Amiodarone toxicity

AMIODARONE SSRIs-SERTRALINE Sertraline may t amiodarone levels Sertraline may inhibit CYP3A4-mediated metabolism of amiodarone Watch for amiodarone toxicity for those taking high doses of amiodarone, consider using an alternative SSRI with a lower affinity for CYP3A4... 

AMIODARONE ANTIEPILEPTICS-PHENYTOIN Phenytoin levels may be t by amiodarone conversely, amiodarone levels may be 1 by phenytoin Uncertain amiodarone inhibits CYP2C9, which plays a role in phenytoin metabolism while phenytoin is a known hepatic enzyme inducer. Also, amiodarone inhibits intestinal P-gp, which may T the bioavailability of phenytoin 1 phenytoin dose by 25-30% and monitor levels watch for amiodarone toxicity. Note that phenytoin and amiodarone share similar features of toxicity, such as arrhythmias and ataxia... 

PROTEASE INHIBITORS AMIODARONE Amiodarone levels may be t by protease inhibitors Uncertain but postulated to be due to l metabolism of amiodarone Watch closely for amiodarone toxicity for patients taking high doses of amiodarone, consider 1 dose when starting protease inhibitor anti-HIV therapy... 

A 73-year-old man with acute respiratory failure, presumed to be secondary to amiodarone toxicity, developed sepsis and acute renal insufficiency, and required intermittent hemodialysis. Following a Herpes simplex labialis infection he was treated with oral aciclovir (400 mg tds). The next day he became sleepy, disoriented, and agitated. Over the next 48 hours his neurological condition deteriorated and he responded to pain... 

Cardiogenic shock has been reported in 73-year-old woman with a dilated cardiomyopathy who had digitalis and amiodarone toxicity (44). 

There have been reviews of the lung complications of amiodarone toxicity (61,62) and of its mechanisms (63). 

Dunn M, Glassroth J. Pulmonary complications of amiodarone toxicity. Prog Cardiovasc Dis 1989 31(6) 447-53. 

Chang CC, Petrelli M, Tomashefski JF Jr, McCullough AJ. Severe intrahepatic cholestasis caused by amiodarone toxicity after withdrawal of the drug a case report and review of the literature. Arch Pathol Lab Med 1999 123(3) 251-6. 

Kannan R. Sarma JS, Guha M, et al. (1991) Amiodarone toxicity. IL Desethylamiodarone-induced phos-pholipidosis and ultrastructural changes during repeated administration in rats. Fundam Appl Toxicol 16 103-109... 

Serum aprindine levels can be increased by amiodarone. Toxicity may occur unless the dosage is reduced. 

Early-onset amiodarone toxicity due to diffuse alveolar hemorrhage, with respiratory distress, hemoptysis, severe hj oxia, and bilateral pulmonary infiltrates has been described in a 46-year-old man taking amiodarone [32" ]. 

Pleural effusion is an uncommon manifestation of amiodarone toxicity, which is usually associated with amiodarone-induced interstitial pneumonitis. 

Masi S, De Clety SC, Anslot C, Detaille T. Acute amiodarone toxicity due to an administration error could excipient be responsible Br J CUn Pharmacol 2009 67 (6) 691-3. 

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