Liver enzyme levels three times higher than normalĬonsider stopping amiodarone causal relationship is uncertain. Initiate antithyroid drug therapy consider stopping amiodarone.Īdminister thyroid hormone supplementation. Stop amiodarone initiate corticosteroid therapy. 13, 14 Therefore, long-term amiodarone therapy, with its potential for toxicity, does not appear to be justified in patients who are taking anticoagulant drugs if rate-control strategies can provide satisfactory symptomatic improvement.Ĭhest radiograph pulmonary function tests, including Dlco However, recent studies have shown that aggressive attempts to maintain sinus rhythm using amiodarone or other drugs do not improve outcomes in relatively asymptomatic patients. 11, 12 In one randomized controlled trial (RCT), 12 sinus rhythm was maintained successfully for 16 months in 65 percent of patients treated with amiodarone, compared with 37 percent of patients treated with sotalol or propafenone (ARR, 28 percent NNT, 3.6). 10 Several smaller studies have shown that amiodarone is similar to quinidine and sotalol in the treatment of atrial fibrillation in these patients. Various practice guidelines recommend amiodarone as a second-line drug in the long-term treatment of atrial fibrillation in patients with structural heart disease and in highly symptomatic patients without heart disease. The relative efficacy of amiodarone and ICDs in preventing sudden death in patients without coronary disease is under investigation.Īmiodarone is used in the treatment of atrial fibrillation, although the FDA has not approved this indication. 6 – 9 In these patients, amiodarone may be used as an adjunct to reduce the frequency of ICD shocks or to control atrial fibrillation in selected highly symptomatic patients. Because implantable cardioverter-defibrillators (ICDs) are more effective than amiodarone in reducing mortality in high-risk patients with previous myocardial infarction, primary treatment should be an ICD. 5 The benefit of amiodarone therapy was more pronounced in the patients who had congestive heart failure, with treatment reducing the annual mortality rate from 24.3 percent to 19.9 percent (ARR, 4.4 percent NNT, 23). One meta-analysis of 13 studies of patients with congestive heart failure or recent myocardial infarction showed a small reduction in total annual mortality, from 12.3 percent to 10.9 percent (absolute risk reduction, 2.4 percent number needed to treat, 42).

Studies on the use of amiodarone for the primary prevention of sudden death in high-risk patients have had mixed results.

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