Amiodarone Carvedilol

Cardiac drugs Amiodarone, " carvedilol, diltiazem, " dipyridamole, felodipine, nifedipine, propranolol, propafenone, quinidine, verapamil "... 

Nagele El, Bohlmann M, Eck U, Petersen B, Rodiger W. Combination therapy with carvedilol and amiodarone in patients with severe heart failure. Eur. J. Eleart Fail. 2000 2 71-9. 

Fukumoto, K., Kobayashi, T., Komamura, K., Kamakura, S., Kitakaze, M., and Ueno, K. 2005. Stereoselective effect of amiodarone on the pharmacokinetics of racemic carvedilol. Drug Metab. Pharmacokinet. 20 423-427. 

Amiodarone and carvedilol have been used in combination in 109 patients with severe heart failure and left ventricular ejection fractions of 0.25 (16). They were given amiodarone 1000 mg/week plus carvedilol titrated to a target dose of 50 mg/day. A dual-chamber pacemaker was inserted and programmed in back-up mode at a basal rate of 40. Significantly more patients were in sinus rhythm after 1 year, and in 47 patients who were studied for at least 1 year the resting heart rate fell from 90 to 59. Ventricular extra beats were suppressed from 1 to 0.1/day and the number of bouts of tachycardia over 167 per minute was reduced from 1.2 to 0.3 episodes per patient per 3 months. The left ventricular ejection fraction increased from 0.26 to 0.39 and New York Heart Association Classification improved from 3.2 to 1.8. The probability of sudden death was significantly reduced by amiodarone plus carvedilol compared with 154 patients treated with amiodarone alone and even more so compared with 283 patients who received no treatment at all. However, the study was not randomized, and this vitiates the results. The main adverse effect was s)mptomatic bradycardia, which occurred in seven patients two of those developed atrioventricular block and four had sinoatrial block and/or sinus bradycardia one patient developed slow atrial fibrillation. 

In patients with heart failure, amiodarone is often required for the treatment of serious ventricular dysrhythmias. The beneficial effects of carvedilol on left ventricular remodeling, systolic function, and symptomatic status were not altered by amiodarone in 80 patients with heart failure. Adverse effects that necessitated withdrawal of carvedilol were no more frequent in patients taking amiodarone than in those taking carvedilol alone (26 versus 25%) (4). 

Macdonald PS, Keogh AM, Aboyoun C, Lund M, Amor R, McCaffrey D. Impact of concurrent amiodarone treatment on the tolerability and efficacy of carvedilol in patients with chronic heart failure. Heart 1999 82(5) 589-93. 

Caffeine Citalopram Carvedilol Trazodone Amiodarone Miconazole... 

CYP2D6 5 25 S-metoprolol Carvedilol Dextromethorphan Nortriptyline Propanolol Odansetron Chlorpromazine Codeine Flecainide Fluoxetine Haloperidol Amiodarone Fluoxetine Methadone Celecoxib Doxorubicin ... 

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