If you experience any difficulty breathing, wheezing, fever, shortness of breath, cough, or coughing up of blood, accompanied by weakness and weight loss while taking amiodarone, tell your doctor immediately.
Amiodarone may make your skin more sensitive to the sun. Use sunscreen with minimum SPF15 and protective clothing while taking amiodarone. Some people using amiodarone for long-term treatment may develop a blue-grey discoloration of exposed skin.
Report any changes in skin colour to your doctor. If you are scheduled for surgery, inform all doctors involved in your care that you are taking amiodarone. Amiodarone can cause thyroid problems both overactive and underactive.
Important considerations for taking amiodarone Keep these considerations in mind if your doctor prescribes amiodarone oral tablet for you. General You can take this drug with or without food. However, you should take it the same way each time. Take amiodarone at the same times every day, at regular intervals.
Protect this drug from light. Refills A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled.
These precautions probably should apply to digitoxin administration as well. Other antiarrhythmic drugs, such as quinidine, procainamide, disopyramide, and phenytoin, have been used concurrently with oral amiodarone. There have been case reports of increased steady-state levels of quinidine, procainamide, and phenytoin during concomitant therapy with amiodarone. Phenytoin decreases serum amiodarone levels.
Quinidine and procainamide doses should be reduced by one-third when either is administered with amiodarone. Plasma levels of flecainide have been reported to increase in the presence of oral amiodarone; because of this, the dosage of flecainide should be adjusted when these drugs are administered concomitantly. In general, any added antiarrhythmic drug should be initiated at a lower than usual dose with careful monitoring. Combination of amiodarone with other antiarrhythmic therapy should be reserved for patients with life-threatening ventricular arrhythmias who are incompletely responsive to a single agent or incompletely responsive to amiodarone.
The continued need for the other antiarrhythmic agent should be reviewed after the effects of amiodarone have been established, and discontinuation ordinarily should be attempted. If the treatment is continued, these patients should be particularly carefully monitored for adverse effects, especially conduction disturbances and exacerbation of tachyarrhythmias, as amiodarone is continued.
In amiodarone-treated patients who require additional antiarrhythmic therapy, the initial dose of such agents should be approximately half of the usual recommended dose. Potentiation of warfarin-type CYP2C9 and CYP3A4 substrate anticoagulant response is almost always seen in patients receiving amiodarone and can result in serious or fatal bleeding. Clopidogrel, an inactive thienopyridine prodrug, is metabolized in the liver by CYP3A4 to an active metabolite.
A potential interaction between clopidogrel and Cordarone resulting in ineffective inhibition of platelet aggregation has been reported. This may lead to low amiodarone serum levels and potential decrease in efficacy.
Rifampin is a potent inducer of CYP3A4. Administration of rifampin concomitantly with oral amiodarone has been shown to result in decreases in serum concentrations of amiodarone and desethylamiodarone. Other substances, including herbal preparations: John's Wort in patients receiving amiodarone could result in reduced amiodarone levels. Other reported interactions with amiodarone: Fentanyl CYP3A4 substrate in combination with amiodarone may cause hypotension, bradycardia, and decreased cardiac output.
Dosage and administration Tablets. Should use the lowest effective dose according to individual therapeutic outcome. Since Cordarone has a very long half-life, it can be taken every other day mg may be given every other day, and it is recommended to take mg daily , or you can take a break 2 days per week.
Do not dial in one syringe with other drugs. Pregnancy and breast feeding Since the drug acts on the thyroid gland of the fetus, amiodarone is contraindicated in pregnancy except in special cases life-threatening ventricular arrhythmias. Amiodarone is allocated in breast milk in significant amounts, so it is contraindicated in nursing mothers.
During feeding the drug should be discontinued. Not recommended for combination therapy with the following drugs: Caution should be used in combination with Cordarone following drugs: In some cases sinus node dysfunction, elderly patients are described bradycardia or in exceptional cases sinus cardiac arrest.
Rare are conduction disturbances sinoatrial block, AV block of various degrees, intraventricular block. There are reports of the emergence of new arrhythmias or worsening of existing ones, in some cases - followed by cardiac arrest. From the information available it is impossible to determine the reason for this use of the drug or is associated with the severity of heart disease, or it may be due to treatment failure. These effects are observed mainly in cases of Cordarone with drugs that prolong cardiac ventricular repolarization period interval QTc or electrolyte imbalance see "Interactions".
For part of the view: Sometimes they can cause abnormalities in the appearance of the colored halo in bright light or a feeling of fog. Ethinyl Estradiol; Norethindrone Acetate: Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: Ethinyl Estradiol; Norethindrone; Ferrous fumarate: For example, when fentanyl was administered to patients receiving amiodarone, the incidence of bradycardia and other adverse cardiovascular effects was much higher than in patients not on amiodarone who received fentanyl.
Major Monitor for an increased incidence of etoposide-related adverse effects if used concomitantly with amiodarone. Coadministration may cause accumulation of etoposide and decreased metabolism, resulting in increased etoposide concentrations. Major Etravirine is an inducer of CYP3A4; amiodarone concentrations may be decreased with coadministration.
Coadminister these drugs with caution. It is recommended to monitor amiodarone concentrations when possible. Major A dose adjustment of everolimus is necessary when prescribed with amiodarone due to increased plasma concentrations of everolimus. For patients with breast cancer, neuroendocrine tumors, renal cell carcinoma, and renal angiolipoma with tubular sclerosis complex TSC , reduce the dose of Afinitor to 2.
If amiodarone is discontinued, increase everolimus to its original dose after a washout period of 2 to 3 days. Zortress dosing for prophylaxis of organ rejection should be guided by TDM. Carefully weigh the benefits of combined use of amiodarone and simvastatin against the potential risks. Amiodarone increases the simvastatin exposure by approximately 2-fold.
Ezogabine has been associated with QT prolongation. If coadministration is necessary, the manufacturer of ezogabine recommends caution during concurrent use with amiodarone. When fentanyl is administered to patients receiving amiodarone, the incidence of bradycardia and other adverse cardiovascular effects was much higher than in patients not on amiodarone who received fentanyl.
Due to the extremely long elimination half-life of amiodarone, fentanyl should be used cautiously in patients who are receiving amiodarone or who have received amiodarone in the preceding month.
Moderate Fesoterodine is rapidly hydrolyzed to its active metabolite, 5-hydroxymethyltolterodine, which is metabolized via hepatic CYP3A4 and 2D6. Amiodarone can inhibit hepatic CYP2D6 and CYP3A4 isoenzymes, which may impair both CYP metabolic pathways of 5-hydroxymethyltolterodine and result in elevated plasma concentrations of 5-hydroxymethyltolterodine and an increased risk for adverse reactions.
According to the manufacturer, no dosage adjustments of fesoterodine are recommended during concurrent use of moderate CYP3A4 inhibitors. Fingolimod initiation results in decreased heart rate, and Class III antiarrhythmic drugs have been associated with cases of torsades de pointes in patients with bradycardia.
Major Flecainide has been used in combination with amiodarone in specialized settings to treat refractory arrhythmias. Close monitoring of therapeutic response is warranted for patients receiving combination therapy, including serum drug concentration monitoring.
Amiodarone inhibits the hepatic metabolism of flecainide via CYP2D6 inhibition. When amiodarone is added to flecainide therapy, plasma flecainide levels may increase two-fold or more in some patients, if flecainide dosage is not reduced.
Serum drug concentration monitoring is strongly recommended to guide dosage with such combination therapy. Coadministration of amiodarone with drugs that prolong the QT interval should be done with a careful assessment of risks versus benefits. Although rare, cases of QT prolongation and torsade de pointes TdP have been reported during flecainide therapy; causality has not been established.
Based on theoretical considerations, the manufacturer recommends allowing at least 2 to 4 plasma half-lives to elapse following flecainide discontinuation before switching to another antiarrhythmic drug. Severe The concomitant use of flibanserin and moderate CYP3A4 inhibitors, such as amiodarone, is contraindicated. Moderate CYP3A4 inhibitors can increase flibanserin concentrations, which can cause severe hypotension and syncope.
If initiating flibanserin following use of a moderate CYP3A4 inhibitor, start flibanserin at least 2 weeks after the last dose of the CYP3A4 inhibitor. If initiating a moderate CYP3A4 inhibitor following flibanserin use, start the moderate CYP3A4 inhibitor at least 2 days after the last dose of flibanserin.
Severe Fluconazole has been associated with QT prolongation and rare cases of torsades de pointes TdP. The concurrent use of fluconazole and other drugs that prolong the QT and are CYP3A4 substrates, such as amiodarone, is contraindicated due to the risk of life-threatening arrhythmias such as TdP. Coadministration of fluconazole with amiodarone may result in an elevated plasma concentration of the interacting drug, causing an increased risk for adverse events, such as QT prolongation.
Major Because QT prolongation and torsade de pointes TdP have been reported in patients treated with fluoxetine, the manufacturer recommends caution when using fluoxetine with other drugs that prolong the QT interval. Drugs with a possible risk for QT prolongation and TdP include amiodarone. In addition, amiodarone inhibits CYP2D6 and may theoretically increase concentrations of other drugs metabolized by this enzyme, such as fluoxetine.
Major The concomitant use of amiodarone and other drugs known to prolong the QT interval, such as olanzapine, should only be done after careful assessment of risks versus benefits. If possible, avoid coadministration of amiodarone and olanzapine. Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval in rare instances. Minor The concomitant use of amiodarone and other drugs known to prolong the QT interval should only be done after careful assessment of risks versus benefits.
Drugs with a possible risk for QT prolongation include fluphenazine. Moderate Amiodarone is a CYP3A4 inhibitor and may reduce the metabolism of flurazepam and increase the potential for benzodiazepine toxicity. Minor Amiodarone inhibits cytochrome P 2C9. Caution is recommended when administering amiodarone with other CYP2C9 substrates, such as flurbiprofen, that have a narrow therapeutic range or where large increase in concentrations may be associated with adverse reactions.
Moderate In theory, concurrent use CYP2C9 inhibitors, such as amiodarone, and fluvastatin, a CYP2C9 substrate, may result in reduced metabolism of fluvastatin and potential for toxicity, including myopathy and rhabdomyolysis. Major Due to the risk of QT prolongation and torsade de pointes TdP , avoid coadministration of amiodarone and fluvoxamine if possible.
QT prolongation and TdP has been reported during fluvoxamine postmarketing use. Moderate The incidence of marijuana associated adverse effects may change following coadministration with amiodarone. Major Extreme caution is advised when administering fosamprenavir concurrently with amiodarone. If these drugs must be used together, therapeutic monitoring of amiodarone concentrations is recommended.
Taking these drug together may cause the plasma concentrations of fosamprenavir and amiodarone to be altered. Amiodarone is a substrate and inhibitor of CYP3A4; amprenavir the active metabolite of fosamprenavir if a potent inhibitor, moderate inducer and substrate of CYP3A4. In addition, fosamprenavir is a substrate for the drug transporter P-glycoprotein P-gp ; amiodarone is a P-gp inhibitor. Major When possible, avoid concurrent use of foscarnet with other drugs known to prolong the QT interval, such as amiodarone.
Foscarnet has been associated with postmarketing reports of both QT prolongation and torsade de pointes TdP. If these drugs are administered together, obtain an electrocardiogram and electrolyte concentrations before and periodically during treatment. Major Monitor serum electrolytes if coadministration of furosemide and amiodarone is necessary.
Furosemide therapy may cause electrolyte abnormalities i. Major Monitor for an increased incidence of gefitinib-related adverse effects if gefitinib and amiodarone are used concomitantly. Coadministration may decrease the metabolism of gefitinib and increase gefitinib concentrations.
In patients with poor CYP2D6 metabolism, the mean exposure to gefitinib was 2-fold higher when compared to extensive metabolizers; the contribution of drugs that inhibit CYP2D6 on gefitinib exposure has not been evaluated. Major According to the manufacturer, gemifloxacin should be avoided in patients receiving Class III antiarrhythmics such as amiodarone. Gemifloxacin may prolong the QT interval in some patients.
The maximal change in the QTc interval occurs approximately 5 to 10 hours following oral administration of gemifloxacin. The likelihood of QTc prolongation may increase with increasing dose of the drug; therefore, the recommended dose should not be exceeded especially in patients with renal or hepatic impairment where the Cmax and AUC are slightly higher. Major Avoid coadministration of gemtuzumab ozogamicin with amiodarone due to the potential for additive QT interval prolongation and risk of torsade de pointes TdP.
If coadministration is unavoidable, obtain an ECG and serum electrolytes prior to the start of and as needed during treatment. Although QT interval prolongation has not been reported with gemtuzumab, it has been reported with other drugs that contain calicheamicin.
Minor In vitro studies have demonstrated the positive inotropic effects of ginger, Zingiber officinale. It is theoretically possible that ginger could affect the action of antiarrhythmics, however, no human data are available. Moderate Caution is advised with the coadministration of glecaprevir and amiodarone as coadministration may increase serum concentrations of glecaprevir and increase the risk of adverse effects. Glecaprevir is a substrate of P-glycoprotein P-gp ; amiodarone is a P-gp inhibitor.
Moderate Caution is advised with the coadministration of pibrentasvir and amiodarone as coadministration may increase serum concentrations of pibrentasvir and increase the risk of adverse effects. Pibrentasvir is a substrate of P-glycoprotein P-gp ; amiodarone is an inhibitor of P-gp. Major Amiodarone should be used cautiously and with close monitoring with goserelin. Androgen deprivation therapy e. Major Granisetron has been associated with QT prolongation. Major Grapefruit juice has been shown to increase amiodarone peak serum concentrations and AUC when a single dose of amiodarone was administered orally.
No change in ECG or arterial blood pressure measurements were identified in this single dose study; however, the impact on chronic dosing of amiodarone was not evaluated. To prevent potential drug accumulation, it would be prudent to avoid taking oral amiodarone with grapefruit juice. Major Amiodarone may significantly increase guanfacine plasma concentrations. FDA-approved labeling for extended-release ER guanfacine recommends that, if these agents are taken together, the guanfacine dosage should be decreased to half of the recommended dose.
Specific recommendations for immediate-release IR guanfacine are not available. Monitor patients closely for alpha-adrenergic effects including hypotension, drowsiness, lethargy, and bradycardia. Upon amiodarone discontinuation, the guanfacine ER dosage should be increased back to the recommended dose.
Severe Halofantrine should be avoided in patients receiving drugs which may induce QT prolongation; these drugs include class III antiarrhythmics. Major QT prolongation and torsade de pointes TdP have been observed during haloperidol treatment. Excessive doses particularly in the overdose setting or IV administration of haloperidol may be associated with a higher risk of QT prolongation.
According to the manufacturer of haloperidol, caution is advisable when prescribing the drug concurrently with medications known to prolong the QT interval. Mild to moderate increases in haloperidol plasma concentrations have been reported during concurrent use of haloperidol and inhibitors of CYP3A4 or CYP2D6.
Therefore, it is advisable to closely monitor for adverse events when haloperidol is co-administered with drugs that inhibit CYP3A4 and CYP2D6 and prolong the QT interval, such as amiodarone. Major It would be prudent to avoid use of Hawthorn, Crataegus laevigata also known as C. Following hawthorn administration to guinea pigs, the cardiac action potential duration is increased and the refractory period is prolonged.
Hawthorn may also lower peripheral vascular resistance. Hawthorn thus has effects similar to the class III antiarrhythmics and would theoretically interact with drugs with similar cardiac electrophysiology e.
Patients should be advised to only use hawthorn with these antiarrhythmic agents after discussion with their prescriber. If co-use is advised, patients should receive periodic blood pressure and heart rate monitoring. Major Concomitant administration of amiodarone and phenytoin or fosphenytoin may result in phenytoin toxicity, secondary to a two- or three-fold increase in total, steady-state serum phenytoin concentrations likely due to a amiodarone-induced decrease in phenytoin metabolism.
In addition, reduced amiodarone serum concentrations may occur during phenytoin coadministration. A similar interaction may occur with ethotoin. Close monitoring for symptoms of hydantoin anticonvulsant toxicity including nystagmus, lethargy and ataxia; and evaluation of serum concentrations with appropriate dosage reduction as necessary, is essential in patients receiving these medications. Minor Coadministration of losartan with amiodarone may result in increased exposure to losartan but decreased concentrations of the active metabolite.
Because beta-blockers have similar effects, concomitant administration of beta-blockers including metoprolol with amiodarone may cause additive electrophysiologic effects slow sinus rate or worsen AV block , resulting in symptomatic bradycardia, sinus arrest, and atrioventricular block. Caution is advised as metoprolol in combination with amiodarone has resulted in severe sinus bradycardia.
Because beta-blockers have similar effects, concomitant administration of beta-blockers including propanolol with amiodarone may cause additive electrophysiologic effects slow sinus rate or worsen AV block , resulting in symptomatic bradycardia, sinus arrest, and atrioventricular block.
Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Major Avoid coadministration of hydroxychloroquine and amiodarone. Hydroxychloroquine increases the QT interval and should not be administered with other drugs known to prolong the QT interval. Ventricular arrhythmias and torsade de pointes TdP have been reported with the use of hydroxychloroquine. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with hydroxyzine include amiodarone.
Severe Amiodarone should not be administered concomitantly during the first four hours post-infusion of ibutilide, due to the potential for additive Class III antiarrhythmic effects. In addition, both ibutilide and amiodarone are associated with a risk of QT prolongation and torsades de pointes TdP.
Major The concomitant use of amiodarone and other drugs known to prolong the QT interval, such as iloperidone, should only be done after careful assessment of risks versus benefits. Iloperidone has been associated with QT prolongation; however, torsade de pointes TdP has not been reported. Major Any agent that inhibits cytochrome P CYP 3A4 may decrease the metabolism of imatinib and increase imatinib concentrations leading to an increased incidence of adverse reactions.
Major Indapamide may induce hypokalemia, increasing the potential for proarrhythmic effects e. Potassium levels should be within the normal range prior and during administration of these agents. In the absence of electrolyte imbalances, these agents can be used together safely. Severe Coadministration of indinavir and amiodarone is contraindicated due to the potential for serious or life-threatening reactions, such as cardiac arrhythmias.
Indinavir is an inhibitor of CYP3A4 and increased plasma concentrations of drugs extensively metabolized by this enzyme, such as amiodarone, should be expected with concurrent use. Caution is recommended when administering amiodarone with CYP2C9 substrates including indomethacin.
In all cases the patient's management must be judged on the individual response and well being, tab cordarone 100mg. There is 100mg reason in such cases cordarone discontinue amiodarone treatment, tab cordarone 100mg. The onset is usually slow but may be rapidly progressive. Tab time and dose relationships of adverse effects are under continued study. The incidence of cordarone tumors was greater than control even at the lowest dose level tested, i. Are there tab other precautions or warnings for this medication? Fluoroquinolones, macrolide antibiotics, and 100mg are known to cause QTc prolongation. There have been reports of death associated with amiodarone-induced thyrotoxicosis. This information is for educational purposes only, and not meant to provide medical advice, treatment, or diagnosis. DEA concentrations were not affected. Some patients develop eye symptoms of halos, photophobia, and dry eyes. Other antiarrhythmic drugs, such as quinidine, procainamide, disopyramide, tab cordarone 100mg, and phenytoin, have been used concurrently with oral amiodarone.
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