Stopping Amiodarone

Hello everyone. On the advice of a friend, (thanks Ron!), I am searching for ANYONE that find or has found themselves in the position I am currently in.

I am a sudden cardiac death survivor of over two years. Went into a V Tach storm on 3/11/11. Prior to this I had an ICD implanted in 2005. The combination of my ICD, AMIODARONE and magnesium brought me out of it.

Now, fast forward a little over two years and I find myself in another horrible predicament.

I had blood work done this past Friday due to tremors. They started about 6 weeks ago. Finally biting the bullet I had blood drawn to test my thyroid and liver.

Tuesday I found out that I must stop the Amiodarone immediately because it has damaged my thyroid. Was told that my level was extremely low meaning my thyroid wasn't producing and working as it should.

Now i have been off my amiodarone for almost 3 days now. This drug has a long half-life and my body will not be rid of it for weeks maybe months (remember I have been on it over 2 years).

Has anyone had to stop amiodarone abruptly? If so, what happened? Anyone suffer sudden cardiac death or ventricular arrhythmias that were uncontrollable even with an ICD?

There has to be someone else that has experienced this too.

Thank you,
Nicole33

7 Comments

Correction

by Nicole33 - 2013-07-25 10:07:07

Meant afib 1024LAKE.

Yooper

by 1024LAKE - 2013-07-25 10:07:31

Was on it for 5 years when the tremors and skin coloring side effects took place. Quit cold and the afib came back . Had a couple ablations and finally a pacemaker and an AV node ablation 2 years ago. Still going at 86.

How long

by Nicole33 - 2013-07-25 10:07:59

How long did it take for the agin to come back 1024LAKE?

Amiodarone

by golden_snitch - 2013-07-26 03:07:19

Hi!

I got off of it abruptly, and had no issues except for my atrial arrhythmias coming back. A friend of mine, who has VT, stopped it, too. She had had several VT ablations and took Amioarone for more than 8 years. She got off of it, weeks or even months later suffered another short non-sustained VT episode, and then agreed to have a her CRT-P device upgraded to a CRT-D. The ICD is now taking care of her VT episodes.

Have they ever tried to ablate your VTs? My former EP published a quite interesting article on the role of catheter ablations in ICD patients:
http://circep.ahajournals.org/content/2/6/713.full

Best
Inga

Interesting half life

by donr - 2013-07-26 04:07:00

Nicole - I was intrigued by your comment on how long it would take for your body to be rid of the stuff, so I looked up the half life of it - avg 58 days, ranging from 25-100 days, depending on the individual's metabolism. That's quite a half life!

Has your Cardio mentioned any way to test you for Amiodarone in your blood serum? A general rule for anything w/ a half life is that it takes 5 complete half lives for it to be reduced to an insignificant level - which is arbitrarily defined as 1/32 of it's starting level. Right now, after 2 yrs, your body fat is saturated w/ the drug, so that is going to supply it to your blood serum for quite a while.

I have no idea how much of a feel you have for the concept of a half life of a drug, so I'm going to give you a short tutorial to help you understand what will be happening while your body essentially de-toxifies it.

The day you took your first pill, you had zero Amiodarone in either your blood serum or your body fat, so they gave you a loading dose to fill up all the fat molecule's demand for it in long term storage. The loading dose included enough med to make some available for the heart to use in addition to that filling the fat sponge. (A typical loading dose is given as 10 gms over a week to two weeks. Call it ten days for simple math. That means 1 gm per day, or about 5 times your total daily maintenance daily dose. That means every day, your body fat acts like a big sponge & sucks up about 80% of what you take - that leaves the normal maintenance qty available for your heart.) Then they set you up w/ your daily dose - probably two pills per day. This tells ME THREE things: 1) the half life of the med in your blood serum is APPROXIMATELY 6-8 hrs. Why? because they try to dose you when your body has de-toxed about 2 half lives of the drug - the concentration corresponding to that level is about the minimum therapeutic level. Since you take the stuff twice a day, two half lives is about 12 hrs. 2) The body fat must have a pretty tenacious grip on what it stores for it to take so long for your body to finish off what it has stored. Realize that when you stop taking it, there is no longer any additional med being taken in to keep the saturated body fat from exuding its stored med into the blood serum. 3) Your blood serum level MUST drop dramatically since the half life of that in the blood serum is considerably shorter than the advertised 58 days for the drug overall & the qty in your body fat is fixed at the beginning of the period at about 10 gms (the total loading dose given to start) - approximately 100 times the usual dose of 100mg.

The bottom line of all this drug-induced meandering is that even though it takes a long time to get rid of all of it, you will not be as greatly under its influence during that time because that which has not been de-toxed is securely bound up in fat cells stretching from the tip of your big toe to the top of your head.

Hope I helped you feel better, rather than confusing you.

Don

Up the creek...

by Nicole33 - 2013-07-26 09:07:58

Without a paddle. From the two comments made I should prepare for the VTach to return. That is horrible.

Thank you for sharing.

Nicole

Nicole

by golden_snitch - 2013-07-26 11:07:32

You've got a defib implanted - they don't implant those devices, if they don't expect a VT/VF to return. With drugs or without, you have that device because you're always at risk that the VT comes back. So, I don't understand your point. Also, if you should suffer a VT storm again that the ICD can't control, you can still get I.V. Amiodarone at a clinic as an emergency treatment. I don't think that the effect Amiodaron pills have had on your thyroid rules that emergency I.V. use out completely. And then there's also Sotalol that's approved for the treatment of VTs. Amiodarone is not the only drug available.

The friend I was talking about has congestive heart failure, her heart muscle isn't healthy. She also has permanent complete heart block in addition to the VTs. Plus, the last VTs she has had were non-sustained, and she didn't even pass out. Her ICD has not shocked her, yet. Remember, she doesn't take Amiodarone any longer, only betablockers, but she has not been shocked at all.

Inga

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