Effects of Amiodarone pre-surgery

[sylviayasgur]

hi all,
this is the first i am hearing about administering amiodarone pre-surgery. my husband, joey, was on betapace/sotalol pre-surgery as preventative for afib. after surgery, the sotalol did not work, so they immediately went to amio. he_over the years_ tried to wean off the amio numerous times, but would go into afib. he remained on a very small dose (100 mg every other day) for some time, with some incidents of afib.
after all these years, he decided it was time to try something else (i nagged enough!!). multaq, although it's touted to be amio's little brother, did not do the trick.
joey is now on tikosyn (he had to be hospitalized for 3 days to regulate that med) and it seems to be doing the trick. it's been about a month and so far, so good.
amio is a very strong med. even on scant dose of it, joey had diminished lung capacity (minimal, but he's a runner and biker), he has retinal deposits, and had extreme sun sensitivity (no more).
unfortunately, we don't plan to stay on these meds for extended periods of time, but when they are doing the trick and others may not, we manage to stay on them.
hope this helps,
sylvia

 

[Ruth]

I guess I'm the 1-3% then because my thyroid was permanently damaged from 8 weeks of Amioderone. I was also told that side effects are "rare" unless one took it for several months/years yet I was *sick as a dog* every single day I was on that horrid drug. But, I took it in the hopes of stopping the AFib that never did respond to it but felt it was a gamble worth taking to avoid cardioversion. Sigh. Taking it prophylacticly, umm.... dunno about that.

Y'all are lucky if you can tolerate Amioderone...... just don't let anyone kid 'ya that it's an easy drug to take, it's serious stuff with serious side effects for some of us.

 

[Lynlw]

I guess I'm the 1-3% then because my thyroid was permanently damaged from 8 weeks of Amioderone. I was also told that side effects are "rare" unless one took it for several months/years yet I was *sick as a dog* every single day I was on that horrid drug. But, I took it in the hopes of stopping the AFib that never did respond to it but felt it was a gamble worth taking to avoid cardioversion. Sigh. Taking it prophylacticly, umm.... dunno about that.

Y'all are lucky if you can tolerate Amioderone...... just don't let anyone kid 'ya that it's an easy drug to take, it's serious stuff with serious side effects for some of us.

I Believe that some of the side effects occur more often in people long term (6 months) but also can and do happen in people on the just a short time. The "last resort" is for people who may be on it long or short term, since MANY of the people who start it go into AFib after surgery and they hope it (the AFib) is temporary. Part of the reason it is recomended to start it in the hospital (not for pre op of course) is because there can be very dangerous side effects, rythmn problems ect and they will be monitorred.

 

[ARGreenMN]

I'm afraid of the thyroid thing too, and they're closely monitoring my blood for any signs of that. So far so good. I've been fortunate in that it hasn't made me sick or had any side effects (have even layed out in the sun twice now with no adverse effects). Not downplaying in any way those that have had side effects, just saying I haven't had any (yet anyway). But I am a little concerned about it so will keep asking questions.

The thing is, I don't think any of us WANT to be on it. But when a medical professional (or in my case, several professionals, because I asked for 2nd, 3rd and 4th opinions) tells you it's what's best, it's hard to say no I don't want it anyway. Especially when those same medical professionals just saved your life. So for now, I'm putting my faith in their expertise and hoping for the best, but also keeping a close eye out for side effects and will also keep asking them if I can go off it sooner rather than later.

 

[Luana]

Andy, the thyroid thing is the least thing to worry about. If you become hypothyroid, thyroid replacement hormone (a simple pill, yes, another dang pill) is all that's needed. My already damaged thyroid did not get any more damaged with amiordarone.

 

[Lynlw]

I'm afraid of the thyroid thing too, and they're closely monitoring my blood for any signs of that. So far so good. I've been fortunate in that it hasn't made me sick or had any side effects (have even layed out in the sun twice now with no adverse effects). Not downplaying in any way those that have had side effects, just saying I haven't had any (yet anyway). But I am a little concerned about it so will keep asking questions.

The thing is, I don't think any of us WANT to be on it. But when a medical professional (or in my case, several professionals, because I asked for 2nd, 3rd and 4th opinions) tells you it's what's best, it's hard to say no I don't want it anyway. Especially when those same medical professionals just saved your life. So for now, I'm putting my faith in their expertise and hoping for the best, but also keeping a close eye out for side effects and will also keep asking them if I can go off it sooner rather than later.

Andy, No one, well certainly not me, is saying you or anyone shouldn't take it., and I am very happy you are not having any problems. Most of my posts here (not just this thread, but VR in general), when people ask questions, especially before surgery (like Barb asked here), is so they are aware of certain things, like meds, that for the most part they have never heard of if they are new to heart problems. So IF something comes up, like Afib after surgery, they can make informed decisions or IF they choose to ask- Why they are trying Amiodarone as the first med, when both the FDA and drug manufacturer say it should be used after other meds didn't work, because of the side effects. Or better yet, maybe someone will read something here and think of things to discuss with their doctors, BEFORE surgery, if it is something they are concerned about. Before surgery and before there even is a problem, they could say, "I know AFib is a common tempory complication after surgery, what meds do you try" and talk about concerns you might have about Amodarone or anything else.
I just know from My own personal experience, making decisions for my son, that I learned a few thing because of others experience, that when we met with the different surgeons, I asked questions about. For example, before both Justin's 4th and 5th surgeries, his heart was fused to his sternum that made opening his chest safely a little more difficult. I knew some children that had very bad complications because of this,(and one did not make it) but also knew there were things some of the surgeons did, like put them on bypass before they opened them, that made it a little safer. So I asked alot of questions about how they would open him what was their plan A, B, when we were still deciding on surgeons. When we were having our pre op meetings after deciding who and where, I asked alot of questions about possible complications and how they would be handled, because of things I learned over the years from my CHD groups.
I KNOW not all people are as anal as I tend to be, but I figure if it helps me to know about things like this, other people might want to have the same kind of discussions with their doctors too.

 

[ARGreenMN]

Totally agree Lyn, information is power! Also glad you're so pro-active (Justin is lucky to have such a great mom!). My son's 23, and I can't even imagine what you've been through. Keep up the great work and the great posts!

 

[Lynlw]

Totally agree Lyn, information is power! Also glad you're so pro-active (Justin is lucky to have such a great mom!). My son's 23, and I can't even imagine what you've been through. Keep up the great work and the great posts!

Thank you. I'm the lucky one and we are BOTH Blessed.

 

[sylviayasgur]

joey has had thyroid issues for years, way before the amio. taking amio did affect his thyroid levels. all that was necessary was keeping a very close eye on them and adding more thyroid meds or reducing them. actually, joey could tell when he felt he needed more, he would become arthritic and stiff and put on a few lbs and tired.
interestingly enough, the pharmacist never had any issue dispensing amiodarone with a prescription. now, however, he is on a med called tikosyn (dofetilide) and only specific cardios who are on a list are allowed to prescribe it. then, it's not a med that is normally stocked, so it has to be ordered from the manufacturer. and, it's very very costly.
go figure.
they usually, from what i understand, try another anti-arrthmic first (sometimes) before using amio following surgery. it's very effective and i think most docs assume it will be short term (to take care of any irregularities in the heart after it's been manhandled).
just stay on top of your body, symptoms, etc. while on the amio. from experience, it's not the worst drug if you are proactive and really monitor yourself.
and, it can be very effective in doing what it's supposed to do.
stay well,
sylvia

 

[jake]

How many people had Afib BEFORE sergery?

How many people had Afib BEFORE sergery?

I’ve been reading a lot about this drug (amiodarone) that is supposed to control Afib after these surgeries, I am assuming that this is necessary for anyone who has to have their heart stopped because of any procedure (valve replacement, aorta replacement, etc).

I would love to get a consensus of you all who have had OHS and:

1) Had to take Amiodarone and what you were told (how long you would be on it in a perfect case scenario) and in what dosage.

2) How long you actually had to take it before stopping it

3) How many of you can’t stop taking it because you now have heart rhythm issues you didn’t have before.

4) If you were offered any safer alternatives

5) How many of you have had measurable liver or thyroid damage as a result of the Amiodarone.

Everyone has a different story to tell, but I would like to get the facts based on real people with real experiences. The information on a lot of these posts is kind of fragmented and disconnected so I would love to get the down and dirty info on this drug. Near as I can figure, this by itself may be the biggest risk in having OHS. Check me if I’m wrong.

6) how many of you folks had heart rate issues or Afib before sergery and how many didnt, but now do after sergery.

 

[Ross]

Actually I find it highly disturbing that they are doing this preemptively. This drug was meant as a last resort, when all other avenues have failed. I think if they told me to take it without a need to, I'd tell em to shove it.

Straight out of the manufacterers prescribing info on page 22 of the link below:

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

 

[Lynlw]

Actually I find it highly disturbing that they are doing this preemptively. This drug was meant as a last resort, when all other avenues have failed. I think if they told me to take it without a need to, I'd tell em to shove it.

I have to agree with you on this.

 

[Ross]

I’ve been reading a lot about this drug (amiodarone) that is supposed to control Afib after these surgeries, I am assuming that this is necessary for anyone who has to have their heart stopped because of any procedure (valve replacement, aorta replacement, etc).

I would love to get a consensus of you all who have had OHS and:

1) Had to take Amiodarone and what you were told (how long you would be on it in a perfect case scenario) and in what dosage.

2) How long you actually had to take it before stopping it

3) How many of you can’t stop taking it because you now have heart rhythm issues you didn’t have before.

4) If you were offered any safer alternatives

5) How many of you have had measurable liver or thyroid damage as a result of the Amiodarone.

Everyone has a different story to tell, but I would like to get the facts based on real people with real experiences. The information on a lot of these posts is kind of fragmented and disconnected so I would love to get the down and dirty info on this drug. Near as I can figure, this by itself may be the biggest risk in having OHS. Check me if I’m wrong.

6) how many of you folks had heart rate issues or Afib before sergery and how many didnt, but now do after sergery.

Jake I can answer this on behalf of my friend Tbone that passed away last year.

1. Terry developed Afib as a result of congenital heart defect. Initially, 200mg daily and was supposed to be short term.

2. He ended up taking it for years. I know of at least 8 to my knowledge.

3. He never could stop taking it.

4. He tried Betapace and one other, but afib returned and was placed back on Amiodarone.

5. He had liver damage as a result of prolonged use. Became diabetic also.

6. His was not a direct result of surgery, but of CHD later in life.

He lost his life during his attempt to have the ongoing Afib addressed and some progressing of CHD problems also.

 

[kfay]

I’ve been reading a lot about this drug (amiodarone) that is supposed to control Afib after these surgeries, I am assuming that this is necessary for anyone who has to have their heart stopped because of any procedure (valve replacement, aorta replacement, etc).

I would love to get a consensus of you all who have had OHS and:

1) Had to take Amiodarone and what you were told (how long you would be on it in a perfect case scenario) and in what dosage.

2) How long you actually had to take it before stopping it

3) How many of you can’t stop taking it because you now have heart rhythm issues you didn’t have before.

4) If you were offered any safer alternatives

5) How many of you have had measurable liver or thyroid damage as a result of the Amiodarone.

Everyone has a different story to tell, but I would like to get the facts based on real people with real experiences. The information on a lot of these posts is kind of fragmented and disconnected so I would love to get the down and dirty info on this drug. Near as I can figure, this by itself may be the biggest risk in having OHS. Check me if I’m wrong.

6) how many of you folks had heart rate issues or Afib before sergery and how many didnt, but now do after sergery.

I think a lot of us have been put on Amiodarone AFTER surgery for a given amount of time. I fell into that category...they wanted me on it for 3 months post op (I was not in A-fib...had had a maze done). I called around 6-8 weeks out and asked to stop it because I was afraid of the side effects. They said fine, so I stopped it. To my knowledge, I have no damage from that short term use of Amiodarone.

At about 4 months post op, I developed new rhythm problems that were a direct result of my surgery. I tried several different medications, starting with the most benign, beta blockers and then calcium channel blockers. Neither helped. I went back to the Mayo clinic, who had put me on the Amiodarone to start with, and they did a pretty extensive run through on the medication options that were available to me. We also discussed ablation. Amiodarone was brought up, but, because I live in the South, and am relatively fair, not to mention the other more serious issues with it, it was decided at my age (47) they did not want me on it. At that point, we decided to proceed with an ablation, which did not work, then we did a second one several months later, and the thought was that it did not work. So, then we tried more drugs, including Multaq, which is basically a less toxic form of Amiodarone. I went off of it after two months due to side effects. I then realized that the second ablation had worked for the most part.

Rhythm issues can crop up for any of us. There are PLENTY of other options out there other than Amiodarone, and I think most Dr's are willing to explore them before going there.

 

[tobagotwo]

If you don't think it's dangerous, just ask your cardio to stop it due to, well...anything. You'll likely find that it's the only drug your cardio has ever put you on that they will stop or reduce dose immediately at your request.

They use it because it often works (although not always). They're willing to risk your well-being in other ways to make their heart ministrations a success. How well did your (anyone's) cardiologist decribe the risks of taking amiodorone to you as a patient? Did any mention that it has the capacity to be more dangerous than the surgery itself (without being specifically asked)? Or did they just say that this would help to keep you from getting arrhythmias ?

I reject the qualifications notion. Fully qualified cardiologists told people who were having Silzone valves removed that they should replace them with new Silzone valves. Some "experts" are still saying that valve disease is tied to high cholesterol, despite overwhelming evidence that it isn't related at all. Cardiologists aren't evil, but neither are they infallible. Some, in fact, are downright gullible. There is no magic medicine here for us. Many pills are no less risky than surgery and deserve no less scrutiny by the patient, or less concern from those around them.

Amiodorone has its place in treating arrhythmias, especially for dangerous arrhythmias post-op. It's very effective for that, within the limitations of its dangers. It can and has saved lives. You may be lucky and have few or even no noticeable effects, or you may take a long time to develop side effects, or you may be rapidly, permanently damaged by it.

As it's specifically not an FDA-approved use for preops, it would seem that the cardiologist has a greater responsibility to ensure that the patient understands the basis on which he or she is receiving it. At the very least, anyone taking it should be fully informed of its risks verbally by the doctor in his or her office. It should be a conscious choice, not an instruction.

That's why I wonder at the paradox wherein we would dissuade someone from having even the possibility of having the surgery again due to the perceived danger, but we will freely offer advice to each other regarding how to choke down amiodorone tabs without questioning, even as our bodies try desperately to reject them.*

(* This is a generalized, rhetorical statement to provoke thought, and is absolutely not directed at anyone or any response posted in this or other threads.)

Best wishes,

 

[james]

Anyone hear from Martin?
I am about to call his nurse and spy in.
If you are on post and tell us how you are.

 

[jake]

hmmmmmm My surgeon has told me that he will not be putting me on Amioderone because of my family history of thyroid problems and "this is a control drug of last resort for post surgery control of heart rate." He has indicated to me that I am to stay on my metropolol and we will re-evaluate how it is working post surgery.

All the research I have uncovered, at least 80% of it indicates that Amioderone is supposed to be the go to drug after other less problematic drugs are not effective. It seems like the more I read the forum, the more doctors are using it as the primary weapon of choice.

Kinda makes ya go haugh!

 

[Luana]

I was started on amiodarone in the hospital. After discharge, cardiologist said I should be on it about a month. I didn't call or ask anyone, just stopped on my own after a month. I've been hypothyroid for many years, and oddly enough, it didn't throw me out of whack; I was much more concerned about pulmonary stuff than thyroid. The thyroid stuff can be taken care of easily.

 

[neil]

i was on it for 3 month for af after my op,stopped it a treat, was well monitered and suffered no side effects, saying that its not a drug you want to be on longterm, but it did the trick for me