Martin, How are you feeling today? Did your doctor get back to you?
I have never even heard of this drug. Is it standard procedure to take it before or after surgery? I will add this to the question list I am making for the surgeon. Since we have the date set for Hopkins, I am wondering if we even see him again before the day of surgery. Is it customary for the surgeon to see you the day you have your preop? All of a sudden, I am confused about what the whole process will be like. Thanks, Barb
Barb, You can get a pretty detailed list of all the possible side effects, at
http://www.drugs.com/sfx/amiodarone-side-effects.html
Most information, says it should be started in the hospital, because of the potential problems in high doses (which are just 400 a day and above). they are pretty common, here is a short bit
Amiodarone Side Effects - for the Professional
Amiodarone
Adverse reactions have been very common in virtually all series of patients treated with Amiodarone for ventricular arrhythmias with relatively large doses of drug (400 mg/day and above), occurring in about three-fourths of all patients and causing discontinuation in 7 to 18%. The most serious reactions are pulmonary toxicity, exacerbation of arrhythmia, and rare serious liver injury, but other adverse effects constitute important problems. They are often reversible with dose reduction or cessation of Amiodarone treatment. Most of the adverse effects appear to become more frequent with continued treatment beyond six months, although rates appear to remain relatively constant beyond one year. The time and dose relationships of adverse effects are under continued study.
Neurologic problems are extremely common, occurring in 20 to 40% of patients and including malaise and fatigue, tremor and involuntary movements, poor coordination and gait, and peripheral neuropathy; they are rarely a reason to stop therapy and may respond to dose reductions or discontinuation. There have been spontaneous reports of demyelinating polyneuropathy.
Gastrointestinal complaints, most commonly nausea, vomiting, constipation, and anorexia, occur in about 25% of patients but rarely require discontinuation of drug. These commonly occur during high-dose administration (i.e., loading dose) and usually respond to dose reduction or divided doses.
Read more:
http://www.drugs.com/sfx/amiodarone-side-effects.html#ixzz0rVitWvG6
This is the warning from the package insert
http://www.upsher-smith.com/PDFs/Pacerone_PI.pdf
PaceroneĀ® (Amiodarone HCI) Tablets are intended for use only in patients with the indicated life-threatening
arrhythmias because amiodarone use is accompanied by substantial toxicity.
Amiodarone has several potentially fatal toxicities, the most important of which is pulmonary toxicity
(hypersensitivity pneumonitis or interstitial/alveolar pneumonitis) that has resulted in clinically manifest
disease at rates as high as 10 to 17%in some series of patientswith ventricular arrhythmias given doses around
400 mg/day, and as abnormal diffusion capacity without symptoms in a much higher percentage of patients.
Pulmonary toxicity has been fatal about 10% of the time. Liver injury is common with amiodarone, but is
usually mild and evidenced only by abnormal liver enzymes. Overt liver disease can occur, however, and has
been fatal in a few cases. Like other antiarrhythmics, amiodarone can exacerbate the arrhythmia, e.g., by
making the arrhythmia less well tolerated or more difficult to reverse. This has occurred in 2 to 5% of patients
in various series, and significant heart block or sinus bradycardia has been seen in 2 to 5%. All of these events
should be manageable in the proper clinical setting in most cases. Although the frequency of such
proarrhythmic events does not appear greater with amiodarone than with many other agents used in this
population, the effects are prolonged when they occur.
Even in patients at high risk of arrhythmic death, in whom the toxicity of amiodarone is an acceptable risk,
PaceroneĀ® Tablets pose major management problems that could be life-threatening in a population at risk of
sudden death, so that every effort should be made to utilize alternative agents first.
The difficulty of using PaceroneĀ® Tablets effectively and safely itself poses a significant risk to patients.
Patients with the indicated arrhythmias must be hospitalized while the loading dose of PaceroneĀ® Tablets is
given, and a response generally requires at least one week, usually two or more. Because absorption and
elimination are variable, maintenance-dose selection is difficult, and it is not unusual to require dosage
decrease or discontinuation of treatment. In a retrospective survey of 192 patients with ventricular
tachyarrhythmias, 84 required dose reduction and 18 required at least temporary discontinuation because of
adverse effects, and several series have reported 15 to 20% overall frequencies of discontinuation due to
adverse reactions. The time at which a previously controlled life-threatening arrhythmia will recur after
discontinuation or dose adjustment is unpredictable, ranging fromweeks tomonths. The patient is obviously
at great risk during this time and may need prolonged hospitalization. Attempts to substitute other
antiarrhythmic agents when PaceroneĀ® Tablets must be stopped will be made difficult by the gradually, but
unpredictably, changing amiodarone body burden. A similar problem exists when amiodarone is not effective;
it still poses the risk of an interaction with whatever subsequent treatment is tried
