Unusual neurotoxicity associated with amiodarone therapy

Palakurthy, Prasad R.

doi:10.1001/archinte.147.5.881

Cited by 20 publications

(8 citation statements)

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“…The frequency of adverse neurologic effects in longer-term amiodarone clinical trials has been much lower, at less than 5% (43,44,45,46), as in the present study.…”

Section: Discussionsupporting

confidence: 65%

Predictors of the risk of falls among elderly with chronic atrial fibrillation

Santos¹,

Nobre²,

Nussbacher³

et al. 2012

Clinics

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OBJECTIVES:Though elderly persons with chronic atrial fibrillation have more comorbidities that could limit indications for the chronic use of anticoagulants, few studies have focused on the risk of falls within this particular group. To evaluate the predictors of the risk of falls among elderly with chronic atrial fibrillation, a cross-sectional, observational study was performed.METHODS:From 295 consecutive patients aged 60 years or older with a history of atrial fibrillation who were enrolled within the last 2 years in the cardiogeriatrics outpatient clinic of the Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, 107 took part in this study. Their age was 77.9±6.4 years, and 62 were female. They were divided into two groups: a) no history of falls in the previous year and b) a history of one or more falls in the previous year. Data regarding the history of falls and social, demographic, anthropometric, and clinical information were collected. Multidimensional assessment instruments and questionnaires were applied.RESULTS:At least one fall was reported in 55 patients (51.4%). Among them, 27 (49.1%) presented recurrent falls, with body lesions in 90.4% and fractures in 9.1% of the cases. Multivariate logistic regression showed that self-reported difficulty maintaining balance, use of amiodarone, and diabetes were independent variables associated with the risk of falls, with a sensitivity of 92.9% and a specificity of 44.9%.CONCLUSION:In a group of elderly patients with chronic atrial fibrillation who were relatively independent and able to attend an outpatient clinic, the occurrence of falls with recurrence and clinical consequences was high. Difficulty maintaining balance, the use of amiodarone and a diagnosis of diabetes mellitus were independent predictors of the risk for falls. Thus, simple clinical data predicted falls better than objective functional tests.

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“…The frequency of adverse neurologic effects in longer-term amiodarone clinical trials has been much lower, at less than 5% (43,44,45,46), as in the present study.…”

Section: Discussionsupporting

confidence: 65%

Predictors of the risk of falls among elderly with chronic atrial fibrillation

Santos¹,

Nobre²,

Nussbacher³

et al. 2012

Clinics

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“…Najczęściej opisuje się drżenie zamiarowe o częstotliwości 6-10 Hz, zwykle obustronne, symetryczne (39-43%), często towarzyszące polineuropatii, oraz ataksję chodu (7-37%) [15][16][17]. Znacznie rzadziej wystę-pują: encefalopatia, neuropatia nerwu wzrokowego oraz miopatia i rabdomioliza o piorunującym przebiegu [18][19][20].…”

Section: Amiodaronunclassified

“…Dokład-ny mechanizm toksyczności amiodaronu nie jest znany. Podobnie jak inne leki, amiodaron tworzy wewnątrzlizoso-malne kompleksy lipidowe powodujące blaszkowate ciała wtrętowe w komórkach Schwanna, aksoplazmie oraz śród-błonkach naczyń nerwów [17,25,28]. Przewlekłe podawanie amiodaronu szczurom lub myszom powoduje podobne zmiany jak u ludzi wraz z dowodami ośrodkowej i obwo-dowej neurotoksyczności (modele zwierzęce toksyczności amiodaronowej) [29].…”

Section: Amiodaronunclassified

Drug-induced neuropathies

Banach¹,

Juranek²,

Antczak³

2015

fmpcr

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A -przygotowanie projektu badania, B -zbieranie danych, C -analiza statystyczna, D -interpretacja danych, E -przygotowanie maszynopisu, F -opracowanie piśmiennictwa, G -pozyskanie funduszy Działania niepożądane leków stanowią najczęstszą przyczynę toksycznego uszkodzenia obwodowego ukła-du nerwowego. Częstość ich występowania waha się od 10 do 100% i zależy od rodzaju zastosowanego leku, długości terapii oraz obecności chorób towarzyszących. Neurotoksyczność polekowa stanowi jedną z najczęstszych przyczyn zmniejszania dawki terapeutycznej danego leku bądź całkowitego przerwania dotychczasowej terapii, osłabiając jej skuteczność i negatywnie wpływając na stan zdrowia pacjentów oraz generując dodatkowe koszty opieki zdrowotnej. W praktyce lekarskiej coraz częściej obserwuje się negatywnie oddziałujące na układ nerwowy objawy niepożądane podstawowych leków opieki medycznej, począwszy od leków stosowanych w zaburzeniach rytmu serca oraz obniżających poziom cholesterolu (amiodaron, statyny), przez leki stosowane w chorobach autoimmunologicznych (etanercept, infliksymab, leflunomid), przeciwpadaczkowe (fenytoina), przeciwzakaźne -bakteriobójcze, przeciwgrzybicze lub pierwotniakobójcze (nitrofurantoina, metronidazol, izoniazyd), aż do leków przeciwnowotworowych (talidomid, bortezomib, oksaliplatyna, cisplatyna, suramina, paklitaksel, winkrystyna i inne). Niewykryte i nieleczone neurotoksyczne objawy niepożądane leków mogą doprowadzić do trwałych zmian w obwodowym układzie nerwowym, upośledzając samodzielne funkcjonowanie pacjentów (doprowadzając niekiedy nawet do trwałego kalectwa), negatywnie oddziałując na przebieg terapii oraz na samopoczucie i stan psychiczny chorych. W niniejszej pracy skupimy się na kilku wybranych lekach z wymienionych wyżej kategorii, opisując skutki ich negatywnego oddziaływania na obwodowy układ nerwowy, co w znaczny sposób wpływa na stan zdrowia pacjentów. Słowa kluczowe: neurotoksyczność, statyny, polekowe neuropatie, amiodaron, talidomid, bortezomib.Neurotoxicity is one of the most common side effects of many routinely used drugs, affecting the peripheral nervous system and impairing treatment efficiency. Drug-induced neurotoxicity ranges from 10% to 100% and depends on the medicine used, duration of therapy, and presence of concomitant disorders. Neurotoxic side effects have been increasingly reported by primary care physicians, affecting treatment and generating additional costs both for patients and for health care providers. Many of the most neurotoxic drugs are also the most widely used, often listed as essential medicines for the most common ailments and disorders, and include cardiovascular/blood pressure drugs (statins, amiodarone), drugs for autoimmune diseases (etanercept, infliximab, leflunomide), anticonvulsants (phenytoin), drugs for bacterial, protozoan, or viral infections (nitrofurantoin, metronidazole, isoniazid), and antineoplastic drugs (thalidomide, bortezomib, oxaliplatin, cisplatin, suramin, paclitaxel, vincristine, and others). Undetected and untreated drug-induced n...

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“…The adverse ef fects associated with its long-term adminis tration have been well reviewed [2], The risk of developing adverse reactions seems to increase with increasing serum amioda rone concentrations [3], with as many as 26% of treated patients requiring discontin uation of amiodarone therapy [4], We re port the development of acute polymyositis (not reported so far) together with hyperthy roidism in a patient who was on continuous amiodarone medication for 3 years. We also discuss the possibility of these conditions being side effects of amiodarone hydrochlo ride.…”

mentioning

confidence: 99%

“…A variety of neurological side effects have been reported in association with amioda rone therapy, particularly in patients receiv ing high doses of the drug (incidence varies from 3.2 to 74%) [3], Hand tremor, ataxia, peripheral sensory and motor neuropathy or severe proximal muscle weakness are infre quent side effects of amiodarone [5], and in part these are dose/duration dependent [6] According to our knowledge, acute polymyo sitis has not yet been reported to be a side effect of this drug.…”

mentioning

confidence: 99%

Acute Polymyositis and Hyperthyroidism in a Patient on Long-Term Amiodarone Therapy

Jaradah¹,

Bhatnagar²,

Diab³

et al. 1990

Med Princ Pract

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A 52-year-old male received continuous oral amiodarone therapy for 3 years for the management of ventricular tachycardia nonresponsive to other antiarrhythmics, after he sustained a Q wave anterior myocardial infarction. He developed pain and weakness in both thigh and shoulder muscles in addition to weight loss and profuse sweating. His investigations confirmed the diagnosis of acute polymyositis and hyperthyroidism. His symptoms disappeared and the abnormal biochemical tests returned to normal after the withdrawal of amiodarone. We have not been able to find any other such report and believe that these were adverse side-effects of this drug.

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Unusual neurotoxicity associated with amiodarone therapy

Cited by 20 publications

References 0 publications

Predictors of the risk of falls among elderly with chronic atrial fibrillation

Predictors of the risk of falls among elderly with chronic atrial fibrillation

Drug-induced neuropathies

Acute Polymyositis and Hyperthyroidism in a Patient on Long-Term Amiodarone Therapy

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