DOWNRIVER CARDIOLOGY CONSULTANTS
PATIENT EDUCATION INFORMATION: REGARDING: CORDARONE OR PACERONE
(AMIODARONE)
This drug is utilized to treat heart rhythm problems. It was originally approved by the FDA for the treatment of
life-threatening ventricular arrhythmias. These are heart rhythm problems originating in the lower or pumping
chamber of the heart that frequently can be fatal. More recently it has also been utilized in the treatment of
arrhythmias in the atrial chambers or top chambers of the heart. Although it is the best medication for heart
rhythm problems that exists, as far as effectiveness, its multiple and sometimes serious side effects limit its use.
Many of these side effects are dose related, meaning that there are more frequent side effects as higher dosages
are utilized. Generally higher doses are needed in the ventricular arrhythmias (approximately 400 mg/day)
versus the lower doses with atrial arrhythmias (150-200 mg/day). The most common use in atrial arrhythmias
is for atrial fibrillation. Amiodarone has an extremely slow onset and duration of action. Generally it requires
a loading or higher dose to obtain benefits earlier and it can be expected to have continued effects for several
months after stopping the drug.
The most common side effect of Amiodarone is nausea and vomiting which may occur in up to 1/3 of patients.
This symptom is alleviated when the loading dose is reduced. Additionally, splitting the pill and/or taking it
with meals may be helpful. Many of the other side effects of Amiodarone are also dose related, meaning that
they are more frequent at the higher doses required for ventricular arrhythmias than they are at the lower doses
used in treating atrial fibrillation.
The most important complication is inflammation of the lungs, which may lead to pulmonary fibrosis or
scarring in the lungs. If you notice any shortness of breath you should notify your physician. Many patients
taking Amiodarone develop shortness of breath from other reasons and it is important that your physician
differentiates the shortness of breath from these other diseases from the effects of Amiodarone. Lung status
should be followed with chest x-rays and pulmonary function studies (including diffusion capacity).
Elevations of the blood tests associated with liver disease are seen frequently in patients on Amiodarone. If
this level increased three times above normal or doubles in a patient with elevated liver functions to start with,
the medication should be discontinued. Any visual changes that develop while on Amiodarone should receive
immediate attention and an eye examination.
Small eye deposits occur in the majority of patients on
Amiodarone and are usually seen during an eye examination. They might cause some visual halos or blurred
vision. In the absence of any symptoms, these small deposits do not require discontinuation of medication.
Amiodarone affects thyroid function in many patients and may cause either symptoms of an over-active or
under-active thyroid. This should be followed by periodic testing of thyroid function.
If you notice any
increased heart rhythm problems, you should also notify your physician in case this is either an effect from the
Amiodarone or in the event it has caused an over-active thyroid.
Amiodarone may have interactions with other medications. Generally it increases the effect of other
medications. You should make your physician aware of your use of Amiodarone prior to him or her instituting
other medications. In particular, cyclosporin may have a markedly increased effect.
Suggestions for use with other medications are listed below:
DCC, December 2007

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


Coumadin (Warfarin) – reduce Coumadin dose by 1/3 to 1/2
Lanoxin (Digoxin) – reduce Lanoxin dose by 1/2.
Quinidine – reduce Quinidine dose by 1/3 to ½ or discontinue.
Procainamide – reduce Procainamide dose by 1/3 or discontinue
Dilantin – may need to reduce dose.
Amiodarone may have many nonspecific symptoms and side effects which should be reported to your
physician. This includes but is not limited to: rash, muscle weakness, involuntary movements, lack of
coordination, abnormal gait, dizziness, slow heart rate, or sleep disorders.
FOLLOW UP
INITIAL
3
MONTHS
6
MONTHS
DATE
DATE
12
MONTHS
OFFICE VISIT
DATE
DATE
CBC. LYTES, MG, BUN, CREATININE
DATE
DATE
DIGOXIN OR OTHER DRUG LEVELS
DATE
DATE
18
MONTHS
ONLY WITH
SYMPTOMS
DATE
WHICH MAY INCREASE
THYROID PROFILE
DATE
DATE
DATE
DATE
LIVER ENZYMES
CHEST X-RAY
DATE
DATE
PULMONARY FUNCTION
WITH DIFFUSION
DATE
DATE
ELECTROCARDIOGRAM
DATE
OPHTHALMOLOGIC EXAM
DATE
DATE
DATE
Including funduscopic and slit lamp examinations.
DATE
DATE
Treatment of hypothyroidism may not be necessary until TSH exceeds 2 times normal value. However, an
elevated TSH warrants closer follow up of lab and heart rate.
Adapted from Singh, BN: Clin Cardiol 20:608-618, 1997.
EKG:
BASELINE
DATE
ATRIAL FIBRILLATION
3
6
MONTHS
MONTHS
DATE
DATE
12
MONTHS
DATE
VENTRICULAR TACHYCARDIA
3
6
12
BASELINE
MONTHS
MONTHS
MONTHS
DATE
DATE
DATE
DATE
CHEST X-RAY/PULMONARY FUNCTION WITH DIFFUSION CAPACITY
BASELINE
DATE
DCC, December 2007
ATRIAL FIBRILLATION
6 MONTHS
12 MONTHS
DATE
DATE
BASELINE
DATE
VENTRICULAR TACHYCARDIA
3 MONTHS
6MONTHS
9 MONTHS
DATE
DATE
DATE
THYROID FUNCTION/LIVER FUNCTION
LAB
INITIAL DATE
T3
FREE T4
TSH
AST (SGOT)
ALT (SGPT)
BILIRUBIN
ALK PHOS
POTASSIUM/MAGNESIUM
INITIAL
DCC, December 2007
6 MONTHS
12 MONTHS
12 MONTHS
18 MONTHS