Side effects and efficacy of low-dose amiodarone in rhythm disorders

Rano Kirkimbayeva 1 * , Ayan Abdrakhmanov 2 3, Rustam Albayev 4, Telman Seisembekov 1, Aizhanа Shaimerdinova 5
More Detail
1 Department of Cardiology, NCJSC "Astana Medical University", Astana, Republic of Kazakhstan
2 Department of Arrhythmology, Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Republic of Kazakhstan
3 Department of Cardiology, NCJSC "Astana Medical University", Astana, Republic of Kazakhstan
4 Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Republic of Kazakhstan
5 Department of Internal Medicine with courses in Gastroenterology, Endocrinology and Pulmonology, NCJSC "Astana Medical University", Astana, Republic of Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 21, Issue 2, pp. 7-10. https://doi.org/10.23950/jcmk/14493
OPEN ACCESS 176 Views 79 Downloads
Download Full Text (PDF)

ABSTRACT

Amiodarone is one of the most widely used antiarrhythmic drugs, which is the most effective drug for maintaining sinus rhythm.   Taking this drug correlates with side effects such as pulmonary toxicity, thyroid dysfunction, neurotoxicity, hepatotoxicity, and skin manifestations. In addition, in some cases, amiodarone remains as a first-line therapy to maintain sinus rhythm. The side effects of amiodarone depend on the dose and duration of the drug. Systematic reviews and meta-analyses have shown the safety profile of a low dose of amiodarone, defined as 200 mg and a very low dose of amiodarone 100 mg. Due to the use of catheter ablation, the use of a low dose of amiodarone is sufficient. In this literature review, we have cited the side effects of a low dose of amiodarone. In addition, although there is evidence of a safer low-dose spectrum, it is not free from side effects and needs to develop an algorithm for early detection of adverse events, as well as studying the effectiveness according to modern research methods, such as an implantable heart monitor, which in turn is of undoubted interest.

CITATION

Kirkimbayeva R, Abdrakhmanov A, Albayev R, Seisembekov T, Shaimerdinova A. Side effects and efficacy of low-dose amiodarone in rhythm disorders. J CLIN MED KAZ. 2024;21(2):7-10. https://doi.org/10.23950/jcmk/14493

REFERENCES

  • Narayana SK, Woods DR, et al. Management of amiodarone-related thyroid problems. Ther Adv Endocrinol Metab. 2011;2:115–126. https://doi.org/10.1177/2042018811398516.
  • Freedman MD, Somberg JC, et al. (1991). Pharmacology and Pharmacokinetics of Amiodarone. The Journal of Clinical Pharmacology, 31(11), 1061–1069. https://doi.org/10.1002/j.1552-4604.1991.tb03673.x
  • Oates JA, Wood A, et al. (1987). Amiodarone. New England Journal of Medicine, 316(8), 455–466. https://doi.org/10.1056/nejm198702193160807
  • Hamilton, D., Nandkeolyar, S., et al. Amiodarone: A Comprehensive Guide for Clinicians. American Journal of Cardiovascular Drugs. https://doi.org/10.1007/s40256-020-00401-5
  • Bílek R, Danzig V. Antiviral activity of amiodarone in SARS-CoV-2 disease. Physiol Res. 2022 Dec 16;71(6):869-875. Epub 2022 Nov 25. https://doi.org/10.33549/physiolres.934974.
  • Chokesuwattanaskul R, Shah N, et al. Low-dose Amiodarone Is Safe: A Systematic Review and Meta-analysis, J Innov Card Rhythm Manag 2020 Apr 15; 11(4):4054-4061. https://doi.org/10.19102/icrm.2020.110403.
  • Gu J, Liu X, et al. Extensive antiarrhythmic drugs after catheter ablation of persistent atrial fibrillation, Acta Cardiol. 2012 Aug;67(4):407-14. https://doi.org/10.1080/ac.67.4.2170681.
  • Xiuli X, Choumi T, et al. Administration of antiarrhythmic drugs to maintain sinus rhythm after catheter ablation for atrial fibrillation: a meta-analysis, Cardiovasc Ther. 2015 Aug;33(4):242-6. https://doi.org/10.1111/1755-5922.12133.
  • Ad N, Holmes S, et al. Amiodarone after surgical ablation for atrial fibrillation: Is it really necessary? A prospective randomized controlled trial, J Thorac Cardiovasc Surg. 2016 Mar;151(3):798-803. https://doi.org/10.1016/j.jtcvs.2015.07.034.
  • Vorperian VR, Havighurst TC, et al. Adverse effects of low dose amiodarone: a meta-analysis, J Am Coll Cardiol. 1997 Sep; 30(3):791-8. https://doi.org/10.1016/s0735-1097(97)00220-9.
  • Gao Y, Zhang P, Liang X. Effects of low-dose amiodarone and Betaloc on the treatment of hypertrophic cardiomyopathy complicated with malignant ventricular arrhythmias. Pak J Med Sci. 2014;30(2):291–294
  • Blackman DJ, Ferguson JD, et al. Dose of amiodarone in atrial fibrillation - neither guidelines nor clinical practice reflect available evidence, Eur Heart J. 2002 Jun; 23(11):908. https://doi.org/10.1053/euhj.2002.3244.
  • Kochiadakis GE, Marketou ME, et al. Amiodarone, sotalol, or propafenone in atrial fibrillation: which is preferred to maintain normal sinus rhythm? Pacing Clin Electrophysiol. 2000 Nov; 23(11 Pt 2):1883-7. https://doi.org/10.1111/j.1540-8159.2000.tb07044.x.
  • Kochiadakis GE, Igoumenidis NE, et al. Long-term maintenance of normal sinus rhythm in patients with current symptomatic atrial fibrillation: amiodarone vs propafenone, both in low doses, Chest. 2004 Feb; 125(2):377-83. https://doi:10.1378/chest.125.2.37.
  • Huang RD, Lin JJ, et al. Comparison of Amiodarone and Propafenone in Blanking Period after Radiofrequency Catheter Ablation in Patients with Atrial Fibrillation: A Propensity Score-Matched Study, Biomed Res Int. 2020 Jun 26;2020:1835181. https://doi.org/10.1155/2020/183518.
  • Jong GP, Chang MH, et al. Long-term efficacy and safety of very-low-dose amiodarone treatment for the maintenance of sinus rhythm in patients with chronic atrial fibrillation after successful direct-current cardioversion. Chin Med J (Engl). 2006;119(24):2030–5, PMID: 17199952 https://doi.org/10.3389/fphys.2021.606931
  • Mahmarian JJ, Smart FW, et al. Exploring the minimal dose of amiodarone with antiarrhythmic and hemodynamic activity. Am J Cardiol. 1994 Oct 1;74(7):681-6. https://doi.org/10.1016/0002-9149(94)90309-3.
  • Iwasawa S, Uyeda T, et al. Efficacy and Safety of Low-Dose Amiodarone Therapy for Tachyarrhythmia in Congenital Heart Disease. Pediatr Cardiol. 2018 Jun;39(5):1016-1022. https://doi:10.1007/s00246-018-1853-4.
  • Busch CD, Heiberger CJ et al. Amiodarone-induced Hemoptysis: A Rare Presentation of Amiodarone-induced Pulmonary Toxicity Occurs at a Low Dose. Cureus. 2019 Jul 31; 11(7):e5289. https://doi.org/10.7759/cureus.5289.
  • Meter M, Prusac IK, et al. Acute respiratory failure on a low dose of amiodarone – is it an underdiagnosed and undertreated condition? Respir Med Case Rep. 2021 Sep 5:34:101500. https://doi.org/10.1016/j.rmcr.2021.101500.
  • Ott MC, Khoor A, et al. Pulmonary toxicity in patients receiving low-dose amiodarone. Chest. 2003 Feb;123(2):646-51. https://doi.org/10.1378/chest.123.2.646.
  • Gefter WB, Epstein DM, et al. Lung disease caused by amiodarone, a new antiarrythmic agent, Radiology. 1983 May; 147(2):339-44. https://doi.org/10.1148/radiology.147.2.6836114.
  • Chang SN, Hwang JJ, et al. Amiodarone-related pneumonitis. J Formos Med Assoc. 2007 May;106(5):411-7. https://doi.org/10.1016/S0929-6646(09)60328-4
  • Kounis NG, Frangides С, et al. Dose-dependent appearance and disappearance of amiodarone-induced skin pigmentation. Clin Cardiol. 1996 Jul;19(7):592-4. https://doi.org/10.1002/clc.4960190713.
  • Fishman TJ, Spencer S, et al. Amiodarone induced “Blue man syndrome”; an unusual presentation. Heart and lung. November 25, 2019 doi.org/10.1016/j.hrtlng.2019.11.005.
  • Kaur A, Mehta D, et al. A Rare Case of Blue-Gray Discoloration Induced by Low-Dose Amiodarone. The American Journal of Cardiology, 16, 2022 doi.org/10.1016/j.amjcard.2022.11.045
  • Singhal A, Ghosh P, et al. Low dose amiodarone causing pseudo-alcoholic cirrhosis, Age Ageing. 2003 Mar; 32(2):224-5. https://doi.org/10.1093/ageing/32.2.224.
  • Ruzieh M, Moroi M, et al. Adverse Events for Amiodarone Versus Placebo Am J Cardiol. 2019 Dec 15; 124(12):1889-1893. https://doi.org/10.1016/j.amjcard.2019.09.008.
  • Molinaro J, DeVries P, et al. New-onset hallucinations with amiodarone: a case report. Ann Gen Psychiatry. 2022 Aug 24;21(1):34. https://doi.org/10.1186/s12991-022-00409-y.
  • Singhal A, Ghosh P, et al. Low dose amiodarone causing pseudo-alcoholic cirrhosis, Age Ageing. 2003 Mar; 32(2):224-5. https://doi.org/10.1093/ageing/32.2.224.
  • Arkun A, Van Deusen S, et al. Hepatic dysfunction and neurotoxicity in a patient receiving long-term low-dose amiodarone therap, J Emerg Med. 2010 Apr;38(3):337-9. https://doi.org/10.1016/j.jemermed.2008.01.006.
  • Cohen-Lehman J, Dahl P, et al. Effects of amiodarone therapy on thyroid function. Nat Rev Endocrinol. 2010;6(1):34–41 https://doi.org/10.1038/nrendo.2009.225
  • Reiffel J. Reduced-dose Antiarrhythmic Drugs: Valuable or Valueless? J Innov Card Rhythm Manag. 2020 Apr; 11(4): 4063–4067. https://doi.org/10.19102/icrm.2020.110404.
  • Ayurzana et al. A low dose of amiodarone-indused sinoatrial node dysfunction: a case report. Cardiometry. 2022; 22: 118-120. https://doi.org/10.18137/cardiometry.2022.22.118120.
  • Kuncipálová H, et al “Blue-grey syndrome” – A rare adverse effect of amiodarone Case report – Special issue: Panvascular medicine. Volume 60, Issue 6, December 2018, Pages e638-e644 doi.org/10.1016/j.crvasa.2018.03.003.