Amiodarone - A &amp;#x2018;Broad Spectrum&amp;#x2019; Antiarrhythmic Drug

Punnam, Sujeeth R.; Goyal, Sandeep; Kotaru, Veera Pavan; Pachika, Ajay; Abela, George S.; Thakur, Ranjan K.

doi:10.2174/187152910790780032

Cited by 31 publications

(23 citation statements)

References 81 publications

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“…Initially it was used as anti-anginal agent due to its vasodilator properties and later in 1970s as an antiarrhythmic agent for both ventricular and supraventricular tachycardia with significant efficacy. 6 Amiodarone controls arrhythmia by inhibiting the influx of sodium and calcium into the cardiac tissue resulting in suppression of excitability and conductivity of cardiac tissues, especially in myocytes. It also inhibits voltage and ligand-gated potassium channel currents, and this prolongs the action potential in cardiac tissues.…”

Section: Discussionmentioning

confidence: 99%

Amiodarone pulmonary toxicity: a report on two cases

Zedan

Mukarram

Burns³

et al. 2015

SW Resp Crit Care Chron

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Amiodarone is an iodine-containing antiarrhythmic drug commonly used for the treatment of ventricular and supraventricular arrhythmias. Amiodarone toxicity has several clinical presentations and affects multiple organs. One well-known serious side effect of amiodarone is pulmonary toxicity which can be acute, sub-acute, or chronic. Amiodarone pulmonary toxicity may present a diagnostic dilemma, particularly when clinical suspicion of pulmonary infection is high. Here we report two cases of amiodarone lung toxicity that were diagnosed in an early stage and improved after the discontinuation of amiodarone.

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Section: Discussionmentioning

confidence: 99%

Amiodarone pulmonary toxicity: a report on two cases

Zedan

Mukarram

Burns³

et al. 2015

SW Resp Crit Care Chron

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“…1 Embora estejam descritos casos de neuropatia óptica associados a estas doenças, a sua presença deve suscitar a pesquisa do anticorpo anti-NMO, dado poderem fazer parte de um espectro de neuromielite óptica.…”

Section: Discussionunclassified

“…A neuropatia óptica é um efeito secundário neurológico incomum, ocorrendo até 1,79% dos doentes, 1,4 sendo uma causa incomum de edema bilateral da papila.…”

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Edema Bilateral do Disco Óptico Secundário a Amiodarona: Manifestação de uma Neuropatia Óptica Iatrogénica

2015

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RESUMOUm doente de 69 anos, sexo masculino, inicia de forma súbita uma hipovisão unilateral indolor. Encontrava-se medicado com amiodarona, 200mg/dia, iniciada 2 meses antes por fibrilação auricular. A avaliação oftalmológica inicial constatou um edema bilateral do disco óptico. O restante exame neurológico não apresentava alterações de relevo. Após a exclusão de uma etiologia arterítica ou relacionada com hipertensão intracraniana, estabeleceu-se um diagnóstico diferencial entre a neuropatia óptica isquémica anterior não-arterítica e uma neuropatia óptica secundária a amiodarona. Este último diagnóstico foi favorecido pela presença bilateral e simultânea de edema do disco óptico, pela melhoria progressiva do quadro após descontinuação do fármaco e, principalmente, pela persistência do edema para além das 6 semanas. Refira-se que um início agudo é comum nesta patologia. A neuropatia óptica secundária a amiodarona é uma causa rara mas potencialmente grave de disfunção do nervo óptico, sendo habitualmente necessária a sua descontinuação. Palavras-chave: Amiodarona; Doenças do Nervo Óptico; Papiledema. ABSTRACTA 69-years-old male patient was treated with amiodarone 200mg/day over the passed two months for atrial fibrillation. He presented a sudden, painless and unilateral visual loss. Ophthalmologic evaluation revealed a bilateral optic disc edema. Neurological examination was otherwise unremarkable. After properly excluding increased intracranial pressure and giant cell arteritis, the main differential diagnosis was between nonarteritic anterior ischemic optic neuropathy and optic neuropathy secondary to amiodarone. The latter diagnosis was favored due to a presence of bilateral and simultaneous optic disc edema, gradual improvement of symptoms after discontinuation of the drug, and, mostly, by persistence of optic disc edema beyond 6 weeks. Of note, an acute presentation of this disorder is common. Amiodarone optic neuropathy is a rare but potentially serious cause of optic nerve dysfunction, and its discontinuation is usually warrant. Keywords: Amiodarone; Optic Nerve Diseases; Papilledema. INTRODUÇÃOA amiodarona é um anti-arrítmico (classe III), frequentemente utilizada em arritmias ventriculares e supraventriculares (nomeadamente na fibrilhação auricular).1 São reconhecidos diversos efeitos adversos sistémicos, nomeadamente oftalmológicos, dermatológicos, gastrointestinais, pulmonares, hepatotóxicos, cardiovasculares e tiroideus. 1,2Os efeitos neurológicos mais comuns são a ataxia, tremor, neuropatia periférica e as alterações cognitivas.3 Relatos iniciais reportavam uma frequência destes efeitos até 74% dos doentes tratados.2,3 Contudo, estudos mais recentes indicam uma incidência de apenas 2,8%. Esta diferença poderá dever-se a uma mudança da dose média diária prescrita, sendo de 600mg nos anos 80 e 200 mg actualmente. 3A neuropatia óptica é um efeito secundário neurológico incomum, ocorrendo até 1,79% dos doentes, 1,4 sendo uma causa incomum de edema bilateral da papila.Apresentamos um caso em cuja sintomat...

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“…Additionally, we don’t have an amiodarone alone group. As a “broad antiarrhythmic drug”, amiodarone may suffice as anti-arrhythmic prophylaxis without adding the risk of hemodynamic instability of lidocaine (16). Dorian et al reported (17) that when compared to lidocaine, amiodarone improves survival for out-of-hospital ventricular fibrillation, resistant to epinephrine and electrical cardioversion.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic amiodarone and lidocaine improve survival in an ovine model of large size myocardial infarction

Li¹,

Wei²,

Watkins³

et al. 2013

Journal of Surgical Research

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Background Large animal models serve as a critical link in the translation of basic science to clinical practice. However, large animal models of MI, especially a large size MI, are associated with high mortality due to arrhythmia. The prophylactic effect of amiodarone and lidocaine were retrospectively reviewed in our ovine MI model. Methods One hundred-fourteen Dorset hybrid sheep with 25–30% MI were included in this study. Animals were prophylacticly treated with amiodarone plus lidocaine before ligation of the 4–6 coronary artery branches supplying the apex of the heart (arrhythmia-prevention group, AP group, n=45) and with epinephrine (shock-prevention group, SP group, n=49), respectively. Animals without prophylactic treatment (no-prevention group, NP group, n=20) were used as the control group. The incidence of arrhythmia requiring treatment, mortality due to arrhythmias, hemodynamics and arterial blood gas values during the surgery were analyzed in these three groups. Results There was no significant difference in infarct size among the three groups. The incidence of arrhythmia requiring treatment was significantly decreased in the AP group compared to the NP or SP groups 4.4% (AP) vs. 35% (SP) or 45% (NP) p<0.05). The mortality due to lethal arrhythmia was 2.2% in the AP group, significantly lower than in the NP group (15%) or the SP group (18.4%). Besides heart rate (HR), hemodynamic data there were no significant differences between the AP and NP group. Metabolic acidosis was not observed in any group as indicated by pH and lactate values. Conclusions Prophylactic amiodarone plus lidocaine decreased the mortality due to lethal arrhythmia after acute myocardial infarction in our sheep model without significant negative effect on hemodynamics. However, epinephrine improved hemodynamics but also increased mortality due to lethal arrhythmia. Thus, prophylactic amiodarone plus lidocaine is recommended to improve the stability in a large MI animal model.

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Amiodarone - A ‘Broad Spectrum’ Antiarrhythmic Drug

Cited by 31 publications

References 81 publications

Amiodarone pulmonary toxicity: a report on two cases

Amiodarone pulmonary toxicity: a report on two cases

Edema Bilateral do Disco Óptico Secundário a Amiodarona: Manifestação de uma Neuropatia Óptica Iatrogénica

Prophylactic amiodarone and lidocaine improve survival in an ovine model of large size myocardial infarction

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