The authors reviewed the files of 37 patients under 15 years of age (22 boys and 15 girls) in order to study the long-term efficacy and tolerance of amiodarone therapy. The mean age of the patients at the time of initiation of amiodarone was 6.2 +/- 4.7 years. Amiodarone was prescribed at a loading dose of 500 mg/m2 and at a maintenance dose of 250 mg/m2. This drug was prescribed in second intention in 29/37 patients and as monotherapy in 15/37 patients. The treated arrhythmias were supraventricular in 25 patients (atrial: 10; junctional: 15) and ventricular in 12 patients. Underlying cardiac disease was present in 21/37 patients (57%) and the arrhythmias were postoperative in 14/37 cases (38%). Efficacy and tolerance of amiodarone were estimated on clinical and biological data, the results of Holter monitoring, ophthalmological slit-lamp examination and thyroid function tests. The average duration of therapy was 4 +/- 3 years. The efficacy of amiodarone was judged to be good in 59% and satisfactory in 38% of cases. Secondary effects and complications included: corneal deposits: 14 cases (38%); skin pigmentation: 1 case; photosensitivity: 10 cases (27%). There was a high incidence of thyroid disorders: 7 cases (19%) with 4 cases of biological or clinical hyperthyroidism and 3 cases of clinical or biological hypothyroidism.(ABSTRACT TRUNCATED AT 250 WORDS)
cordarone drug card
Flecainide is an antiarrhythmic drug that blocks sodium channels during phase 0 of cardiac action potential, delaying conduction and reducing contractility. Intoxication by this drug is rare. Onset of effect, which is rapid, takes the form of hypotension and cardiac arrhythmias; mortality is high. No antidote is available and management is based on the few cases that have been reported. The metabolism of flecainide is affected by both kidney and liver failure, which lead to accumulation of the drug. Flecainide should not be used in patients with such failure unless the potential benefits clearly outweigh the risks. If flecainide is prescribed, diligent clinical, electrocardiographic, and hemodynamic vigilance is imperative and plasma levels of the drug should be monitored. We report a case of flecainide poisoning in which the drug was prescribed to treat atrial fibrillation in a woman with resolving sepsis with renal and hepatic complications.
Dans les hôpitaux de l’étude, le dabigatran était habituellement prescrit de façon appropriée pour l’indication de fibrillation auriculaire non valvulaire chez des patients ne présentant pas d’insuffisance rénale. Cependant, il est justifié de tenir davantage compte des antécédents cardiaques (notamment les valvulopathies et la présence de prothèses valvulaire), des interactions médicamenteuses ainsi que de la consignation des risques et des avantages. Ces données mettent en relief l’importance et la possibilité de la participation du pharmacien à l’évaluation et à la sélection des patients ayant des indications pour un traitement par anticoagulant ainsi que de son analyse de ces cas, particulièrement lorsque les médicaments sont nouveaux sur le marché.
Confluent infiltrates and interstitial condensates with (sub)segmentary spreading are typical radiological findings in amiodarone pneumopathy. A case is presented where daily amounts of 200-600 mg and a total of 18.3 g amiodarone led to alveolitis with fibrosis within 4 weeks, which is uncommon in the early stage.
In 109 patients on statin treatment we found 35 potential (p) DDIs of statins in 30 (27.5%) patients, most of which were in the therapy before admission (27 pDDIs). The pDDIs were moderate (20 pDDIs) and major (15 pDDIs). Of the total number of pDDIs, 24 were targeting the muscular system. The drugs most frequently involved in the statins' pDDIs were amiodarone and fenofibrate. Two of the patients with pDDIs reported muscle pain, both having additional risk factors for statin induced muscular effects.
cordarone heart medication
In this large cohort of patients with AF, underlying coronary disease was significantly associated with dofetilide success. This finding may have utility for clinical decisions regarding initiation of dofetilide.
cordarone drug action
Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and initiation of antithyroid drugs. Impossibility to stop amiodarone, failure to control hyperthyroidism and unfavourable evolution can lead to thyroidectomy. Cardiac manifestations, persistence of hyperthyroidism and interactions between amiodarone and anaesthetic or haemodynamic drugs may contraindicate anaesthesia. We report nine consecutive cases of amiodarone-associated hyperthyroidism that prompted us to perform thyroidectomy under general anaesthesia. The features and anaesthetic data of patients were noted. The antithyroid medical treatment failed in all patients. After thyroidectomy, evolution was favourable in all nine cases, without any intra or postoperative complication, in spite of the extent of hyperthyroidism and the severity of the associated cardiac problems. Despite potential high risks, thyroidectomy for amiodarone-induced hyperthyroidism does not seem to increase morbidity or mortality and allows a quick return to euthyroidism and reintroduction of amiodarone.
cordarone drug information
The purpose of the present prospective randomized study was to evaluate the effects of n-3 polyunsaturated fatty acids on recurrence rates of atrial fibrillation (AF) and inflammation after electrical cardioversion.
cordarone oral dose
Although amiodarone is one of the most effective pharmacologic agents used in clinical management of atrial fibrillation (AF), little is known about its differential effects in atrial and ventricular myocardium.
Amiodarone-induced pulmonary toxicity is a serious side-effect, but the underlying molecular mechanisms remain unclear. We examined phospholipidosis and apoptosis in rat alveolar epithelial cells after medium-term oral amiodarone treatment. Amiodarone (30 mg/kg daily, a dosage corresponding to that used clinically) or vehicle was administered by gavage in 33 Wistar rats for two weeks. Apoptosis was assessed by terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labelling (TUNEL) and the expression of apoptosis- and phospholipidosis-related proteins was measured by immunohistochemistry. Amiodarone decreased phospholipase-C-γ1 and increased phosphatidylinositol-(4,5)-bisphosphate, resulting in phospholipidosis, evidenced by the appearance of intracellular inclusion bodies with a multi-lamellated interior. Amiodarone exerted two opposite effects on apoptosis; compared to controls, the expression of activated-caspase-8 was higher in treated rats, while the expression of apoptosis inhibitors survivin, Bcl-2 and c-Flip was lower. On the other hand, the expression of activated-caspase-3 was lower after treatment. Overall, amiodarone attenuated apoptosis, evidenced by fewer TUNEL-positive cells. Medium-term oral amiodarone administration induced phospholipidosis in rat alveolar epithelial cells. Although such treatment decreased anti-apoptotic proteins, apoptosis was attenuated via a decrease in the caspase-3 pathway. These findings improve current understanding on the mechanisms underlying amiodarone-induced pulmonary toxicity.
cordarone heart medicine
Our data show a superiority of DDD(R) mode versus VVI(R) mode regarding subjective and objective parameters as NYHA-classification, BNP, 6 minute walk test, left ventricular ejection fraction and left ventricular endsystolic volume after 12 months. The improvements seem to depend on the reduction of ventricular pacing with advanced atrial contraction. But only a small number of patients needed the upgradation.
cordarone 5 mg
In two Dutch anticoagulation clinics, data on age, sex, height, weight, co-medication, coumarin derivative doses, and international normalized ratio values were obtained from 624 patients taking PHE and 471 taking ACE. Single nucleotide polymorphisms relevant to coumarin derivative dosing on the CYP2C9 and VKORC1 genes were determined. Using multiple linear regression, we developed genotype-guided and non-genotype-guided algorithms to predict the maintenance dose with patient characteristics and genetic information. In addition, loading doses were derived from the calculated maintenance doses. We performed external validation in an independent data set with 229 PHE and 168 ACE users. CYP2C9 and VKORC1 genotype, weight, height, sex, age, and amiodarone use contributed to the maintenance dose of PHE and ACE. The genotype-guided algorithms explained 55.9% (PHE) and 52.6% (ACE) of the variance of the maintenance dose, the non-genetic algorithms 17.3% (PHE) and 23.7% (ACE). Validation in an independent data set resulted in an explained variation of 59.4% (PHE) and 49.0% (ACE) for the genotype-guided algorithms and for 23.5% (PHE) and 17.8% (ACE) for the non-genotype-guided algorithms, without height and weight as parameters.
Amiodarone is a well-known mitochondrial toxin consisting of a benzofuran ring (ring A) coupled to a p-OH-benzene structure substituted with 2 iodines and a diethyl-ethanolamine side chain (ring B).
cordarone 400 mg
A retrospective study was conducted in a group of 460 patients in order to evaluate the effectiveness and frequency of side effects of amiodarone over a mean observation period of 2 years. The effectiveness was considered to be excellent or good in 71.5 p. cent of cases of ischaemic heart disease, in 84.8 p. cent of cases of supraventricular arrhythmia and in 92.3 p. cent of cases of ventricular arrhythmia. Side effects were observed in 32.8 p. cent of patients and treatment had to be suspended in 19.8 p. cent of cases. The most frequent side effects were photosensitisation (11.9%), thyroid disorders (5.6%) and bradycardia or sinus dysfunction (11.9%). Some of these side effects appear to be related to the cumulative dose received.
cordarone drug interactions
Disorders of the thyroid gland are among the most common conditions diagnosed and managed by pediatric endocrinologists. Thyroid hormone synthesis depends on normal iodide transport and knowledge of its regulation is fundamental to understand the etiology and management of congenital and acquired thyroid conditions such as hypothyroidism and hyperthyroidism. The ability of the thyroid to concentrate iodine is also widely used as a tool for the diagnosis of thyroid diseases and in the management and follow up of the most common type of endocrine cancers: papillary and follicular thyroid cancer. More recently, the regulation of iodide transport has also been the center of attention to improve the management of poorly differentiated thyroid cancer. Iodine deficiency disorders (goiter, impaired mental development) due to insufficient nutritional intake remain a universal public health problem. Thyroid function can also be influenced by medications that contain iodide or interfere with iodide metabolism such as iodinated contrast agents, povidone, lithium and amiodarone. In addition, some environmental pollutants such as perchlorate, thiocyanate and nitrates may affect iodide transport. Furthermore, nuclear accidents increase the risk of developing thyroid cancer and the therapy used to prevent exposure to these isotopes relies on the ability of the thyroid to concentrate iodine. The array of disorders involving iodide transport affect individuals during the whole life span and, if undiagnosed or improperly managed, they can have a profound impact on growth, metabolism, cognitive development and quality of life.
cordarone iv dosing
Systemic primary amyloidosis (AL amyloidosis), with predominant cardiac involvement.
cordarone 60 mg
To compare the energy required for defibrillation and postshock outcomes after the administration of dronedarone, amiodarone, and placebo in a porcine model of cardiac arrest.
cordarone drug classification
In order to elucidate the incidence of undesirable effects of amiodarone on thyroid activity, the authors examined a group of 11 patients who used this preparation for 8 to 44 months on account of disorders of the cardiac rhythm. In two patients clinical examination revealed obvious thyrotoxicosis, which after discontinuation of amiodarone receded spontaneously in the first patient in the course of five months, in the second patient within two months. In the third patient in this group the result of the thyreoliberin test (TRH) suggested subclinical hypothyroidism. In the remaining eight patients with clinical euthyroidism in none all results of laboratory examinations (basal thyroxine values, serum triiodothyronine, thyrotropin response to TRH administration) were in the range of reference values. Amiodarone-induced dysfunction of the thyroid gland--not only dysfunction detectable by laboratory examination, but also clinically apparent, thus is not a rare phenomenon. It is therefore indicated that amiodarone administration should be preceded and associated with examinations focused on thyroid function.
Amiodarone, an antiarrhythmic agent, is known to induce pulmonary toxicity in some patients. Previously described radiographic findings include alveolar and interstitial infiltrates. We report a patient who developed biapical infiltrates on chest X-ray film and demonstrated an unusual, symmetric appearance on CT. Correlative postmortem histologic findings are presented. Amiodarone-induced pulmonary toxicity should be considered in the differential diagnosis of pulmonary parenchymal infiltrates seen on CT of patients receiving this medication.
cordarone 900 mg
From June 2008 to July 2011, 210 patients with chronic atrial fibrillation and rheumatic heart disease were randomized: (1) control group, patients underwent only valve replacement followed by amiodarone for rhythm control, (2) left atrial group (LA group), patients underwent valve replacement and left atrial mono-polar radiofrequency ablation, (3) bi-atrial group (BA group), patients underwent valve replacement and bi-atrial mono-polar radiofrequency ablation. The primary endpoints included: cardiac death, stroke, and recurrent AF after discharge.
cordarone y alcohol
Atrial fibrillation (AF) in the setting of heart failure (HF) is linked to embolic stroke and exacerbation of HF. The rate of new-onset AF in patients with left ventricular dysfunction and mild to moderate HF enrolled in the SoLVD trials was significantly lower with enalapril than with placebo (5.4% vs 24% over 2.9 years, P < .0001). The objective of this study was to predict economic benefits over 5 and 10 years of reduced AF incidence in patients receiving enalapril for the treatment of HF from a Canadian third-party payer perspective.
cordarone overdose death
In recent years we have observed new cases of thyroid disease occurring after heart transplantation (HTx). In these patients, the presence of this disease complicates their post-transplant course and occasionally results in life-threatening thyrotoxicosis. The present study examines the incidence and risk factors of thyroid disease in these patients with special emphasis on the use of amiodarone before HTx. Recommendations for follow-up of thyroid disease in HTx patients are discussed.
cordarone 20 mg
Atrioventricular (AV) junctional ablation was performed in a 59-year-old woman with recurrent atrial fibrillation refractory to treatment with digoxin, beta-blockers, verapamil, quinidine, procainamide, and amiodarone. She received two shocks of 500 J which produced complete AV block. After six weeks, both 24-hour ECG recordings and an exercise tolerance test showed infrequent premature ventricular complexes, 3 degrees AV block, and paced ventricular rhythm with 100 percent capture. She suddenly collapsed and was found to be in ventricular fibrillation and could not be resuscitated. Serial sections of the conduction system showed marked fatty infiltration of the approaches to the AV node with almost complete separation from the node. A partially fibrosed atrioHisian connection was also present. Fibroelastosis with chronic inflammatory changes was present in the AV node, bundle of His, and right and left bundle branches. In addition, marked inflammatory changes with fibrosis were present in the atrial septum, in the summit of the ventricular septum, with degenerative changes in the tricuspid and aortic valves. The sequelae of these findings outside the conduction system in other patients remains to be determined.
cordarone loading dose
Thirteen patients with intractable ventricular arrhythmias were studied; they underwent long-term treatment by a combination of antiarrhythmic drugs and ventricular pacing. Eleven patients had a history of tachycardia and two had torsade de pointes; eleven of thirteen had had cardioversion and/or defibrillation. Prior to permanent pacemaker implantation, temporary pacing in the VVI mode was used in combination with one or more of the following drugs: amiodarone, aprindine, digitalis, metoprolol, mexiletine, procainamide, pindolol, propranolol, or quinidine. Various pacing rates were tried; when permanent pacing was instituted, a unipolar system which was at least rate-programmable was used. Right ventricular VVI pacing, combined with drug therapy, was successful in ten of thirteen patients. Five of the ten patients are alive and free of arrhythmias after 78, 72, 72, 54, and 11 months, respectively. Although five patients died (after 60, 48, 30, 24, and 9 months, respectively), none of the deaths were related to arrhythmias. We suggest that in patients with ventricular arrhythmias refractory to conventional treatment, a therapeutic trial of right ventricular VVI pacing in combination with a drug regimen be used.
cordarone 50 mg
The Authors report a case of toxic multinodular goiter induced by longstanding administration of Amiodarone, in which the option was near total thyroidectomy for control of toxic symptoms without withdrawal of the antiarhuthmic drug. In this case, the post-operative period was complicated by compressive cervical hematoma, which was managed by performing an emergent tracheostomy.
HCM-related sudden cardiac death.