Arrhythmias - Amiodarone
PATIENT INFORMATION SHEET
Amiodarone (Cordarone, Pacerone) is the most powerful medicine for the treatment of heart rhythm disorders. While the benefits of this medicine are great, so is the potential for side effects. This sheet will describe these side effects so that you will know what to be aware of. This is not meant to scare you but make you better informed. Together, we can hopefully identify and prevent these adverse effects from developing by reducing or discontinuing your medicine.
The usual dose of Amiodarone is 200 to 400mg per day. Each pill is 200mg. This medicine is usually taken with food. Amiodarone interacts with a number of medicines particularly warfarin (Coumadin) and digoxin (Lanoxin). Always check with your doctor before starting a new medicine to be sure it is compatible.
Common major side effects (These may occur in up to 30% of patients taking this drug):- Corneal deposits: This may cause you to see halo's around lights at nighttime. These deposits rarely cause any other visual disturbances. The drug does not have to be stopped unless your vision is significantly affected.
- Sensitivity of your skin to sunlight: A sunscreen and/or clothing which protects sun exposed limbs, a hat and sun glasses are recommended
- Grey-blue discoloration of skin: This usually occurs after prolonged administration of amiodarone at high doses. This blue "slate" appearance gradually appears in blotches (usually on the face) and frequently will resolve once the drug is stopped.
- Thyroid disorders: Either an over active or under active thyroid may result from this drug which is 37% iodine by weight.
- Pneumonia: This is the most serious side effect which occurs in up to 4%.
- Slow heart rates: Amiodarone can slow the heartbeat. The higher the dose, the slower the heart rate will become. Lowering the dose usually corrects this problem.
- Liver disease: Liver tests need to be monitored twice a year. (Yes, you can still drink alcoholic beverages if you take this medicine!)
- Tremor: This usually only occurs during the first month. When this side effect is severe, you will notice difficulty in holding a glass of water, for example, without spilling it or a major deterioration of your handwriting.
- Muscle weakness: This affects the large muscles of the legs and may make it difficult to get up from a chair.
- Constipation: For those prone to this, be sure and eat plenty of fruits and vegetables.
- Dry eyes: This is a minor side effect which responds well to using artificial tears. Use 1 drop in each eye three or four times a day.
- Upset stomach and lack of appetite: Not frequent.
- Blindness: Only a handful of cases have been reported with this adverse effect in the entire world’s experience. It is exceedingly rare. In these cases, the drug is thought to cause damage the optic nerve. Other possible causes of optic nerve damage however have not been totally eliminated so that the Amiodarone has not been unequivocally proven to be the culprit. If you have any sensation that your vision is dramatically getting worse, call us immediately.
- In order to prevent any major problems, we will see you twice a year and obtain blood tests to monitor your liver and thyroid. If you think you are developing any of the above side effects, please feel free to call and discuss this.
- This medicine takes a long time to take full effect, usually two to three months. To speed things up, the dose during the first month is usually much higher, 200mg to 400mg with meals three times a day. After one month, the dose usually is reduced to 200mg once a day.
If you have any questions, please call or write Alan Schwartz, M.D. by telephone, e-mail or fax.
Ver 1.3-08/99