Categories of heart ailments are considered to be life threatening, and require medication to prevent recurrence. Anti-arrhythmic drugs are commonly prescribed for treating heart ailments of the above categories. Amiodarone, belonging to the class of anti-arrhythmic drugs is one of the many prescription medications frequently prescribed for patients with the above conditions. Adverse effects could be toxic and dangerous in nature; hence it is essential to know all about the medication and the side effects of amiodarone. This is especially important, considering that the medication is also prescribed off-label to treat other conditions.
Overview of the drug and its mechanism of action
Prescribed for treating recurrent hemodynamically unstable ventricular tachycardia, amiodarone is also prescribed as an off-label medication for atrial fibrillation. This is prescribed both for inpatients as well as outpatients. The medication comes with warnings about possible adverse conditions and is hence exclusively meant to be used only in specific conditions. The medication works by blocking potassium currents that trigger repolarization of the heart muscle. Consequently, the benzofuran derivative brings about an increase in the cardiac action potential, reducing cardiac muscle cell excitability. This in turn helps prevent abnormal heart rhythms, the symptomatic condition among patients with arrhythmias.
It is regarded as different from medications of other anti-arrhythmia categories. The mechanism of action also involves beta-adrenergic receptors, calcium channels and sodium channels. As a result of this mechanism of action, there is the possibility of unwanted effects that includes hypotension, and TdP, acronym for Torsades de pointes. The medication can also result in the bradycardia, and a possible impact on liver and other vital organs. Additionally, the medication can also result in hypothyroidism. All the possible side effects are outlined below.
Warnings about the medication
In addition to possible side effects of amiodarone, it is also essential to be aware of the warnings associated with the medication. Patients and caregivers are expected to be fully aware of this and take suitable preventive or remedial measures. The possibility of lung damage cannot be ruled out, and this could have extremely dangerous consequences. Hence, it is necessary that patients with existing lung diseases consult a specialist, regarding use of the medication. Individuals with existing breathing problems are advised to seek medical intervention on observance of symptoms such as fever, coughing, blood in spit, wheezing or any shortness of breath.
The medication is known to cause damage to the liver, and patients with any existing conditions affecting the liver are expected to seek assistance on observing certain symptoms. For instance, feelings of nausea, pain in the stomach, unexplained fatigue, a distinct discoloration of the skin/eyes, and discoloration of the urine are all symptoms of ill effects. Patients with pre-existing conditions such as low potassium or magnesium levels in the blood, and slow heartbeat are at risk of exposure to worsening arrhythmias. It is of paramount importance to inform the treating specialist about the existing conditions, so as to prevent undesirable outcomes.
Warning about drug interactions
All medication are known to interact with other medications. This includes prescriptions medications, OTC formulation and herbal or natural remedies. This is primarily a result of the mechanism of action of the medications, that trigger undesirable effects or outcomes from other medications. This may include increased outcomes in either of the medications, or it could affect the efficacy of medications. Interactions could also include other possible adverse effects. Patients on antifungal medications are advised to intimate the treating specialists about certain medications in use – fluconazole, ketoconazole etc. Similarly, individuals are to intimate the specialists about use of beta blockers, calcium channel blockers, diuretics, fluoroquinolone antibiotics, and medications for irregular heartbeats.
General information about inpatient use of amiodarone
Patients on the medication are generally hospitalized for a week or more when treatment is commenced. During this period, the patient is monitored to check for possible adverse effects. It is important to continue being monitored in some way during the course of the treatment with the medication. Typically, patients are administered stronger dosage initially, and then the medication is gradually decreased, when the desired outcomes are achieved. During the period of treatment, doctors may opt for a decrease in dosage if side effects are observed or reported. The medication is not to be stopped abruptly and patients need to be monitored even during the period after the medication has been stopped. This is because the drug is likely to remain in the body for some time after the medication has been stopped.
What information needs to be shared with treating specialists
Patients are expected to share certain information with treating specialists prior to commencing treatment. For instance, individuals any kind of allergies to iodine, or amiodarone in the past, are to specifically inform the doctor. Allergies include any known reactions to the ingredients in the medication. Patients are to also intimate the doctors about all medications being consumed, including prescription, OTC, supplements, and herbal remedies. As mentioned earlier, there is the possibility of drug interactions and this makes it necessary to clearly list out the medications in use. This includes anticoagulants, cholesterol lowering medications, antidepressants, HIV protease inhibitors, diabetic medications, and pain killers.
Patients who have had a history of diarrhea, abnormal blood pressure levels, or other conditions mentioned in earlier sections are to seek advice regarding use. Women who are either pregnant or planning a pregnancy are also advised to stop the medication with supervision, as the drug is known to harm the fetus. Women who are nursing infants are also advised to discontinue breastfeeding as this may cause an adverse effect on the infant. Aged patients are to take the medication only with extreme caution and on specific advice of the specialist, after a complete evaluation. It may be a good idea to consider other possible alternatives to avoid the undesired outcomes from the medication.
Patients who plan to undergo dental surgery or laser eye surgery need to share information about the use of amiodarone. When on the medication, patients are to avoid extended exposure to sunlight and take precautionary measures to limit direct exposure. The medication is known to be sensitive to sunlight and there is the possibility of the skin turning blue-grey in appearance. To make matters worse, this condition may not be reversible after the medication is discontinued. Hence, patients are to diligently follow the instructions of healthcare specialists and prevent exposure to sunlight.
There is the possibility of an impact on vision from the medication, with rare possibilities of permanent loss of vision. Any symptom that is indicative of an impact on vision is to be reported and suitable remedial treatment is to be taken. Symptoms include, dry eyes, observance of halos or blurred vision. Finally, patients are to remain cautious long after discontinuing the medication as the drug is known to remain in the body for a long time, after cessation of treatment. Consequently, the possibility adverse effects remains and requires to be monitored carefully.
Finally, individuals on the medication are advised to stop taking grapefruit juice altogether, both during the course of treatment and for a certain period after discontinuing the medication. Patients are not to take a double dose of the medication to make up for a missed dose. The best option is to continue taking the medication as per the schedule, by skipping the missed dose.
Possible side effects of amiodarone
Here is a compilation of possible side effects of amiodarone. A little note about side effects of medications is necessary at this juncture. This is a compilation of possible undesirable outcomes, and is not exhaustive in nature. It is also not necessary that all patients may experience side effects. Some may not experience adverse effects, while some may end up with unwanted effects. The duration and the intensity of the effects may also differ from patient to patient. Commonly reported and documented undesirable effects include constipation, a sudden loss of appetite and a reduction in libido. Patients are known to find it difficult to either fall asleep or remain asleep for a reasonably long period when on the medication. There could be an impact on the ability to smell or taste food, while some patients are known to experience a headache. The amount of saliva that is typically generated may change when on the medication, while patients are known to also experience flushing symptoms.
Adverse effects that are considered as serious in nature
While the above-mentioned effects may or may not require treatment, the following effects require medical intervention at the earliest. Patients are advised to seek assistance at the earliest when any of the following effects are experienced. This includes, the outbreak of rashes, or an abrupt weight gain/loss. Individuals who experience some kind of restlessness are advised to seek evaluation at healthcare facility, to rule out or prevent aggravation. Any unexplained fatigue, or nervousness is also an indication of a possible serious effect. Patients may also end up with easily irritated behavior, inconsistent with previous conduct. There could be possible intolerance to heat and cold, while some patients are known to end up with thinning hair.
There could be an impact on the menstruation cycles, while patients may experience abnormally heavy sweating. Any swelling in the neck that appears like goiter is also an indication of serious effects that require treatment. Swelling could also manifest in the feet, in the ankles, or the lower legs. Apart from the above effects, there is also the possibility of a reduction in the ability to concentrate, while a section of patients are known to experience shivering or shaking in a part of the body, which may be uncontrollable in nature. Patients who have difficulty in coordinating movements need to seek medical assistance. A distinct numbing or tingling sensation in the hands, in the feet, legs or kind of tiredness in the muscles are all indications of effects that require medical intervention.
There is a possibility of overdose, and patients are advised to immediately seek treatment on experiencing blurred vision, a reduction in heartbeat rate or feelings of nausea. A lightheaded feeling among patients who have taken an overdose of the medication, is an indication of serious effects, and requires treatment. Patients who feel faint are to be taken to healthcare facilities for emergency attention.
Education: Master’s in Nursing (MSN) from Johns Hopkins University. Experience: 7 years writing for online health portals and nursing journals, specializing in patient education and chronic illness management.
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