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| Interactions: | Acenocoumarol
Adverse Effect: Increased risk of bleeding Clinical Management: In patients receiving Acenocoumarol , the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with Amiodarone, and should be reassessed periodically during concurrent therapy. Adjustments of the Acenocoumarol dose may be necessary in order to maintain the desired level of anticoagulation.
Amlodipine
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Amlodipine should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Atenolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Atenolol Comb.
Adverse Effect: Hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Betaxolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Bisoprolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Carvedilol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Celiprolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Cimetidine
Adverse Effect: Amiodarone toxicity (bradycardia, heart block, hypotension) Clinical Management: Monitor for potential amiodarone toxicity (eg, bradycardia, heart block, & hypotension) and adjust the dose accordingly. If concurrent use cannot be avoided, select another H2-antagonist (eg, ranitidine or famotidine) that has less potential to alter the pharmacokinetics of amiodarone.
Cisapride
Adverse Effect: cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: The concurrent use of cisapride and Amiodarone is contraindicated.
Clonazepam
Adverse Effect: clonazepam toxicity (confusion, slurred speech, enuresis) Clinical Management: Monitor for signs of intoxication (eg, marked sedation, dizziness, ataxia, weakness, decreased cognition or motor performance, slurred speech, enuresis). If symptoms are present, reduce clonazepam dose.
Cyclosporin
Adverse Effect: Increases Cyclosporine concentrations Clinical Management: Monitor Cyclosporine concentrations and adjust the dosage accordingly.
Digoxin
Adverse Effect: Digoxin toxicity (nausea, vomiting, cardiac arrhythmias) Clinical Management: Monitor digoxin levels (therapeutic range: 0.8 to 2.0 ng/mL) when amiodarone is added to or deleted from therapy and be alert for signs of digoxin toxicity. The oral dose of digoxin may need to be decreased by as much as 50% if it is administered concurrently with amiodarone.
Diltiazem
Adverse Effect: atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and calcium channel blockers should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Esmolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Felodipine
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Felodipine should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Fentanyl
Adverse Effect: cardiac toxicity (low cardiac output) Clinical Management: Monitor for cardiovascular complications, adjust the dose or discontinue one or both drugs if needed.
Flunarizine
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Flunarizine should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Frusemide
Hypokalaemia induced by diurectic
Labetalol
Adverse Effect: Hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Lacidipine
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Lacidipine should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Levobunolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Lidoflazine
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Lidoflazine should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Lignocaine
Adverse Effect: lidocaine toxicity (cardiac arrhythmia, seizures, coma) Clinical Management: Monitor patients receiving amiodarone and lidocaine, especially the elderly. The lidocaine dose may need to be decreased.
Methotrexate
Adverse Effect: an increased risk of methotrexate toxicity (leukopenia, thrombocytopenia, anemia, nephrotoxicity, mucosal ulcerations) Clinical Management: Patients receiving methotrexate and amiodarone concurrently should be closely monitored for signs of methotrexate toxicity.
Metoprolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Metoprolol Comb.
Adverse Effect: Hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Mexiletine
Adverse Effect: QT interval prolongation and torsades de pointes Clinical Management: Amiodarone should be used cautiously with mexiletine.
Nimodipine
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Nimodipine should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Nitrendipine
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Nitrendipine should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Oxprenolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Phenytoin
Adverse Effect: An increased risk of phenytoin toxicity (ataxia, hyperreflexia, nystagmus, tremor) and/or decreased amiodarone effectiveness Clinical Management: Patients should be observed for evidence of phenytoin toxicity and phenytoin serum levels should be drawn periodically. Assessment of amiodarone effectiveness is also necessary. Because of the long half-life of amiodarone, the full extent of this interaction may not be evident for several weeks; careful monitoring is required.
Pimozide
Adverse Effect: Increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: Pimozide is contraindicated in individuals with congenital QT syndrome, patients with a history of cardiac arrhythmias, or patients taking other drugs which may prolong the QT interval.
Pindolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Procainamide
Adverse Effect: Procainamide toxicity (cardiac arrhythmias) Clinical Management: If these drugs are to be administered concurrently, the dose of procainamide should be decreased by 20% and the patient should be closely monitored for procainamide levels and electrophysiologic evidence of toxicity.
Propranolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Propranolol Comb.
Adverse Effect: Hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients receiving beta blockers particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Quinidine
Adverse Effect: quinidine toxicity (diplopia, giddiness, hypotension) Clinical Management: In patients receiving amiodarone therapy, the initial dose of quinidine should be approximately one-half the usual recommended dose. During conversion from quinidine to amiodarone, the dose levels of quinidine should be reduced by 30% to 50% several days after the addition of amiodarone. If concurrent use is deemed necessary, monitor the patient for conduction disturbances and exacerbation of tachyarrhythmias.
Rifampicin
Adverse Effect: decreased amiodarone plasma concentrations Clinical Management: Concurrent administration of amiodarone and rifampin should be avoided. If concurrent administration is clinically necessary, the patients cardiac status should be carefully monitored.
Sotalol
Adverse Effect: an increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) Clinical Management: The concurrent administration of sotalol and Amiodarone is not recommended. The Amiodarone should be withheld for at least three half-lives prior to dosing with sotalol.
Sparfloxacin
Adverse Effect: Prolongation of the QTc interval and/or torsades de pointes Clinical Management: Sparfloxacin is contraindicated in individuals with known QTc prolongation or in patients being treated concurrently with drugs that are known to increase the QTc interval and/or cause torsades de pointes.
Timolol
Adverse Effect: hypotension, bradycardia, or cardiac arrest Clinical Management: Monitor cardiac function carefully. Amiodarone should be used with caution in patients onTimolol particularly if there is suspicion of underlying dysfunction of the sinus node, such as bradycardia or sick sinus syndrome, or if there is partial AV block.
Verapamil
Adverse Effect: Atrioventricular block and slowing of sinus rate Clinical Management: Concurrent use of amiodarone and Verapamil should be avoided in patients with sick sinus syndrome or partial AV (atrioventricular) block.
Warfarin
Adverse Effect: An increased risk of bleeding Clinical Management: In patients on chronic oral anticoagulant therapy with warfarin, a prophylactic 25% reduction in the warfarin dosage is recommended at the initiation of therapy with amiodarone. The prothrombin time ratio or international normalized ratio (INR) should be closely monitored with the addition and withdrawal of amiodarone, and periodically reassessed during concurrent therapy. Warfarin dosage adjustment is usually required to maintain the desired level of anticoagulation. |
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