These individuals should be cardioverted. Amiodarone can be used in individuals with hemodynamically stable ventricular tachycardia. In these cases, amiodarone can be used regardless of the individual's underlying heart function and the type of ventricular tachycardia; it can be used in individuals with monomorphic ventricular tachycardia , but is contraindicated in individuals with polymorphic ventricular tachycardia as it is associated with a prolonged QT interval which will be made worse with anti-arrhythmic drugs.

In the ARCH trial, intravenous amiodarone 2 g administered over 2 d has been shown to reduce the incidence of atrial fibrillation after open heart surgery when compared to placebo.

While amiodarone is not approved for AF by the FDA, it is a commonly prescribed off-label treatment due to the lack of equally effective treatment alternatives. So-called 'acute onset atrial fibrillation', defined by the North American Society of Pacing and Electrophysiology NASPE in , responds well to short duration treatment with amiodarone. This has been demonstrated in seventeen randomized controlled trials, of which five included a placebo arm.

The incidence of severe side effects in this group is low. The benefit of amiodarone in the treatment of atrial fibrillation in the critical care population has yet to be determined but it may prove to be the agent of choice where the patient is hemodynamically unstable and unsuitable for DC cardioversion. Contraindications[ edit ] Women who are pregnant or may become pregnant are strongly advised to not take amiodarone.

If this combination is used, a low dose of buspirone, such as 2. Subsequent dosage adjustments should be based on clinical response. A drug interaction study with repeated administration of aprepitant, another moderate CYP3A4 inhibitor, did not modify the exposure to cabazitaxel; however, formal drug interaction studies have not been conducted with P-gp inhibitors.

Use caution when cabazitaxel is administered concomitantly with P-gp inhibitors. Moderate Monitor for an increase in cabozantinib-related adverse events if concomitant use with amiodarone is necessary.

The manufacturer of cabozantinib recommends a dose reduction when used with strong CYP3A4 inhibitors; however, recommendations are not available for concomitant use with a moderate inhibitor of CYP3A4.

Moderate Canagliflozin is a substrate of drug transporter P glycoprotein P-gp. Amiodarone is a PGP inhibitor and may theoretically increase concentrations of canagliflozin. Patients should be monitored for changes in glycemic control.

Moderate Adjust amiodarone and carbamazepine doses as needed based on efficacy and tolerability. Consider monitoring amiodarone serum concentrations during concurrent use. Monitoring for adverse effects, such as CNS effects and extrapyramidal symptoms, is advisable during coadministration. Concomitant administration of amiodarone and carvedilol increased the concentration of the S - enantiomer of carvedilol by at least 2-fold.

Caution is advised as metoprolol, another beta-blocker metabolized by CYP2D6, in combination with amiodarone has resulted in severe sinus bradycardia.

While the combination should be used cautiously and with close monitoring, it should be noted that post-hoc analysis of amiodarone therapy in patients after acute myocardial infarction in two clinical trials revealed that amiodarone in addition to a beta-blocker significantly lowered the incidence of cardiac and arrhythmic death or resuscitated cardiac arrest when compared with amiodarone or beta-blocker therapy alone.

Patients receiving amiodarone concurrently with carvedilol should be monitored for bradycardia or heart block, especially when one agent is added to pre-existing treatment with the other.

Minor Since celecoxib is metabolized by cytochrome P 2C9, concurrent administration with amiodarone, which can inhibit this enzyme, may result in increased levels of celecoxib. The clinical significance of this interactions has not been established. Major Avoid coadministration of amiodarone with ceritinib if possible due to the risk of QT prolongation; because amiodarone has an extremely long half-life, an interaction is possible for days to weeks after discontinuation of amiodarone.

Additionally, amiodarone exposure may be increased by ceritinib administration. If concomitant use is unavoidable, monitor for amiodarone-related adverse reactions; also, periodically monitor electrolytes and ECGs. An interruption of therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs. Ceritinib causes concentration-dependent prolongation of the QT interval. Amiodarone is a Class III antiarrhythmic agent.

Although the frequency of torsade de pointes TdP is less with amiodarone than with other Class III agents, amiodarone is still associated with a well-established risk of QT prolongation and TdP.

Severe Amiodarone may inhibit hepatic CYP3A4 isoenzymes, and therefore has the potential to increase serum concentrations of cerivastatin. Monitor for signs and symptoms of myopathy in patients receiving amiodarone concurrently with these HMG-CoA reductase inhibitors.

Inhibitors of these isoenzymes, such as amiodarone, would be expected to lead to an increase in cevimeline plasma concentrations. Chloroquine administration is associated with an increased risk of QT prolongation and torsades de pointes TdP. If possible, avoid coadministration of amiodarone and chloroquine.

Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: This risk is generally higher at elevated drugs concentrations of phenothiazines. Chlorpromazine is specifically associated with an established risk of QT prolongation and TdP; case reports have included patients receiving therapeutic doses of chlorpromazine.

Agents that prolong the QT interval could lead to torsade de pointes when combined with a phenothiazine, and therefore are generally not recommended for combined use. Moderate Clonidine can produce bradycardia and should be used cautiously in patients who are receiving other drugs that lower the heart rate including amiodarone. Monitor for potential bradycardia or atrioventricular block during coadministration.

Major Cholestyramine can enhance amiodarone clearance presumably via reduced enterohepatic recirculation, thereby reducing amiodarone serum concentrations. This interaction between amiodarone and cholestyramine may be of benefit to temporarily reduce amiodarone serum concentrations prior to surgery and possibly limit the cardiac depressant effects of the drug in the immediate post-surgical period, although more data are needed before this recommendation can be made.

Major Reduce the dose of cilostazol to 50 mg twice daily when coadministered with amiodarone, and monitor for an increase in cilostazol-related adverse reactions.

Cilostazol is a CYP3A4 substrate. Amiodarone is a moderate CYP3A4 inhibitor both in vitro and in vivo. Moderate Cimetidine may decrease the CYP3A4 metabolism of amiodarone, potentially resulting in increased plasma concentrations of amiodarone and the active metabolite. Therefore, caution is recommended when coadministering cinacalcet with other CYP3A4 enzyme inhibitors, such as amiodarone.

Major Concurrent use of amiodarone and ciprofloxacin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP. Concomitant use should only be done after careful assessment of risks versus benefits, especially when the coadministered agent might decrease the metabolism of amiodarone.

Severe Post-marketing surveillance reports have documented QT prolongation and ventricular arrhythmias, including torsade de pointes TdP and death, when known and potent inhibitors of CYP3A4 are coadministered with cisapride. Amiodarone has the potential to inhibit the metabolism of cisapride through CYP3A4 and thus, should not be used with cisapride.

Major Citalopram causes dose-dependent QT interval prolongation. According to the manufacturer of citalopram, concurrent use of citalopram with other drugs that prolong the QT interval is not recommended. If concurrent therapy is considered essential, ECG monitoring is recommended.

The manufacturer of amiodarone recommends avoiding coadministraton and a careful assessment of risks versus benefits if coadministration cannot be avoided. Moderate Concomitant use of clindamycin and amiodarone may decrease clindamycin clearance and increase the risk of adverse reactions.

Caution and close monitoring are advised if these drugs are used together. Moderate Amiodarone is a CYP3A4 inhibitor and may reduce the metabolism of clonazepam and increase the potential for benzodiazepine toxicity.

Moderate Amiodarone is a CYP3A4 inhibitor and may reduce the metabolism of clorazepate and increase the potential for benzodiazepine toxicity. Major Treatment with clozapine has been associated with QT prolongation, torsade de pointes TdP , cardiac arrest, and sudden death.

The manufacturer of clozapine recommends caution during concurrent use with medications known to cause QT prolongation such as amiodarone. Elevated plasma concentrations of clozapine occurring through CYP inhibition may potentially increase the risk of life-threatening arrhythmias, sedation, anticholinergic effects, seizures, orthostasis, or other adverse effects.

According to the manufacturer, patients receiving clozapine in combination with a CYP2D6 or CYP3A4 inhibitor should be monitored for adverse reactions.

Consideration should be given to reducing the clozapine dose if necessary. If the inhibitor is discontinued after dose adjustments are made, monitor for lack of clozapine effectiveness and consider increasing the clozapine dose if necessary. Cobicistat; Elvitegravir; Emtricitabine; Tenofovir Alafenamide: Moderate Caution is advised when administering tenofovir, PMPA, a P-glycoprotein P-gp substrate, concurrently with inhibitors of P-gp, such as amiodarone.

Coadministration may result in increased absorption of tenofovir. Monitor for tenofovir-associated adverse reactions. Major Avoid the concurrent use of cobimetinib with chronic amiodarone therapy due to the risk of cobimetinib toxicity.

If concurrent short-term 14 days or less use of amiodarone is unavoidable, reduce the dose of cobimetinib to 20 mg once daily for patients normally taking 60 mg daily; after discontinuation of amiodarone, resume cobimetinib at the previous dose. Use an alternative to amiodarone in patients who are already taking a reduced dose of cobimetinib 40 or 20 mg daily.

Major The concomitant use of amiodarone and other drugs known to prolong the QT interval should only be done after careful assessment of risks versus benefits, especially when the coadministered agent might decrease the metabolism of amiodarone. If possible, avoid coadministration of amiodarone and drugs known to prolong the QT interval. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with amiodarone include promethazine.

Promethazine carries a possible risk of QT prolongation. Monitor for side effects like sedation and changes in heart rate or rhythm.

Major Due to the risk for serious colchicine toxicity including multi-organ failure and death, avoid coadministration of colchicine and amiodarone in patients with normal renal and hepatic function unless the use of both agents is imperative. Coadministration is contraindicated in patients with renal or hepatic impairment because colchicine accumulation may be greater in these populations.

Amiodarone can inhibit colchicine's metabolism via P-glycoprotein P-gp and CYP3A4, resulting in increased colchicine exposure. If coadministration in patients with normal renal and hepatic function cannot be avoided, adjust the dose of colchicine by either reducing the daily dose or the dosage frequency, and carefully monitor for colchicine toxicity.

Specific dosage adjustment recommendations are available for the Colcrys product for patients who have taken a moderate CYP3A4 inhibitor like amiodarone in the past 14 days or require concurrent use: Moderate Colesevelam may decrease the absorption of oral antiarrhythmics. To minimize potential for interactions, consider administering oral antiarrhythmics at least 1 hour before or at least 4 hours after colesevelam.

Minor Amiodarone inhibits CYP3A4, and may increase serum estrogen concentrations and estrogenic-related side effects e. Major Avoid coadministration of amiodarone with crizotinib due to the risk of additive QT prolongation and torsade de pointes TdP ; an increase in treatment-related adverse reactions e.

If concomitant use is unavoidable, monitor ECGs and electrolytes. An interruption of therapy, dose reduction, or discontinuation of therapy may be necessary for QT prolongation. Due to the extremely long half-life of amiodarone, a drug interaction is possible for days to weeks after discontinuation. Cyclobenzaprine is structurally similar to tricyclic antidepressants. Tricyclic antidepressants have been reported to prolong the QT interval, especially when given in excessive doses or in overdosage settings.

Cyclobenzaprine is associated with a possible risk of QT prolongation and torsade de pointes TdP , particularly in the event of acute overdose. Moderate Use caution if cyclophosphamide is used concomitantly with amiodarone, as there may be an increased risk of pulmonary toxicity.

Amiodarone is a CYP3A4 inhibitor and may decrease the clearance of cyclosporine, which may reduce cyclosporine dosage requirements or cause cyclosporine toxicity. Moderate Increased serum concentrations of dabigatran are possible when dabigatran, a P-glycoprotein P-gp substrate, is coadministered with amiodarone, a P-gp inhibitor.

Patients should be monitored for increased adverse effects of dabigatran. Due to the long half-life of amiodarone, the increase in renal clearance may persist after discontinuation of amiodarone. Data from the RE-LY trial indicate no significant changes in dabigatran trough concentrations were seen in patients who received concomitant therapy with amiodarone. In clinical studies, dabigatran was found to have no effect on the pharmacokinetics of amiodarone. P-gp inhibition and renal impairment are the major independent factors that result in increased exposure to dabigatran.

Major Coadministration of amiodarone with daclatasvir plus sofosbuvir is not recommended due to the potential for serious symptomatic bradycardia. Cases of symptomatic bradycardia, some requiring pacemaker intervention, have been reported when amiodarone was administered with sofosbuvir and another direct-acting antiviral, including daclatasvir.

One patient developed a fatal cardiac arrest after receiving amiodarone with ledipasvir; sofosbuvir. Bradycardia generally occurs within hours to days; however, cases have been observed up to 2 weeks after initiating the hepatitis C virus HCV treatment regimen. The mechanism of this effect is unknown.

If coadministration is required, cardiac monitoring in an inpatient setting for the first 48 hours of coadministration is recommended, after which outpatient or self-monitoring of the heart rate should occur on a daily basis through at least the first 2 weeks of treatment.

Due to the long half-life of amiodarone, patients discontinuing amiodarone just prior to starting the HCV regimen should also undergo similar cardiac monitoring as outlined above. Minor Monitor patients for hypoglycemia if saxagliptin and amiodarone are used together. Patients should be monitored for increased anticholinergic effects if these drugs are used concomitantly; dosage adjustments of darifenacin may be necessary.

Major Darunavir is an inhibitor of CYP3A4 and increased plasma concentrations of drugs extensively metabolized by this enzyme, like amiodarone, is expected with concurrent use. Coadminister with extreme caution, therapeutic monitoring of antiarrhythmic concentrations is recommended. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Major Coadministration of HIV treatment doses of ritonavir and amiodarone is contraindicated due to the potential for serious or life-threatening reactions, such as cardiac arrhythmias.

Cautious consideration may be given to administering amiodarone with boosting doses of ritonavir. Ritonavir is an inhibitor of CYP3A4 and increased plasma concentrations of drugs extensively metabolized by this enzyme, such as amiodarone, should be expected with concurrent use. In addition, both ritonavir and amiodarone are associated with QT prolongation; concomitant use increases the risk of QT prolongation.

Major Avoid the concomitant use of amiodarone and dasatinib; both of these drugs may prolong the QT interval increasing the risk of torsade de pointes TdP. In vitro studies have shown that dasatinib has the potential to prolong cardiac ventricular repolarization prolong QT interval.

Amiodarone and dasatinib are both CYP3A4 substrates and inhibitors. Concomitant use of amiodarone and dasatinib may result in increased dasatinib plasma concentrations and dasatinib-related toxicity. Therefore, coadministration of dasatinib and amiodarone may result in increased amiodarone plasma concentrations and amiodarone-related toxicity. Major The concomitant use of amiodarone and other drugs known to prolong the QT interval should be done only after careful assessment of risks versus benefits, especially when the coadministered agent might decrease the metabolism of amiodarone.

Acute cardiotoxicity can occur during administration of daunorubicin or doxorubicin; cumulative, dose-dependent cardiomyopathy may also occur. Sinus tachycardia is the most common arrhythmia, but other arrhythmias such as supraventricular tachycardia SVT , ventricular tachycardia, heart block, and premature ventricular contractions PVCs have been reported.

Amiodarone is a substrate for CYP2C8. The concomitant administration of deferasirox and the CYP2C8 substrate repaglinide single dose of 0. Although specific drug interaction studies of deferasirox and amiodarone are not available, a similar interaction may occur.

The dose of amiodarone may need to be decreased if coadministered with deferasirox. Major Decrease deflazacort dose to one third of the recommended dosage when coadministered with amiodarone. Concurrent use may significantly increase concentrations of desDFZ, the active metabolite of deflazacort, resulting in an increased risk of toxicity. Additionally, use caution with coadministration of amiodarone with drugs which may induce hypokalemia or hypomagnesemia, including deflazacort.

Antiarrhythmic drugs may be ineffective or may be arrhythmogenic in patients with hypokalemia; any potassium or magnesium deficiency should be corrected before instituting and during amiodarone therapy. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously with amiodarone include degarelix. Major Delavirdine is an inhibitor of CYP3A4 and increased plasma concentrations of drugs extensively metabolized by this enzyme, such as amiodarone, should be expected with concurrent use.

Coadministration of delavirdine with amiodarone should be done with caution. Major In general, adverse cardiovascular effects such as hypotension and atropine-resistant bradycardia can occur in patients receiving amiodarone who subsequently are administered any general anesthetics, particularly volatile anesthetics.

Close perioperative monitoring is recommended in patients undergoing general anesthesia who are on amiodarone therapy as they may be more sensitive to the myocardial depressant and conduction effects of halogenated anesthetics, which may include QT prolongation. Due to the extremely long half-life of amiodarone, a drug interaction is also possible for days to weeks after discontinuation of amiodarone.

Moderate Amiodarone has a complex effect on the metabolism of thyroid hormones and can alter thyroid function tests in many patients. In addition, amiodarone decreases T4 5'-deiodinase activity, which decreases the peripheral conversion of T4 to T3, leading to decreased serum T3.

Serum T4 levels are usually normal but may be slightly increased. TSH concentrations usually increase during amiodarone therapy, but after 3 months of continuous administration, TSH concentrations often return to normal. However, amiodarone can cause hypothyroidism or hyperthyroidism, including life-threatening thyrotoxicosis.

Therefore, patients receiving levothyroxine and amiodarone should be monitored for changes in thyroid function; because of the slow elimination of amiodarone and its metabolites, abnormal thyroid function tests may persists for weeks or months after amiodarone drug discontinuation.

Major Avoid concomitant use of deutetrabenazine and amiodarone, if possible. Clinically relevant QTc prolongation may occur with deutetrabenazine. Dextromethorphan; Guaifenesin; Potassium Guaiacolsulfonate: Quinidine may also be displaced from tissue and protein binding sites. Prolongation of the QT interval is well documented with quinidine, and the addition of amiodarone may increase this effect, placing the patient at an increased risk for the development of torsade de pointes.

Careful clinical observation of the patient as well as close monitoring of the ECG and serum quinidine concentrations are essential with adjustment of the quinidine dosing regimen performed as necessary to avoid enhanced toxicity or pharmacodynamic effects. Combination antiarrhythmic therapy is reserved for patients with refractory life-threatening arrhythmias. As a result, diazepam is susceptible to interactions with drugs that inhibit these hepatic enzymes, such as amiodarone.

Moderate If possible, avoid concurrent use of diclofenac with inhibitors of CYP2C9, such as amiodarone; if coadministration is required, do not exceed a total daily diclofenac dose of mg.

Measure serum digoxin concentrations before initiating amiodarone. Because of the depressant effects of digoxin on the sinus and AV node, concurrent use can potentiate amiodarone's electrophysiologic and hemodynamic effects resulting in bradycardia, sinus arrest, and AV block. Furthermore, amiodarone may induce changes in thyroid function and alter sensitivity to cardiac glycosides, and thyroid function should be monitored closely in patients receiving both drugs simultaneously.

Close monitoring of serum digoxin concentrations and heart rate is essential to avoid enhanced toxicity. Major Coadministration of dihydroergotamine with inhibitors of CYP3A4, such as amiodarone, may potentially increase the risk of ergot toxicity e. Concurrent use of amiodarone and diltiazem may result in bradycardia and depressed cardiac output; monitor clinical response.

In addition, amiodarone is both a substrate and inhibitor of CYP3A4 metabolism, and may potentially interact with diltiazem via CYP3A4 metabolic pathways. Caution is recommended when administering amiodarone with CYP2C9 substrates including ibuprofen.

The metabolism of ibuprofen may be decreased. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here. Your doctor may have suggested this medication for conditions other than those listed in these drug information articles.

If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor. Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it. What form s does this medication come in?

How should I use this medication? This medication may be taken with or without meals, but should be taken in the same manner each day. This medication may be taken with or without meals, but should be taken in the same manner each day. Do not take grapefruit juice during amiodarone treatment because blood levels of amiodarone may increase. The injectable form of amiodarone may be used in hospitals under specific circumstances.

The recommended dose varies according individual circumstances. Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, skip the missed dose and continue with your regular dosing schedule.

Do not take a double dose to make up for a missed or skipped dose.

pharm care final karla

The need to coadminister amiodarone with any other drug known to prolong the QTc interval must be based on a careful assessment of the potential risks and benefits of doing so for each patient. Use caution when coadministering amiodarone with drugs which may induce hypokalemia and, or hypomagnesemia including thiazide amiodarone. In addition, the metabolism of hydrocodone to its active metabolite, hydromorphone, amiodarone hydrochloride 50mg/ml 3 ml, is dependent on CYP2D6. In addition, in vitro studies indicate that CYP1A2 is a primary metabolic pathway of asenapine. Increased amiodarone 50mg/ml may also occur with amiodarone regimens of oral aprepitant, resulting in increased amiodarone-related adverse reactions, including QT prolongation. The results were expressed in NTU and were interpreted as follows: Fosaprepitant is rapidly converted to aprepitant; therefore, a similar hydrochloride is likely. Caution is advised as metoprolol in combination with amiodarone has resulted in severe 50mg/ml bradycardia, amiodarone hydrochloride 50mg/ml 3 ml. Concomitant use of amiodarone and dasatinib may result in increased dasatinib plasma concentrations and dasatinib-related toxicity. It nucral sucralfate 1000mg by changing how electrical hydrochloride affect the heart muscle and by making the heart beat more regularly.

Amiodarone Hydrochloride for Intravenous infusion by Hospira Healthcare Corporation

The solution of further comprising an osmotic agent. Use caution when coadministering amiodarone hydrochloride drugs which may induce hypokalemia and, or hypomagnesemia including amphotericin B. The mixture was pH adjusted with methanesulfonic acid and sodium hydroxide if necessary to a pH of In addition, the metabolism of hydrocodone to its active metabolite, hydromorphone, is dependent on CYP2D6. If concurrent therapy is considered essential, amiodarone hydrochloride 50mg/ml 3 ml, ECG monitoring codeine street price tylenol 3 recommended. Amiodarone is amiodarone inhibitor of CYP3A4. Drospirenone; Ethinyl Estradiol; Levomefolate: Excessive doses particularly in the overdose setting or IV administration of haloperidol may be associated with a higher risk of QT prolongation. Amiodarone is a Class III antiarrhythmic agent. Major Atazanavir is an inhibitor of CYP3A4 and increased plasma concentrations amiodarone drugs extensively metabolized by this enzyme, such as amiodarone, should be expected with concurrent use. In clinical trials, QT prolongation was reported in patients who received mid. If coadministration is necessary, the manufacturer of ezogabine recommends caution during concurrent use with amiodarone. Indeed, although pH values below 2. The metabolism of liposomal irinotecan has not been evaluated; however, coadministration of ketoconazole, a strong CYP3A4 and UGT1A1 inhibitor, with non-liposomal irinotecan HCl resulted in increased 50mg/ml to both irinotecan and its active metabolite, SN Carefully asses treatmentt hydrochloride versus benefits. The dose may be increased to a maximum of 25 mg PO twice daily for inadequate blood 50mg/ml response. Although a starting dose adequate to suppress life-threatening arrhythmias is needed, close monitoring with adjustment of dose is essential.

Amiodarone infusion find mg/min DO ml/hr SH mg/ml

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