Extracardiac toxic effects of amiodarone: literature review and own observations
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Abstract
Amiodarone (AM) is currently one of the most widely used antiarrhythmic drugs, successfully used to treat both ventricular and supraventricular arrhythmias. AM is the drug of choice in many difficult clinical situations. Despite its high efficiency and unique antiarrhythmic activity in comparison with other classes of antiarrhythmic drugs, AM has the broadest spectrum of side effects and complications – both cardiac and extracardiac. AM and its metabolites are highly lipophilic, thus accumulating in large quantities in the liver, lungs, skin, adipose tissue, the eye cornea, as well as other organs. AM-induced pulmonary toxicity is one of the most serious AM`s side effects. The development of AM-induced dysfunction of the thyroid gland, liver and other organs, in most cases, does not lead to serious consequences, but in some situations the revealed side effects are the reason for discontinuation of the drug. A number of randomized trials have emphasized that severe side effects are mainly associated with the administration of high doses of AM, and therefore its use is often limited. It is noteworthy that over the half-century history of the use of AM, indications for its administration have significantly narrowed due to its high toxicity. In recent years, there has been a tendency to prescribe low doses of AM with regular monitoring of its effectiveness and the presence of side effects. The information presented in the review can be useful for the correct use of AM in clinical practice. The article also presents our own clinical observations of severe extracardiac side effects of AM. The complications mentioned above are most often associated with excessive intake of AM, and they can be avoided or minimized by the careful adherence to the minimum maintenance dose. According to up-to-date guidelines, before prescribing any antiarrhythmic drug, it is necessary to carefully weigh not only the expected direct effect, but also take into account its possible side effects and complications.
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Більченко О.С., Красовська К.О., Веремеєнко О.В. та ін. Лікарсько-індуковані інтерстиціальні ураження легень // Вісник Харківського національного університету імені В.Н. Каразіна.– 2019.– Т. 31, № 31.– С. 121–129. doi: 10.26565/2075-5457-2018-31-12.
Зінченко Ю.В., Страфун О.В, Кубан Г.В. Небезпечні побічні ефекти аміодарону: «аміодаронова легеня» // Укр. кардіол. журн.– 2014.– № 6.– С. 85–91.
Астахов С.Ю., Ткаченко Н.В., Папанян С.С. Кордароновая кератопатия и болезнь Фабри: Дифференциальная диагностика, лечение // Офтальмологические ведомости.– 2015.– Т. 8, № 2.– С. 71–78. doi: 10.17816/OV2015271-78.
Барламов П.Н., Мокрушина Ю.С., Щекотов В.В. Пневмопатия, индуцированная приемом амиодарона // Клиническая медицина.– 2013.– Т. 91, № 8.– С. 64–66.
Ивашкин В.Т., Жаркова М.С., Маевская М.В., Лапшин А.В. Случай тяжелого лекарственного гепатита, индуцированного длительным приемом кордарона // Рос. мед. вестн.– 2009.– Т. 14, № 2.– С. 78–83.
Олисова О.Ю. Фоточувствительные дерматозы: лечение и профілактика // Лечащий врач.– 2006.– № 5.– С. 59–62.
Свириденко Н.Ю. Функциональная автономия при эндемическом зобе // Проблемы эндокринологии.– 2005.– № 1.– С. 40–42. doi: 10.14341/probl200551140-41.
Свириденко Н.Ю., Платонова Н.М., Молашенко Н.В. и др. Эндокринные аспекты применения амиодарона в клинической практике (Алгоритм наблюдения и лечения функциональных расстройств щитовидной железы) // Рос. кардиол. журн.– 2012.– Т. 94, № 2.– С. 63–71.
Сердюк С.Е., Бакалов С.А., Соболева В.А. и др. Амиодарон-ассоциированная дисфункция щитовидной железы: частота развития, возможности коррекции // Кардиология.– 2004.– Т. 44, № 10.– С. 32–38.
Сивякова О.Н., Шманова Н.Ю., Дулеба А.П. Случай множественных побочных эффектов амиодарона // Consilium Medicum.– 2018.– Т. 20, № 5.– С. 71–74. doi: 10.26442/2075–1753.
Abuzaid A., Saad M., Ayan M. Amiodarone Pulmonary Toxicity after Drug: A Case Report and Review of the Literature // J. Pulmonary Respiratory Medicine.– 2015.– Vol. 6 (3).– P. 1–3. doi: 10.4172/2161-105X.1000343.
Alvaro A., MacLehose R., Lutsey P. et. al. Association of amiodarone use with acute pancreatitis in patients with atrial fibrillation // JAMA Intern. Med.– 2015.– Vol. 175 (3).– P. 449–450. doi: 10.1001/jamainternmed.2014.6927.
Amiodarone.– URL: https://www.drugs.com/amiodarone.html.
Amjad W., Qureshi W., Farooq A. et al. Gastrointestinal Side Effects of Antiarrhythmic Medications: A Review of Current Literature // Cureus.– 2017.– Vol. 9 (9).– P. 1646. doi: 10.7759/cureus.1646.
Bartalena L., Bogazzi F., Chiovato L. et al. 2018 European Thyroid Association (ETA) Guidelines for the Management of Amiodarone-Associated Thyroid Dysfunction // Eur Thyroid J.– 2018.– Vol. 7 (2).– P. 55–66. doi: 10.1159/000486957.
Benassi F., Molardi A., Righi E. et al. ECMO for pulmonary rescue in an adult with amiodarone-induced toxicity // Heart Vessels.– 2015.– Vol. 30 (3).– P. 410–415. doi: 10.1007/s00380-014-0487-6.
Brugada J., Katritsis D., Arbelo E. et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC) // Eur. Heart J.– 2020.– Vol. 41 (5).– P. 655–720. doi: 10.1093/eurheartj/ehz467.
Bucco S., Arazzi M., Giunta F. et. al. Acute hepatotoxicity from intravenous amiodarone in a patient on hemodialysis // G. Ital. Nefrol.– 2016.– Vol. 33 (1).– P. gin/33.1.1.
Chalasani N., Bonkovsky HL., Fontana R. et al. United States Drug Induced Liver Injury Network. Features and outcomes of 899 patients with drug-induced liver injury: The DILIN Prospective Study // Gastroenterology.– 2015.– Vol. 148 (7).– P. 1340–52.e7. doi: 10.1053/j.gastro.2015.03.006.
Chen C., Wu C. Acute Hepatotoxicity of Intravenous Amiodarone: Case Report and Review of the Literature // Am. J. Ther.– 2016.– № 23 (1).– P. e260–263. doi: 10.1097/MJT.0000000000000149.
Czarnywojtek A., Plazinska M., Zgorzalewicz-Stachowiak M. et al. Dysfunction of the thyroid gland during amiodarone therapy: a study of 297 cases // Ther Clin. Risk Manag.– 2016.– Vol. 2016 (12).– P. 505–513. doi :10.2147/TCRM.S96606.
De Marzio D., Navarro V. Amiodarone. Hepatotoxicity of cardiovascular and antidiabetic drugs // J. Hepatology Gastrointestinal Disorders.– 2016.– Vol. 2 (1).– P. 1–3. doi: 10.4172/2475-3181.1000120.
Epstein A., Olshansky B., Naccarelli G. et al. Practical management guide for clinicians who treat patients with amiodarone // Am. J. Med.– 2016.– Vol 129 (5).– P. 468–475. doi: 10.1016/j.amjmed.2015.08.039.
Erven L., Schalij M.J. Amiodarone: an effective antiarrhythmic drug with unusual side effects // Heart.– 2010.– Vol. 96 (19).– P. 1593–1600. doi: 10.1136/hrt.2008.152652.
Fabiani I., Tacconi D., Grotti S. et. al. Amiodarone-induced pulmonary toxicity mimicking acute pulmonary edema // J. Cardiovasc. Med.– 2011.– Vol. 12 (5).– P. 361–365. doi: 10.2459/JCM.0b013e328334a3f4.
Famularo G., Minisola G., Nicotra G.C., De Simone C. Acute pancreatitis caused by amiodarone // Eur. J. Emerg. Med.– 2004.– Vol. 5 (6).– P. 305–306. doi: 10.1016/j.cgh.2006.11.023.
Fonseca P., Dias A., Gonçalves H., Albuquerque A., Gama V. Acute hepatitis after amiodarone infusion // World. J. Clin. Cases.– 2015.– Vol. 3 (10). P. 900–903. doi: 10.12998/wjcc.v3.i10.900.
Gawałko M., Kapłon-Cieślicka A., Hohl M. et al. COVID-19 associated atrial fibrillation: Incidence, putative mechanisms and potential clinical implications // Int. J. Cardiol. Heart Vasc.– 2020.– Vol. 30.– P. 100631. doi: 10.1016/j.ijcha.2020.100631.
Gurcov R., Jerin C., Flatz W. et al. Superior canal dehiscence syndrome: diagnosis with vestibular evoked myogenic potentials and fremitus nystagmus // HNO.– 2018.– Vol. 66 (1).– P. 28. doi: 10.3389/fneur.2018.00119.
Gurkov R., Manzari L., Blodow A. et al. Amiodarone-associated bilateral vestibulopathy // Otorhinolaryngol.– 2018.– Vol. 275 (3).– P. 23–25. doi: 10.3389/fneur.2018.00119.
Hamilton D. Sr., Nandkeolyar S., Lan H. et al. Amiodarone: A Comprehensive Guide for Clinicians // Am. J. Cardiovasc. Drugs.– 2020.– Vol. 20 (6).– P. 549–558. doi: 10.1007/s40256-020-00401-5.
Hashmi A., Keswani N., Kim S., Graham D. Hepatic dysfunction in patients receiving intravenous amiodarone // South Med. J.– 2016.– Vol. 109 (2).– P. 6–83. doi: 10.14423 / SMJ.0000000000000413.
Hindricks G., Potpara T., Dagres N. et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC // Eur. Heart J.– 2021.– Vol. 42 (5).– P. 373–498. doi: 10.1093/eurheartj/ehaa612.
Huang C., Tseng C., Chu C. et al. Adherence to guidelines in monitoring amiodarone-induced thyroid dysfunction // J. Eval. Clin. Practice.– 2017.– Vol. 12 (4).– P. 108–113. doi: 10.1371/journal.pone.0171379.
Lai S., Lin C., Liao K., Lin C. Amiodarone use and risk of acute pancreatitis: A population-based case-control study // Heart Rhythm.– 2015.– Vol. 12 (1).– P. 163–166. doi: 10.1016/j.hrthm.2014.08.037.
Lim Y., Lin C., Lin Y. et al. Antiarrhythmic agents and the risk of malignant neoplasm of liver and intrahepatic bile ducts // PloS One.– 2015.– Vol. 10 (1).– P. 960. doi: 10.1371/journal.pone.0116960.
Mankikian J., Favelle O., Guillon A. et al. Initial characteristics and outcome of hospitalized patients with amiodarone pulmonary toxicity // Respir. Med.– 2014.– Vol. 108 (4).– P. 638–646. doi: 10.1016/j.rmed.2014.01.014.
Merino J., Perez de Isla L. Treatment with amiodarone: how to avoid complications // The e-Journal of Cardiology Practice.– 2011.– Vol. 10 (2).– Available from: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-/Treatment-with-amiodarone-How-to-avoid-complications.
Nacca N., Bhamidipati C., Yuhico L. et. al. Severe amiodarone induced pulmonary toxicity // J. Thorac. Dis.– 2012.– Vol. 4 (6).– P. 667–670. doi: 10.3978/j.issn.2072-1439.2012.06.08.
Papiris S.A., Triantafillidou C., Kolilekas L., Markoulaki D., Manali E. Amiodarone: review of pulmonary effects and toxicity // Drug Saf.– 2010.– Vol. 33 (7).– P. 539–558. doi: 10.2165/11532320-000000000-00000.
Regitz-Zagrosek V., Roos-Hesselink J., Bauersachs J. et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy: The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC) // Eur. Heart J.– 2018.– Vol. 39 (34).– P. 3165–3241. doi: 10.1093/eurheartj/ehy340.
Ruehl R., Guerkov R. Amiodarone-induced gait unsteadiness is revealed to be bilateral vestibulopathy // Eur. J. Neurol.– 2017.– Vol. 24 (2).– P. 7–8. doi: 10.3389/fneur.2017.00444.
Schwaiblmair M., Berghaus T., Haeckel T. et. al. Amiodarone-induced pulmonary toxicity: An under-recognized and severe adverse effect? // J. German. Cardiac. Society.– 2010.– Vol. 99 (11).– P. 693–700. doi: 10.1007/s00392-010-0181-3.
Tisdale J., Chung M., Campbell K. et al. Drug-induced arrhythmias: a scientific statement from the American Heart Association // Circulation.– 2020.– Vol. 142 (15).– P. e214–e233. doi: 10.1161/CIR.0000000000000905.