amiodarone formula

Amiodarone (Cordarone, Pacerone) is approved by the FDA for two very serious irregular heart rhythms: “1. Recurrent ventricular fibrillation and 2. Recurrent hemodynamically unstable ventricular tachycardia.” The FDA is very clear that “there is no evidence from controlled trials that the use of amidarone favorably affects survival.” The agency makes it quite clear that amiodarone side effects are very serious so the drug should only be prescribed when other treatments have failed. The FDA also states clearly that patients should only be started on amiodarone in a hospital setting to reduce the likelihood of a life-threatening complication. We suspect that this advice is sometimes ignored.

No where in the prescribing information is atrial fibrillation mentioned as an approved indication for amiodarone. As you read some of the stories below you will discover that it is being prescribed for this arrhythmia. This reader shares a poignant story:

Q. My husband has been taking amiodarone for several months. Over the last few weeks, he has been experiencing extreme nausea and vomiting. He has also developed a severe cough that seems to be getting worse. He has extreme shortness of breath, fatigue and weakness and numbness in his fingers and hands.

He was placed on amiodarone because he has congestive heart failure and went into cardiac arrest. My husband now has liver and kidney problems along with everything else, and I firmly believe this medication is the root cause.

I intend to take him off it beginning today. He currently takes two tabs daily. I am going to lower his dosage to one tablet daily beginning today and after one week, lower it to one half tab daily.

I also want to take him off of Coumadin and atorvastatin. I believe that all these drugs are killing him faster than the illness itself. I will keep him on the blood pressure medication, and the medication for his stent but nothing else.

A. We urge you to get in touch with your husband’s physician. His symptoms are concerning and could well be due to amiodarone, which can cause lung damage (Clinical Medicine Insights. Case Reports, Oct. 9, 2016).

Discontinuing amiodarone or any of your husband’s medicines is NOT a do-it-yourself project. Once his physician hears about the serious symptoms he is experiencing, we suspect that his regimen will be adjusted. Never stop any medicine without very careful medical supervision!

Amiodarone Side Effects:

The FDA could not be any clearer than this:

“Amiodarone is intended for use only in patients with the indicated life-threatening arrhythmias because its use is accompanied by substantial toxicity.”

The FDA goes on to describe “potentially fatal toxicities” including lung damage, liver injury and heart rhythm disturbances.

  • Lung toxicity is common (between 10 and 17%) and can be fatal; symptoms may include wheezing, difficulty breathing, fever, shortness of breath and coughing up blood. Pulmonary fibrosis is a very serious complication of amiodarone therapy.

  • Liver damage, liver enzyme elevation, hepatitis

  • Worsening of irregular heart rhythms, Torsades de Pointes, slow heart rate

  • Thyroid disorders, hyperthyroidism, hypothyroidism, thyrotoxicosis

  • Serious visual disturbances, loss of vision, optic nerve damage, blindness

  • Fatigue, tiredness, unsteadiness, dizziness

  • Tremor, hand shaking

  • Nerve tingling in extremities, burning or pain in fingers and toes

  • Digestive distress, nausea, loss of appetite, vomiting, constipation,

  • Deposits in the cornea of the eye

  • Heart failure (note that the patient above was getting amiodarone partly for heart failure)

  • Discoloration of the skin (a blue-grey tinge)

  • Rash, skin reaction (requires immediate medical attention!)

  • Pancreatitis, liver damage

  • Hallucinations

  • Blood disorders

Amiodarone Drug Interactions:

Dangerous or deadly drug interactions; amiodarone can interact with many other medications in very dangerous ways. No one should ever combine amiodarone with any other drugs without having the prescriber and pharmacist double check for incompatibility reactions.

Making Sense of Amiodarone Side Effects:

Did your eyes glaze over halfway down that long list. We wouldn’t blame you for zoning out. Most people cannot read a long list of side effects without fading. Real stories from visitors to this site put side effects into a more personal light:

Katherine in Seattle, Washington shared a tragic story:

“Just read your response to a query about the use of amiodarone. My husband almost died while taking this drug. We noticed that he couldn’t even walk up the stairs after taking amiodarone for awhile. I read on the internet that if one is taking this drug he should be under constant doctor care. We talked to the doctor and he denied that the drug would have caused the symptoms but took my husband off any way and gave him an alternative drug. My husband improved immediately. Not everyone can take this particular drug.”

Don in Dallas says:

“Thank you for your article about bad drugs–especially  Amiodarone–which has been described to me as one of the 10 most toxic drugs in the U. S.

“I am 78 years old.  In May, 2009, I had a bout with atrial fibrillation.  My cardiologist put me on several heart drugs including Amiodarone.  I went to see him in Sep 2009 and advised him that I had concerns about this drug.  He assured me that I had nothing to be concerned about.  In Oct 2009, I had a problem with my left eye. I went to see my doctor.  He just passed this by.  On 12-18-09, I woke up one morning and thought I was going blind.  Everything was very dark and I had lost my side vision.

“I went to my eye doctor who referred me to a neurologist.  She misdiagnosed me with optic neuritis  and gave ma a weeks round of intravenous steroids.  A doctor friend suggest I get a second opinion since optic neuritis is mainly found in females age 20-40 who have MS–which was not me.  I went to an eye specialist at SW Medical Center here in Dallas,  He said I have optic neuropathy (damage to the optic nerve).  Said it was most likely caused by the Amiodarone, and called my heart doctor and told him to take me off it.  He is now my FORMER cardiologist.

“After that, I developed osteoporosis (most likely caused by the steroids) and had to have 3 kyphoplasties to repair three different vertebrae fractures.  My back is ok now but my eyes will never improve. Everything is too bright outside and too dark inside.  Best thing I see is a computer screen due to the back light. In  any event, most of my activities have been curtailed.

“Amiodarone messed me up really bad.  I sent a copy of your article to my former cardiologist;  I recently read an article that said that a Mayo Clinic study indicated that about 1.5% of people who take Amiodarone for a period of time will develop a vision problem.”

Karen in LA:

“Joe, I read in the LA Times about a Father’s Death due to lung damage from Amiodarone. My father also died from drug-induced pulmonary toxicity. He was only on 200mg for 10 months.

“Since his death, I have been notified by many people who have lost loved ones due to pulmonary toxicity and most were on low dose, for a very short time, less than a year, with close to the same story…all were on it for atrial fib (“Off Label”). He was fine one day, woke up the next with flu symptoms, fever, cold, cough, immediate diagnosis, pneumonia. He was hospitalized, got a lung biopsy after not responding to antibiotics; diagnosis amiodarone-induced pulmonary toxicity.

“He was put on a ventilator; no improvement because the half life of the drug is so long. Then he died because there was nothing that could be done.

“There is a website called amiodaronetoxicity.com where family members are sharing their stories. We fear that many are dying from “Pneumonia” and it really could be from amiodarone. Lots of people are on amiodarone for Atrial Fib, Off Label. The pharmaceutical companies withheld stronger warnings for a year in 2003, until finally at the end of 2004 they finally sent out stronger warnings. Too late for my Dad, a retired Doctor, who would have known that his little cough was a huge warning that he was developing lung damage.

“My Dad was a patient of a reputable cardiology group in Los Angeles. I feel that had that warning gone out, the doctors also would have been more in tune to his very slight symptoms. Sadly, the warnings aren’t strong enough, and I continue to hear stories too often. I want the public to be more aware of the symptoms of amiodarone-induced pulmonary toxicity, in the hope that one life can be saved.”

Paula offered a somewhat similar story:

“Hi: I listen to your radio show every Saturday. My husband was given the drug amiodarone which was not monitored by lung function or other tests.  He began feeling that he had asthma/pneumonia-like symptoms and visited his cardiologist, local clinic, and general practitioners. He entered three hospitals and still his condition was not treated.

“After 40 days in the hospital, mostly in intensive care, he died of what was diagnosed as cryptogenic organizing pneumonia. I have all his records and several of the doctors who treated him were knowledgable that he was taking amiodarone but never treated him with steroids. No one should have to go what he went through until he died.  I hope this information will help someone.”

Delores in Evansville, IN

“I wasn’t to share the story about the death of my husband on Dec. 28, 2008. His death certificate said cause of death was pneumonia and congestive heart failure.

“His Dr. had ordered a cardioversion because of an irregular heart beat. We both understood that this was not a dangerous thing and could be done any number of times. The benefits lasted six months and my husband felt fine.

“His heart again lost its rhythm and the Dr. said he needed to go into the hospital in order to take medicines that could possibly extend the time in normal rhythm. My husband asked several times why he could not just have another cardioversion. The Dr. indicated it was unethical to not try to extend the time. He was given amiodaarone and died within 7-10 days.”

Kathy in Seattle:

“My husband took this one medication for his heart and he, too, couldn’t function. He was an avid hiker, in his 70s at the time, and couldn’t even walk up the basement steps. He went to his prescribing doctor, who questioned the cause but my husband insisted he wanted to quit taking amiodarone.

“Three months later (it took that long to get it out of his system) he was back to hiking. We think the drug almost killed him. I looked it up on the internet at the time and it said you should be under constant doctor’s care because 1 out of 7 people have this bad reaction to it! I read your column every Sunday and usually cut out the articles because they affect me or someone I know. Thank you for what you do.”

Bev in Georgia:

“I fully believe my 53-yr-old son died a horrible death from amiodarone after heart surgery. He had a short run of atrial fib which is not unusual and is why he went home with a prescription for amiodarone.

“He had clear lungs that went to shortness of breath and cough and interstitial pneumonia. It was wrongly diagnosed as double pneumonia. His oxygen saturation went down to 70%. He died December 20, 2015. He was intubated and on a ventilator. It was a horrible death.”

The People’s Pharmacy Bottom Line on Amiodarone:

Amiodarone IS appropriate for people with life threatening ventricular heart rhythms. It doubtless helps patients when other options have been exhausted. But this is a drug that requires very careful monitoring and supervision. At the first signs of any of the amiodarone side effects listed above, patients and their families should notify the prescriber immediately. No one should EVER stop amiodarone without medical supervision.

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  1. Linda W
    Bragg Creek, Alberta, TOL OKO
    Reply

    Amiodarone was the worst drug I have ever taken. I had most of the most debilitating side-effects (nausea, anorexia, constipation, weight loss, blurred vision, fatigue, depression…). It was a horror for me, to the point where I felt suicidal, but the worst part was that none of my specialists took my complaints seriously, especially the cardiologists.

    I white1knuckled it for 8 months while awaiting the catheter ablation, yet I still feel nauseous and weak 2 months after stopping, only to find that serious side-effects due to internal organs toxicity may occur up to a few years after ceasing use age due to its storage in fatty tissue, especially the liver. I would rather die that take this drug again.

  2. Kendra
    GA
    Reply

    My mom was born with Tetralogy of Fallot, so she has had heart problems all her life. When she was in her 50’s she started having ventricular tachycardia, so her cardiologist tried various anti-arrhythmic drugs that did not work. Then, he put her on Amiodarone, finally something that worked! She took it for quite a number of years (10+) then her electrophysiologist put her on Tikosyn (don’t remember the reason why it was changed). She took that for about 3 years, and it worked OK in the beginning, but once again she started having more and more episodes where her ICD was shocking her. So, her electrophysiologist put her back on the Amiodarone.

    She has been on that the last 2 yrs up until recently when she was put into hospital for CHF. Finally, when they got all the fluid off her, and she was no better they sent her to Emory (great hospital), and she was diagnosed with pulmonary toxicity. She has been taken off the Amiodarone and been given corticosteroid. She is doing much better except it seems as though she can’t get her thoughts together. But I am almost certain that is from the steroids. My point is that although Amiodarone does have severe side effects, it can also tremendously help someone who is being continuously shocked. (Shout out to my Mom, a true fighter, who is one of the oldest living with Tetralogy of Fallot. She turned 70 on her birthday in July.)

  3. Kathie
    Sitka, Alaska
    Reply

    I was also put on amiodorone In October of 2014 following an aortic valve replacement in August of that year. I took it for 2 1/2 months. My surgery was in Oregon, and we live in Alaska. The cardiologist in Oregon prescribed amiodorone when the my heart rate suddenly was out of control.

    I knew it was bad but promised my primary physician I would stay on it the prescribed four months. I was too weak for a couple of weeks to get off the couch. To get up and move more than a foot or two was almost impossible because of dizziness. Just taking a shower was exhausting. I also had eye issues immediately after receiving the first doses via IV.

    One eye would suddenly go out of focus. When I called the Oregon cardiologist’s office about my symptoms they brushed me off, and told me not to worry about. In December a different cardiologist told me the dose was overkill and to stop it immediately.

  4. Joyce
    Louisiana
    Reply

    Amiodarone almost killed me after only 29. Days on this pill for atrial fib. I developed a partially collasped lung and fluid in lungs and round heart. Had to have a half litter of fluid removed from my lungs in hospital. Quit taking this pill and am back to my health energetic self thank God.

  5. Larry M
    Raleigh, NC
    Reply

    Well, I was just lucky. I had paroxysmal atrial fibrillation which was postural. It only occurred when I was horizontal. Not so bad except that I couldn’t get any sleep. I would lay awake all night trying to sleep, then had to drag myself to work where I would fall asleep upright in my chair. Even fell asleep driving a couple of times.

    Complaints to the cardiologist 2011-2012 led to his proposal to try amiodarone. Instead I insisted on a referral to a really good electrophysiologist. I had a circumferential pulmonary vein ablation instead of medical treatment and it was the smartest decision I have ever made. Complete cure in 2012. Went mountain hiking the next summer with no symptoms.

    I never have understood why the cardiologists hate the cardiac surgeons and vice-versa.

  6. Verna
    Wisconsin Rapids, WI
    Reply

    I was on amiodarone, (IV) after having a rapid and irregular heart beat 5 months ago. Later I was on the pills. Since September I have been off this drug and feel so much better. Many symptoms I thought were due to my congestive heart failure but now believe it was amiodarone. My eyesight is still blurry. An emergency room hospitalist told me nobody over 65 should ever be on this drug. This drug is so dangerous and doctors don’t know the facts.

  7. H. Holmes
    Reply

    I would like to share so many of your articles with family & friends but cannot find a quick and easy way of forwarding via email. Am I missing something?

    • Terry Graedon
      Reply

      The little envelope icon at the top of the page should allow you to email a link easily.

  8. David
    Racine, WI
    Reply

    What good timing for this article. Just started Amiodarone in August for atrial fibrillation!? Will be showing this article to my cardiologist on Friday. Thanks

  9. Bonnie
    SD
    Reply

    In 2004 my father was in the hospital receiving surgery for stage 4 lymphoma. For almost 20 years he had been in and out of episodes of Afib . While in the hospital, his Dr. put him on Amiodarone for heart rhythm regularity. He was taking coumadin. Within 2 weeks he died. His heart went into an unsustainable rhythm and he died after a failed attempt to place a pacemaker in his chest.

  10. Katann
    Dallas, Texas
    Reply

    I have been on Amiodarone for a year now. Tomorrow is my one year anniversary for my aortic valve replacement surgery. It was an elective surgery that was needing to be done due to a birth defect of my aortic valve. It was a well-planned surgery that I sought out a heart surgeon months before. My plan was to have the surgery done right before Christmas last year and recoup during the holidays.

    The day after surgery, I dropped to the floor. It took them 5 minutes of CPR to bring me back to life. After running tests and making sure I didn’t need a pacemaker, I spent another 4 days in ICU. I was moved to a private room and then it happened again. They performed CPR again and rushed me back to ICU. I could not stay conscious and they had to stay with me to keep my heart beating. The doctor called in his team on that Saturday night and they put in a pacemaker. With fractured ribs down both sides, I stayed in the hospital another week till they sent me home. Four days later, I went to ER with a severe wound infection from the heart surgery. I was opened back up and a wound pump was put in place. I had an infection to the sternum. They sent me to a long-term care hospital for another 3+ weeks so that they could administer IV antibiotics. I am Blessed to be alive!

    I have questioned the Amiodarone ever since I was started on the drug. I have read nothing but bad things about it! They kept telling me that I was in A-Fib and would have to remain on it. Back in June of this year, I was told that I had not had any more A-Fib moments, but they would monitor me through the pacemaker monitor. Tomorrow, I go see my Cardiologist. If no more a-fibs have happened since June, they will wean me off the Amiodarone.

    She said that I will cut the pill in half and take those for awhile longer. I hope I am able to get off of them. I really believe that the reason I am still on oxygen at night while I sleep is due to this drug! I also had to have my lungs drained 3 times after having the AVR. They told me once in the hospital that I had pneumonia, but tests came back that I did not. My chest is still hurting from the surgeries. At this point, I don’t feel like it will ever go back to normal. It’s been a long road this past year. I am looking forward to a much better year in 2017!

  11. Barbara
    Reply

    Am not sure why the cardiologists did not pick up these problems unless they were not LISTENING TO THE PATIENT or the PATIENT’s Family.

    I had a dog who had severe hemorrhage from a clostridium infection. With quick diagnosis and PROPER medication and two transfusions of greyhound blood he came through. A followup vet at the clinic checked his blood. He was still anemic according to labs. However, he was back to his spunky self. She said, “In some cases I prefer to look at the patient before I decide on further intervention.” I wonder if vets have something to teach human docs.

  12. Deloris
    Reply

    Even getting amiodarone in a hospital setting may not be absolutely safe. Eight years ago, my mother was admitted to ICU with a bad case of pneumonia, was put on a ventilator and on amiodarone, even though she never had any heart problems. Without any improvement, she died seventeen days later and her death was blamed on acute respiratory distress syndrome and pneumonia. She was also on a propofol IV so she wouldn’t fight the ventilator. The combination of these drugs along with the pneumonia was downright dangerous, but I didn’t know much about these things at the time.

  13. Stephanie
    St. Petersburg, FL
    Reply

    What is the consensus of the medical and pharmaceutical community on the anti-arrhythmic drug, Multaq. Those of us with atrial fibrillation have to take SOMETHING? What is considered safe? I took Flecainide for many years but over time it became ineffective in keeping my heart in rhythm.

  14. Berge
    33073
    Reply

    I was placed on Amiodorone in 2001 by cardiologist in my vacation state when Tykosin did not help my A Fib .I was lucky enough my cardiologist at my home state followed up with Pulmonary and liver function and thyroid tests. I developed tremor which was treated with beta blockers and I had to take Synthroid. But in 2011 I developed marked shortness of breath, so my wonderful interventional cardiologist did an angiogram where my coronary arteries were ok, but she told me to stop Amio which I did (in spite of the advice of a pulmonologist who said my chest X ray is Ok so I can continue Amio . I still have to take Synthroid . I wish people would have a doctor like my interventional cardiologist who was so astute and caring physician who also kept me alive since 2007 with multiple stent insertions for my CAD ( Am 89 , with CABG in 1982 and 9 angioplasties)

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