Sunday, October 19, 2025

Amiodarone

Amiodarone is a **multi-class anti-arrhythmic** (mainly **Class III**) blocking K⁺, Na⁺, β, and Ca²⁺ channels. 

It **prolongs repolarisation**, slows AV conduction, and treats both **atrial and ventricular arrhythmias** with low torsades risk.

IV: **150 mg over 10 min**, then **1 mg/min × 6 h**, then **0.5 mg/min**; oral maintenance **100–200 mg/day**.

Toxicities: thyroid, pulmonary, hepatic, ocular, neurologic. 

Monitor LFTs, TFTs, ECG, CXR periodically.


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# 1) Receptor-level action → clinical effects


**Class:** *Class III anti-arrhythmic (broad-spectrum)*


**Receptor / channel effects (multi-class):**


| Mechanism                 | Target                                  | Effect                                                         | Vaughan-Williams class |

| ------------------------- | --------------------------------------- | -------------------------------------------------------------- | ---------------------- |

| **K⁺-channel blockade**   | Delayed rectifier K⁺ current            | ↑ repolarisation time, ↑ refractory period → prevents re-entry | **III**                |

| **Na⁺-channel blockade**  | Fast inward Na⁺ current (use-dependent) | ↓ conduction velocity                                          | **I**                  |

| **β-blockade**            | β₁, β₂ antagonism                       | ↓ HR, ↓ AV nodal conduction                                    | **II**                 |

| **Ca²⁺-channel blockade** | L-type channels                         | ↓ AV nodal conduction, negative inotropy                       | **IV**                 |


**Net electrophysiologic effects**


* **Prolonged action potential duration** (QT↑ but *low torsades risk*).

* **Slows SA and AV node conduction**, suppresses ectopic foci.

* **Stabilises re-entry and automatic tachyarrhythmias** in atrial and ventricular tissue.


**Clinical outcomes**


* Broad anti-arrhythmic: effective for **AF**, **atrial flutter**, **SVT**, **VT**, **VF** (esp. refractory or post-CPB).

* **Haemodynamic profile:** mild vasodilation, negative inotropy minimal (better tolerated in LV dysfunction).

* **Heart-rate control** + rhythm conversion capabilities.


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# 2) Vial strength, preparation & basic pharmacokinetics (+ disadvantages)


**IV formulation:** 150 mg/3 mL (50 mg/mL) in polysorbate solvent (non-PVC set required).

**Oral tablets:** 100 mg, 200 mg.


**Pharmacokinetics**


* **Onset (IV):** 2–5 min for rate control; 1–2 h for rhythm conversion.

* **Half-life:** biphasic — early 3–10 h; terminal **weeks (20–100 days)** → extensive tissue accumulation.

* **Metabolism:** hepatic via **CYP3A4 → desethyl-amiodarone (active)**.

* **Excretion:** biliary; negligible renal elimination.

* **Highly lipophilic** → large Vd; slow clearance.


**Disadvantages**


* **Very long half-life** → delayed toxicity reversal.

* **Multiple organ toxicities** with chronic use.

* **Hypotension and bradycardia** with rapid IV loading (solvent & vasodilation).


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# 3) Practical dosing


## A. Anaesthesia / Cardiac theatre


**Indications:** peri-operative **AF**, **VT**, **VF**, **post-CPB arrhythmia prophylaxis**.


* **IV loading:** 150 mg over **10 min** (dilute in 100 mL 5% Dextrose).

* **Then infusion:**


  * **1 mg/min (60 mg/h)** for 6 h → then **0.5 mg/min (30 mg/h)** for 18 h or until rhythm stabilises (total 900–1200 mg/24 h).

* **Refractory VT/VF (ACLS):**


  * **300 mg IV push** (undiluted) → may repeat **150 mg** once after 3–5 min if VF/pulseless VT persists.

* **Post-bypass prophylaxis:** 150 mg slow bolus at re-perfusion ± infusion 0.5–1 mg/min for 6–12 h.


## B. ICU / Ward maintenance


* **Oral loading:** 200 mg TDS for 1 week → 200 mg BD for 1 week → 100–200 mg daily maintenance.

* **Transition from IV to PO** once stable rhythm achieved.


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# 4) Special populations — dosing cautions


### Pregnancy


* Crosses placenta → risk of **fetal hypothyroidism, bradycardia**. Use only if life-threatening arrhythmia.


### Lactation


* Excreted in milk → avoid breastfeeding while on therapy.


### Hepatic impairment


* **Reduce dose / monitor LFTs**; hepatotoxicity possible with accumulation.


### Renal impairment


* *No dose adjustment* — not renally cleared.


### Obesity


* Highly lipophilic → large Vd, prolonged accumulation; avoid excessive long-term loading.


### Paediatrics


* **Loading:** 5 mg/kg over 20–60 min (max 300 mg), repeat q8 h PRN (max 15 mg/kg/day).

* **Infusion:** 10–15 mcg/kg/min for maintenance.


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# 5) Drug interactions (clinically key)


* **Warfarin:** inhibits metabolism → ↑ INR → halve warfarin dose, monitor closely.

* **Digoxin:** doubles serum digoxin → halve digoxin dose, monitor ECG/K⁺.

* **Statins (simvastatin, atorvastatin):** ↑ myopathy risk → use lower dose/rosuvastatin preferred.

* **β-blockers / CCBs:** additive bradycardia, AV block, hypotension.

* **QT-prolonging drugs** (fluoroquinolones, macrolides, azoles, antipsychotics): additive torsades risk (though amiodarone’s torsades risk is low).

* **CYP3A4 inhibitors (azoles, macrolides, protease inhibitors, grapefruit):** ↑ toxicity.

* **CYP inducers (phenytoin, rifampicin):** ↓ efficacy.

* **Anaesthetic volatile agents:** additive bradycardia, hypotension.


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# 6) Significant complications & management


| System           | Complication / mechanism                                                                        | Monitoring / Management                                                            |

| ---------------- | ----------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------- |

| **Cardiac**      | Bradycardia, AV block, hypotension (IV solvent)                                                 | Slow/stop infusion; **atropine**, **isoprenaline**, temporary pacing if needed.    |

| **Pulmonary**    | Interstitial pneumonitis / fibrosis (dose-related, chronic)                                     | Baseline + periodic CXR & PFTs; stop drug; corticosteroids if severe.              |

| **Thyroid**      | Contains iodine → **hypothyroidism** (inhibition of T₄→T₃) or **hyperthyroidism** (Jod-Basedow) | Monitor **TFTs q6 months**; treat accordingly (thyroxine / carbimazole ± steroid). |

| **Hepatic**      | Hepatitis, ↑ LFTs                                                                               | Baseline + periodic **LFTs**; stop if >3× ULN.                                     |

| **Ocular**       | Corneal microdeposits (benign) / optic neuritis (rare)                                          | Annual eye exam; discontinue if visual loss.                                       |

| **Dermatologic** | Blue-grey skin discolouration, photosensitivity                                                 | Sun protection; usually cosmetic.                                                  |

| **Neurologic**   | Tremor, ataxia, peripheral neuropathy                                                           | Dose reduction or cessation.                                                       |

| **Electrolyte**  | Hypo-/hyper-thyroid effects alter cardiac response                                              | Monitor K⁺, Mg²⁺, TFTs.                                                            |


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