Amiodarone

When ATH:
C01BD01

Characteristic.

Crystalline powder, white or cream color. Slightly soluble in water, soluble in alcohol, very soluble in chloroform.

Pharmacological action.
Antiarrhythmic, antianginalnoe.

Application.

Severe arrhythmias (usually, with inefficiency or inability to other therapy): Atrial and ventricular premature beats, WPW-syndrome, atrial flutter and atrial fibrillation, ventricular tachycardia, ventricular fibrillation; Background arrhythmia or coronary heart failure, ventricular arrhythmias in patients with Chagas disease myocarditis.

Contraindications.

Hypersensitivity (incl. for iodine), sinusovaya bradycardia, OF блокада, sinus syndrome failure, expressed conduction disorders, cardiogenic shock, thyroid dysfunction.

Pregnancy and breast-feeding.

Category actions result in FDA - D. (There is evidence of the risk of adverse effects of drugs on the human fetus, obtained in research or practice, However, the potential benefits, associated with drugs in pregnant, may justify its use, in spite of the possible risk, if the drug is needed in life-threatening situations or severe disease, when safer agents should not be used or are ineffective.)

Side effects.

Mikrootsloyki retina, optic neuritis, Hyper- (It requires removal of the drug) or hypothyroidism, fibrosis lyegkikh, pneumonitis, pleurisy, bronhiolit, pneumonia, perifericheskie neuropathy and / or myopathies, extrapyramidal tremor, ataxia, cranial hypertension, nightmares, bradycardia, asistolija, OF блокада, nausea, vomiting, abnormal liver function, alopecia, epididymitis, anemia, photosensitivity, allergic reactions.

Cooperation.

Beta-blockers increase the risk of hypotension and bradycardia. Nesovmestim with BCC (It increases the likelihood of developing AV block and hypotension). Kolestiramin reduces T_1/2 level and Amiodarone plasma, cimetidine - uvelichivaet. Proximity effect anticoagulants, Digitalis preparations. Increasing the concentration of cyclosporine in the blood.

Overdose.

Symptoms: bradycardia, gipotenziya, OF блокада, electromechanical dissociation, cardiogenic shock, asistolija, cardiac arrest.

Dosing and Administration.

B /, loading dose - 5 mg / kg for 15 m 2-3 times per day, maintenance therapy - 10-20 mg / kg / day (250 ml 5% aqueous).

Inside, from 100 to 400 mg / day (the maximum dose - 600 mg / day) 8-10 days, possible break - 2 days per week.

Precautions.

Mandatory ECG monitoring. Do not combine with beta-blockers, verapamil, diltiazemom, laxatives, GI motility. The caution is combined with drugs, cause hypokalemia (Diuretic, corticosteroids, amphotericin B for the on / in the), and prescribed to patients with severe and prolonged diarrhea. Prolonged treatment is necessary observation ophthalmologist, regular monitoring of thyroid function, X-ray examination of lungs.

Cooperation

Active substance	Description of interaction
Atenolol	FMR: synergism. Against the background of amiodarone (It has a weak beta-blocking activity) It increases the risk of excessive hypotension and bradycardia.
Atenolol + Xlortalidon	FMR. Against the backdrop of intensified amiodarone chrono, ino- and dromotropic effects.
Warfarin	FMR: synergism. Against the background of a significantly enhanced effect of amiodarone, which can cause heavy bleeding; the combined use of anti-coagulant dose must be reduced by 1/3 - 1/2 and constantly monitor the prothrombin time.
Verapamil	FMR: synergism. Against the background of amiodarone (slows AV conduction) increased risk of AV block; concomitant use is contraindicated.
Halothane	FMR: synergism. Against the background of enhanced inhibition of amiodarone conductivity and myocardial contractility.
Glipizide	FKV. Against the background of amiodarone increases the level of the free fraction of blood, enhanced effect and may develop hypoglycemia.
Digoxin	FKV. Against the background of amiodarone increases plasma concentration, reduced clearance and / or volume of distribution, increased risk of toxicity; dvuhkratnaya necessary reduction dozы.
Diltiazem	FMR: synergism. Against the background of amiodarone (slows AV conduction) increased risk of AV block; concomitant use is contraindicated.
Izofluran	FMR: synergism. Against the background of enhanced inhibition of amiodarone conductivity and myocardial contractility.
Levothyroxine sodium	FKV. FMR. Against the background of amiodarone may weaken (with the development of symptoms of hypothyroidism) or strengthening (thyrotoxic effects) effect.
Metoprolol	FMR: synergism. Against the background of amiodarone (It has a weak beta-blocking activity) It increases the risk of excessive bradycardia and hypotension, possible AV block.
Methotrexate	FKV. Against the backdrop of slowing biotransformation and amiodarone increases plasma concentration.
Nadolol	FMR: synergism. Against the background of amiodarone (It has a weak beta-blocking activity) It increases the risk of excessive hypotension and bradycardia.
Nebyvolol	FMR. Increases (mutually) the likelihood of violations of automaticity, conduction and myocardial contractility.
Nimodipine	FMR: synergism. Against the background of the effect of amiodarone is enhanced cardiodepressivny, increased risk of deep bradycardia, suppression of sinus rhythm and AV blockade; concomitant use is contraindicated.
Nifedipine	FMR: synergism. Against the background of the effect of amiodarone is enhanced cardiodepressivny, increased risk of deep bradycardia, suppression of sinus rhythm and AV blockade; concomitant use is contraindicated.
Pindolol	FMR: synergism. Against the background of amiodarone (especially when on / in) It increases the likelihood of violations of myocardial function and the risk of excessive hypotension.
Prokaynamyd	FKV. Against the background of amiodarone increases the concentration in the blood; the combined appointment necessary dose reduction.
Propafenone	FMR. May exacerbate (mutually) the risk of toxicity.
Propranolol	FMR: synergism. Against the background of amiodarone (It has a weak beta-blocking activity) It increases the risk of excessive hypotension and bradycardia.
Ritonavir	FMR: synergism. Against the background of amiodarone increases the risk of side effects; concurrent use is not recommended.
Sotalol	FMR: synergism. Against the background of amiodarone can prolong the refractory period and provoke arrhythmia; concomitant use is not recommended.
Timolol	FMR: synergism. Increases (mutually) the likelihood of violations of automaticity, conduction and myocardial contractility.
Felodipine	FMR: synergism. Against the background of amiodarone (slows AV conduction) increased risk of AV block; concomitant use is contraindicated.
Phenytoin	FKV. On the background on / in the amiodarone reduces plasma concentration.
Fentanyl	FMR: synergism. Against the background of / in the amiodarone possible hypotension, bradycardia and a decrease in cardiac output.
Quinidine	FKV. Against the background of amiodarone (biotransformation enzymes inhibited by CYP450) increased serum concentration; joint application should start with a low dose.
Celecoxib	FKV. Against the background of amiodarone, ингибирующего CYP2D9, biotransformation slows and increases the plasma concentration; In sharing caution.
Cyclosporine	FKV. Against the background of amiodarone increases the concentration in the blood.
Esmolol	FMR: synergism. Against the background of enhanced effects and amiodarone increases (especially when on / in) the risk of deep bradycardia, suppression of sinus rhythm and AV blockade.