Is Amiodarone Safe for Arrhythmia?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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If you have atrial fibrillation (AF), a type of irregular heartbeat, you may be prescribed amiodarone (Cordarone, Pacerone). It’s commonly used to decrease the frequency of AF episodes when using a rhythm control strategy (trying to regulate the rhythm of your heartbeat).

Some people with AF will instead be prescribed medications to slow and control the heart rate, for example, a beta blocker like metoprolol.  Others, however, will need an anti-arrhythmia medication like amiodarone—a medication that keeps your heart in normal rhythm.

Amiodarone is the main rhythm medication used—so is it safe? Here are 7 things to know.

  1. Do I need it? Beta blockers like metoprolol may be effective in maintaining normal rhythm and can be tried first in some patients. Your cardiologist will help you decide what’s best for you, but for if you have structural heart disease (valve problems, for example) amiodarone is often suggested.
  2. Does amiodarone work to keep me in normal rhythm and out of AF? Yes, amiodarone is effective for the maintenance of sinus rhythm and is consistently more effective than the other antiarrhythmic drugs.
  3. Can I take amiodarone if I have heart failure too? Yes, for atrial fibrillation patients with heart failure or left ventricular hypertrophy, amiodarone is preferred over other options like flecainide or propafenone (other antiarrhythmic medications).
  4. What about amiodarone and the lungs? The most important downside and potential toxicity of amiodarone is lung toxicity. Lung inflammation (hypersensitivity pneumonitis or interstitial/alveolar pneumonitis) can occur up to 10% of the time.  
  5. What other side effects does amiodarone have? Dizziness and ataxia (feeling off-balance and walking wobbly), nausea and loss of appetite are also known side effects and occur about 10 – 30% of the time.
  6. What about amiodarone and the thyroid? This is complicated, as amiodarone may cause over- or underactive thyroid and should be used with caution if you have thyroid disease. Your thyroid function should be monitored prior to treatment and periodically thereafter. Why does this happen? Amiodarone has a direct effect on the thyroid, and has iodine in it, which may also lead to problems with the thyroid.
  7. Is the newer anti-arrhythmic Multaq better than amiodarone? Multaq (dronedarone) is an expensive brand-name-only medication similar to amiodarone. Multaq is better tolerated and has fewer side effects than amiodarone—but it doesn’t work as well. Patients taking Multaq for prevention of atrial fibrillation are half as likely to remain in sinus rhythm as patients on amiodarone.

Dr O.

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