Arrhythmias are serious heart conditions with altered heart beat rhythm, that could sometimes stop pumping blood, resulting in cardiac arrest. Various treatment options for restoring the heart rhythm include medications implantable devices, pacemakers, and surgery. Among the different medications used for treating the condition, amiodarone is regarded as an effective option, from the category of anti-arrhythmic drugs. Undesirable effects of the medication need to be managed in a manner so as to prevent or mitigate toxic or dangerous side effects of amiodarone. Amiodarone is used as an off-label option in the treatment of conditions, other than arrhythmias, and this makes it necessary for users and caregivers to be fully aware of the possible outcomes.

What is arrhythmia, the condition being treated with amiodarone?

Tachycardia refers to the condition wherein the heart beats faster than the required or normal rate. Bradycardia refers to the condition wherein the heart beats slower than the required or normal rate. In addition to faster or slower heart beat rate, there is also the possibility of individuals having an irregular heart beat rate. All these conditions are commonly referred to as arrhythmias, with atrial fibrillation being the most common condition with irregular and racy heart beat rate.

Symptoms associated with the condition

Symptoms commonly associated with the condition include change in heart beat rate, profuse sweating, pain in the chest, skipped heart beats, a lightheaded or dizzy feeling, and possible shortness of breath. Tests help to determine or confirm the condition, while certain factors may be underlying causes for the condition. This includes smoking, certain medications, stress, recent heart attack, and heart conditions that are congenital in nature.

How does amiodarone work? 

As mentioned above, atrial fibrillation is one among the most common of arrhythmias. Amiodarone is used as an off-label treatment option for patients diagnosed with atrial fibrillation. It is actually intended and prescribed for patients with recurrent hemodynamically unstable ventricular tachycardia. Used as part of treatment protocols for inpatients and outpatients, the medication is to be carefully used in clearly defined conditions and circumstances. The highlight of the medication are its properties that make it different from medications of the same category of anti-arrhythmias.

The mechanism of action of the medication is a blocking action, wherein the potassium currents are blocked, and this causes repolarization of the heart muscle. The sequence of actions of the benzofuran derivative result in reduced cardiac muscle cell excitability, mainly attributed to the increased cardiac action potential. Consequently, abnormal heart rhythms are controlled or prevented, which is one of the main symptoms of arrhythmias. Other actions of the medication also involve the beta-adrenergic receptors, apart from calcium and sodium channels.

Does amiodarone come with specific warnings? 

Certain medications come with the possibility of specific warnings about conditions that could occur from either long term or short-term use. Awareness of these warnings are essential to prevent the conditions or to mitigate the conditions. Lung damage is one of the possible conditions from use of the medication, and the implications are serious in nature. Patients diagnosed with lung diseases are to seek specific advice to prevent possible side effects of amiodarone. Apart from diagnosed lung issues, patients with breathing difficulties are also to carefully monitor and report certain symptoms that are indicative of complications. This includes fever, shortness of breath,wheezing, apart from traces of blood in saliva and coughing.

Liver damage from amiodarone

Similar to possible lung damage from amiodarone mentioned above, there is also the possibility of damage to the liver from the medication. Patients diagnosed with liver issues are to constantly check for symptoms that indicate complications. This includes nausea, extreme tiredness and stomach pain. Clear indications of an impact on liver include changes in skin color or the color of eyes or change in urine color.

Impact on other existing conditions

In addition to the above, patients with other conditions may also need to seek specific medical advice on use of amiodarone. Patients with less than normal pace of heartbeat, or low levels of potassium or magnesium in the blood, may end up aggravating arrhythmias. Reporting of the conditions is mandatory as treating specialists may decide on suitable treatment regimen to prevent adverse effects from the medications.

Does amiodarone interact with other medications? 

The possibility of drug interactions exists with prescription medications, supplements, OTC products and alternative treatment options. The mechanism of action of amiodarone may conflict with that of other medications, with possible impact on the effectiveness of either of the medications. Antifungal medications such as fluconazole and ketoconazole may trigger interactions, when taken alongside amiodarone. Other drug interactions are possible when the following drugs are taken with anti-arrhythmias:

 

Does administration of amiodarone require hospitalization

Administration of amiodarone may require the patients to be hospitalized for a week. The patient is closely observed during this period to identify undesirable effects. Treatment protocols generally involve administration of a stronger initial dosage followed by a gradual tapering of the drug. The dosage may also be altered during this period of observance, depending on the manifestation of undesirable effects.  A tapering of dosage is the ideal way to complete the treatment, rather than abrupt discontinuation.  The patients are to be under observation, during the period after the treatment, as the drug may remain in the body for a period after discontinuation of the medication.

Conditions that need to be informed

Allergies to iodine, or amiodarone, need to be informed prior to commencement of medication. Patients on anticoagulants, medications to treat diabetes, antidepressants and other cholesterol lowering medications are to seek medical advice prior to commencing treatment. Similarly, patients on pain killers, HIV protease inhibitors diarrhea, and unusual levels of blood pressure also require expert advice on use of amiodarone.

Is the drug safe for pregnant women?

Amiodarone may have adverse consequences on the health of the fetus. Pregnant women and women planning a pregnancy are therefore explicitly advised to discontinue the medication, with the assistance of treating doctors.  Patients classified as senior citizens are to seek specialist advice regarding use of the medication, as it is known to result in undesirable consequences. Other options are presently available, that may be considered to replace amiodarone for elderly patients.

Precautions by patients on the medications

Exposure to direct sunlight for a long period when on the medication is to be avoided to prevent onset of undesirable effects. Amiodarone is sensitive to sunlight, and as a result the skin color of patients may turn blue-grey. One of the compelling reasons that make it necessary to avoid this condition is the alarming nature of this undesirable outcome. The change in color of the skin may not be reversible among patients even when the drug is stopped.

Impact of amiodarone on vision

The medication could have an impact on vision of patients, and in rare circumstances, the patient may also permanently lose vision. Patients and caregivers are to immediately report certain symptoms that clearly indicate any possible effect on vision. For instance, dry eyes, and blurred vision are indicative of impact on vision. Patients are also known to observe halos while viewing objects.

Commonly reported side effects of amiodarone

Side effects are a possibility, though it is also likely that some patients may not experience any effects whatsoever. Certain patients may experience stronger effects while others may end up with lesser effects. Unpleasant outcomes that have been frequently reported in the past include constipation, and an impact on appetite, apart from reduced interest in indulging in sex. The ability to sleep peacefully, and to rest for sufficiently long periods may also be affected by the medication. Other effects that are frequently reported include loss of taste, smell, and headache. In addition to the above, there is the likelihood of change in the amount of saliva usually secreted.  Undesirable outcomes from the medication include hypotension, Torsades de pointes, and hypothyroidism.

Nature of serious side effects of amiodarone

Certain effects are known to be serious in nature and may require urgent medical attention.  Any sudden change in weight, either an increase or a decrease is to be considered as an adverse effect. Similarly, rashes are another reason for concern, as this could aggravate into a serious condition, and it is necessary to identify the condition at an early stage. Any form of restlessness observed in patients may also require additional suitable evaluation. Patients exhibiting extreme tiredness, or appearing nervous are also to be assessed to rule out other effects.

Impact on behavior and other discernible changes

There is the likelihood of an impact on the behavior of patients on amiodarone. For instance, patients may tend to get easily irritated, that may be totally at variance with conduct before the medication. Patients are known to find it difficult to focus or concentrate, while many may end up with uncontrollable shivering, that may be extend to some parts of the body. It is important to seek medical intervention, for patients with difficulties in movement or coordination.  Other symptoms that may be experienced include muscle fatigue, and a tingling feeling in the limbs.

Patients are also likely to experience some form of intolerance to heat and cold. Additionally, certain patients may experience loss of hair, with a distinct hair loss pattern that is thinning in nature.  Other changes include effects on menstruating women – with changes in the menstruation cycle. Patients are also likely to profusely sweat, while a small section of patients may experience swelling in the neck similar to goiter symptoms. These symptoms are adverse in nature and need to be resolved at the earliest. The swelling may sometimes extend to the feet, ankles, and lower limbs.

How to deal with possible overdose of amiodarone?

It is essential to follow the right processes to manage overdose of amiodarone that may occur at times. Certain symptoms are indicative of overdose, and patients/caregivers are advised to seek immediate medical attention in the event of any changes in vision or heartbeat rate. Other indications include nausea, lightheaded feelings, apart from feeling faint. Though patients are typically administered amiodarone in hospital settings, the off-label use of the medication may sometimes create opportunities for overdose or missed dosages.

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