AMIODARONE HYDROCHLORIDE Drug Interactions
Also known as: Amiodarone Hydrochloride
AMIODARONE HYDROCHLORIDE (brand name: Amiodarone Hydrochloride) is a Antiarrhythmics. 1 INDICATIONS AND USAGE Amiodarone Hydrochloride Injection, USP is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) in patients refractory to other therapy. Amiodarone Hydrochloride…AMIODARONE HYDROCHLORIDE has 3 documented drug interactions in our database, including 0 contraindicated, 3 major, 0 moderate, and 0 minor interactions.
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Contraindicated
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Major
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Moderate
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Minor
Concomitant use of atorvastatin and amiodarone can increase the risk of myopathy and rhabdomyolysis due to elevated atorvastatin plasma concentrations. Patients may experience muscle pain, tenderness, or weakness, which can progress to severe muscle breakdown.
Mechanism
Amiodarone is a moderate inhibitor of CYP3A4, the primary enzyme responsible for atorvastatin metabolism. Inhibition of CYP3A4 by amiodarone leads to decreased clearance and increased systemic exposure of atorvastatin.
Clinical Management
If co-administration is necessary, limit atorvastatin dose to 20 mg daily and monitor patients closely for signs and symptoms of myopathy. Consider alternative statins with different metabolic pathways or alternative lipid-lowering therapies if muscle symptoms develop.
Amiodarone significantly increases the anticoagulant effect of warfarin, leading to an elevated risk of bleeding. This interaction can cause serious or life-threatening hemorrhage if not carefully managed.
Mechanism
Amiodarone inhibits the cytochrome P450 enzymes CYP2C9 and CYP3A4, which are primarily responsible for the metabolism of warfarin. This inhibition leads to increased warfarin concentrations and enhanced anticoagulant activity.
Clinical Management
If co-administration is necessary, reduce the warfarin dose by 30-50% when initiating amiodarone. Closely monitor INR frequently (e.g., daily or every few days) for several weeks after starting or stopping amiodarone, and adjust warfarin dose as needed. Educate patients on bleeding signs and symptoms.
Amiodarone significantly increases digoxin serum concentrations, potentially leading to digoxin toxicity. Patients may experience symptoms such as nausea, vomiting, visual disturbances, and life-threatening arrhythmias. This interaction can occur even with previously stable digoxin doses.
Mechanism
Amiodarone inhibits P-glycoprotein (P-gp), a transporter responsible for digoxin efflux from enterocytes and renal tubular cells. This inhibition reduces digoxin's intestinal secretion and renal clearance, leading to increased systemic exposure and prolonged half-life.
Clinical Management
When initiating amiodarone in a patient on digoxin, the digoxin dose should be reduced by 30-50% (or even discontinued temporarily). Close monitoring of serum digoxin levels, renal function, and electrolytes is essential. Patients should be educated on symptoms of digoxin toxicity.
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