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Amiodarone is only used in the most life-threatening cases of heart arrhythmias because of its several known fatal toxicities. The most serious toxicity associated with amiodarone is pulmonary toxicity, which occurs as hypersensitivity pneumonitis or interstitial/alveolar pneumonitis. The reported prevalence of pulmonary toxicity from amiodarone is between 5 and 18 percent.
Pulmonary toxicity usually manifests as lung inflammation and is often mistaken for heart failure. Symptoms of amiodarone pulmonary toxicity include acute or sudden onset of chest pain in the lungs, bronchospasm, malaise (an overall feeling of illness), shortness of breath, fever and cough.
Amiodarone toxicity occurs when excess amiodarone accumulates in the lungs or the liver, thickening and scarring the organ walls. The drug becomes trapped in the organs and interferes with their functions. Pulmonary toxicity is responsible for the most deaths related to amiodarone therapy.
In order to prevent amiodarone pulmonary toxicity, it is important that a chest x-ray and lung function tests be done prior to prescribing amiodarone as a method of determining if the drug is suitable for the individual patient. Regular lung tests should be performed every three months to ensure proper lung function throughout the treatment period.
Thyroid dysfunction is another possible complication of amiodarone therapy, even in low doses, due to the amount of iodine in the drug. Hypothyroidism, or underactive thyroid, occurs in about 20 percent of patients treated with amiodarone; hyperthyroidism, or overactive thyroid, occurs in roughly 3 percent of patients. These thyroid dysfunctions can be treated concurrently with amiodarone treatment. Although thyroid dysfunction can occur even years after the amiodarone prescription is initiated, thyroid activity usually returns to normal after treatment is discontinued.
Toxicity in the liver can lead to a number of potentially deadly liver diseases. Jaundice is a side effect of amiodarone toxicity in the liver, while other potential complications include cirrhosis and liver failure. Liver function tests should be performed every three to six months to test for liver toxicity.
Numerous other medications can cause toxicity if they interact with amiodarone. Because of the drug''s long half-life, these dangerous interactions can occur for as long as three months after cessation of amiodarone treatment. Physicians must be informed of any other medications taken in the same time frame as amiodarone.
Amiodarone should only be used as a last resort when the risk of sudden death from arrhythmia is greater than the risk of toxicity.
Atrial fibrillation, the most common type of irregular heartbeat, can be expected in one in four adults over the age of 40. Currently, nearly 2.3 million Americans suffer from atrial fibrillation, a type of arrhythmia that significantly increases risk ...
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