AmiodaroneAmiodarone Hydrochloride

About Amiodarone

Amiodarone is a class III antiarrhythmic with effects of all four classes; with long use, one of its main effects is to lengthen the heart’s electrical recovery period. The tablets are labeled for adults with documented, life-threatening recurrent ventricular fibrillation or recurrent, hemodynamically unstable ventricular tachycardia who have not responded to adequate doses of other antiarrhythmics or cannot tolerate them; safety and effectiveness in children have not been established. Before it starts, a chest X-ray, lung function tests, thyroid tests and liver enzymes are done, and low potassium, magnesium or calcium is corrected. Tablets start with loading doses of 800 to 1,600 mg a day, usually for one to three weeks, then 600 to 800 mg a day for a month, then usually 400 mg a day, aiming for the lowest effective dose.

The tablets’ boxed warning reserves them for life-threatening arrhythmias because their use carries substantial toxicity: lung damage and liver injury, each of which can be fatal (the dose is lowered or stopped if liver enzymes rise too far), and worsened arrhythmia, which is why treatment is started where continuous ECG monitoring and resuscitation are available. It can make the thyroid underactive or overactive. Tiny corneal deposits appear in most adults and clear when the dose is lowered or stopped, while optic nerve damage usually impairs vision and has sometimes caused permanent blindness. It can cause sun sensitivity, blue-gray skin with long use, nerve damage in the hands and feet, and a severely slow heartbeat, including when hepatitis C treatment containing sofosbuvir is started. It is not taken in cardiogenic shock; with sick sinus syndrome, second- or third-degree heart block or a slow heart rate causing fainting, unless a pacemaker is working; or with an allergy to amiodarone or iodine. Nausea and vomiting are very common.

Ongoing monitoring includes a check-up and chest X-ray every three to six months, periodic liver and thyroid tests, regular eye exams, and checks of pacing and defibrillation thresholds in anyone with an implanted device. Amiodarone leaves the body very slowly, so side effects and interactions can persist for several weeks after it is stopped. It may harm a developing baby, including the baby’s thyroid and heart rate, and breastfeeding is not recommended. The tablets have an FDA Medication Guide. The injection (generic vials that must be diluted, or ready-to-use Nexterone bags) is infused into a vein by physicians experienced with life-threatening arrhythmias, to start treatment of, and prevent, frequently recurring ventricular fibrillation or unstable ventricular tachycardia unresponsive to other therapy. It is not meant for maintenance; its labels carry no boxed warning, and low blood pressure is its most common side effect.

Taking Amiodarone

How to take it

Once or twice a day as prescribed, the same way each time, always with food or always without; higher daily doses may be split and taken with meals. Keep every appointment for tests, and use sunscreen and protective clothing outdoors.

If you miss a dose

Skip the missed dose and take the next one at the usual time. Do not take two doses at once.

Storage

At room temperature in a tightly closed container, protected from light, out of reach of children. Use a take-back program rather than flushing.

Interactions to know about

It strengthens warfarin, so the warfarin dose is cut by one-third to one-half and clotting tests are checked; digoxin is halved or stopped, and simvastatin is limited to 20 mg and lovastatin to 40 mg a day. Grapefruit juice raises its levels and St. John’s wort lowers them. Other drugs that prolong the QT interval are avoided, other antiarrhythmics are added only when one drug alone has not worked, and beta blockers, diltiazem and verapamil add to slowing of the heart.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Amiodarone differs from pharmacy to pharmacy

The 200 mg tablet has many makers and costs pharmacies little, so its quote is mostly the dispensing fee and markup, which differ between pharmacies. Doses change often in the first months, so early fills can be frequent and of different sizes, each with its own dispensing fee.

Ways to pay less for Amiodarone without insurance

• Ask for generic amiodarone, ask whether it is on the pharmacy’s flat-price generic list, and compare more than one pharmacy.
• If you take 400 mg a day, ask which is quoted lower: one 400 mg tablet, or two 200 mg tablets, which needs the prescription written that way.
• During loading and step-down, ask the prescriber for quantities that match each stage, then for a ninety-day supply once the maintenance dose is settled.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Amiodarone

1. 1.Do any of my medicines, such as warfarin, digoxin or a statin, need a dose change now?
2. 2.Which lung, liver, thyroid or vision symptoms mean I should call right away?
3. 3.Which foods and supplements, such as grapefruit juice or St. John’s wort, should I avoid?
4. 4.How should I protect my skin from the sun?

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