Generic Name and Formulations:
Amiodarone HCl 200mg; scored tabs.
Documented, life-threatening recurrent ventricular fibrillation or hemodynamically unstable ventricular tachycardia.
Give consistently with regard to meals. Loading dose (initiate in hospital with cardiac monitoring): 800–1600mg/day in divided doses with meals for 1–3 weeks. After control achieved, 600–800mg/day for 1 month then reduce to maintenance dose, usually 400mg/day.
Cardiogenic shock. Marked sinus bradycardia. 2nd- or 3rd-degree AV block. Bradycardia with syncope unless paced.
Be experienced with the treatment and monitoring of life-threatening arrhythmias before prescribing this medication. Correct potassium, magnesium and calcium deficiencies prior to initiation. Monitor for pulmonary and liver toxicity; reduce dose or discontinue if either occurs. Perform baseline pulmonary function tests at initiation, then every 3–6 months. Do liver function tests regularly. Surgery. Monitor thyroid function and signs of thyrotoxicosis. Assess implantable cardiac devices. Do regular ophthalmic exams. Withdraw cautiously. Elderly. Neonates (teratogenic effects). Pregnancy, nursing mothers: not recommended.
Interactions may persist months after discontinuing. Symptomatic bradycardia when concomitant with ledipasvir/sofosbuvir or with sofosbuvir plus simeprevir; monitor heart rate when starting antiviral treatment. Potentiates antiarrhythmics (eg, quinidine, procainamide, flecainide; reduce their doses by ⅓ to ½), cyclosporine, digoxin (reduce digoxin dose by ½ or discontinue), oral anticoagulants (reduce anticoagulant dose by ⅓ to ½ and monitor PT), dabigatran, fentanyl, phenytoin, lidocaine, dextromethorphan. Myopathy with statins metabolized by CYP3A4; limit simvastatin dose to 20mg daily or lovastatin dose to 40mg daily. Potentiated by protease inhibitors, loratadine, cimetidine, trazodone, grapefruit juice. Exacerbation of arrhythmias with antiarrhythmics. Additive bradycardia, sinus arrest, and AV block with β-blockers, digoxin, verapamil, diltiazem, ivabradine, clonidine; monitor heart rate. QTc prolongation with Class I and III antiarrhythmics, lithium, phenothiazines, tricyclics, quinolones, macrolides, IV pentamidine, azole antifungals. Antagonized by rifampin, St. John's wort, cholestyramine. May alter results of thyroid function tests. See full labeling.
Class III antiarrhythmic.
Nausea, vomiting, alveolitis, pulmonary inflammation or fibrosis, post-op adult respiratory distress syndrome, exacerbation of arrhythmias, heart block or failure, sinus bradycardia, hepatotoxicity, corneal deposits, optic neuropathy/neuritis (reevaluate if occurs), photosensitivity, skin pigmentation, thyroid disorders, malaise, fatigue, peripheral neuropathy, constipation, anorexia.
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