Amiodarone

CORDARONE

Open Amiodarone in the interactive console ↗

What it isPotassium- and sodium-channel blocking antiarrhythmic; ventricular arrhythmias and off-label atrial fibrillation.

Why this oneExceptional rhythm-control efficacy in structural heart disease distinguishes it despite multiorgan toxicity.

What limits itMonitor lung, liver, thyroid, eyes, and skin; CYP and P-gp inhibition raises warfarin and digoxin exposure.

FDA-approved for

ventricular arrhythmias (1985)

Off-label

atrial fibrillation

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Pulmonary toxicity (fatal ~10% of cases), hepatotoxicity (can be fatal), and proarrhythmia. Reserve for life-threatening ventricular arrhythmias; initiate under hospital/specialist supervision.

FDA dosing	Population	Start	Target	Max
Life-threatening recurrent ventricular arrhythmias (VF, hemodynamically unstable VT)	Adult	800–1600 mg/day loading (usually 1–3 wk)	400 mg/day maintenance	1600 mg/day (loading)

Titration After therapeutic response (usually 1–3 wk), reduce to 600–800 mg/day for 1 month, then to maintenance ~400 mg/day.

Renal Undefined

Hepatic Discontinue or reduce dose if transaminases exceed 3× normal or double from an elevated baseline.

Instructions

Administer consistently with regard to meals; give in divided doses with meals for ≥1000 mg/day or GI intolerance.
Obtain baseline chest X-ray, PFTs, thyroid and liver tests; correct hypokalemia/hypomagnesemia/hypocalcemia before starting.
Adverse effects and interactions persist for weeks after discontinuation (long half-life).

Contraindications

Cardiogenic shock
Sick sinus syndrome, second- or third-degree AV block, or bradycardia leading to syncope without a functioning pacemaker

Cautions

Pulmonary toxicity (pneumonitis, fibrosis, ARDS)
Hepatic injury (can be fatal)
Worsened arrhythmia / QTc prolongation / torsades
Optic neuropathy/neuritis; corneal microdeposits
Thyroid abnormalities (hypo- or hyperthyroidism)
Bradycardia (including with sofosbuvir-based antivirals)
Peripheral neuropathy
Photosensitivity and blue-gray skin discoloration

Adverse reactions

Hypothyroidism/hyperthyroidism
Congestive heart failure
Cardiac arrhythmias
Nausea/vomiting
Constipation
Photosensitivity
Tremor/ataxia
Visual disturbances
Abnormal liver-function tests
Pulmonary inflammation/fibrosis

Pregnancy May cause fetal harm—neonatal hypo/hyperthyroidism, bradycardia, QT prolongation, neurodevelopmental effects, growth restriction, preterm birth.

Lactation Present in breast milk; breastfeeding not recommended.

⚠ BOXED WARNINGS