dr was on top of things, what with having your eyes checked often.

 

[ALCapshaw2]

When I developed exercise induced A-Fib, I told my Cardiologist that I did not want to take Amiodarone until / unless all other options had failed.

He prescribed SOTALOL (the generic form of BetaPace) which he said specifically targets A-Fib. IT WORKED, and at a Very LOW Dose! I don't understand why more Doctors don't try this option FIRST. (I have my hunches...LAZINESS and wanting to 'resolve the problem quickly and discharge the patient')

 

[Ross]

I am sure it has its place. There are lots of other meds to try first, I am told.

Liohheart, glad to know you have gotten through your problems and have a good outcome. Sounds like your dr was on top of things, what with having your eyes checked often.

From the manufacterer themselves:

Because of these possible side effects, Cordarone Tablets should only be used in adults with
life-threatening heartbeat problems called ventricular arrhythmias, for which other
treatments did not work or were not tolerated.

http://www.wyeth.com/content/showlabeling.asp?id=93

Seldom do I hear of any physician trying something else first!

 

[Lionheart]

Liohheart, glad to know you have gotten through your problems and have a good outcome. Sounds like your dr was on top of things, what with having your eyes checked often.

Thanks Ann, my cardio gets some credit since he was good enough to monitor my blood for side effects, but unfortunately I don't recall either him or my surgeon mentioning that I should have eye exams. I think that I did that independently based on what I had read here and in other places. The eye Dr was well aware of potential vision problems from amiodorone.

John

 

[marie]

When I developed exercise induced A-Fib, I told my Cardiologist that I did not want to take Amiodarone until / unless all other options had failed.

He prescribed SOTALOL (the generic form of BetaPace) which he said specifically targets A-Fib. IT WORKED, and at a Very LOW Dose! I don't understand why more Doctors don't try this option FIRST. (I have my hunches...LAZINESS and wanting to 'resolve the problem quickly and discharge the patient')

I had A-Fib before I left the hospital and I too was on Sotalol. Took it about five months.
Earline