Amiodarone

I had a St. Jude Medical CRT-D (a Neutrino nxt hf) implanted on September 15th.  It is monitored using the My Merlin Pulse app, via bluetooth.  So far, so good.

While undergoing the procedure, I experienced a prolonged episode of ventricular tachycardia which required the use of defibrillation to subdue.  I had 3 such shocks in total.

As a result of the VT episode, I was then prescribed Amiodarone (200 mg) in addition to the relatively low dose (6.25 mg, twice a day) of a beta blocker (carvedilol or Coreg) I take daily, along with numerous other medications.  (I do realize the two drugs work differently.  I should also mention I take 50 mcg of Eltroxin for hypothyroidism.)

When I read the fact sheet that came with the prescription for amiodarone, and all the potential side effects,  I was, alarmed.  I am well aware that all presecribed medications come with a similiar potential of some side effects but this one seemed to outdo itself.  The pharamcist hastened to assure me that I was on very low dose and should not experience any serious side effects but, still, one wonders.

I know others on this site take or have taken this medication.  My questions are to you:

1) What dose did you take?

2) How long were you on it?

3) Did you experience any problems with it?

It is my sincere hope that this medication will not be a life long prescription.  The potential for problems it may generate rather boggles the mind.

Other than that, my recovery has gone well.  The tips and suggestions (for dealing with swelling and pain relief) I received from many of you made a great difference.  As did your insights on what, in general, to expect during this time.  Sharing your experiences with me (and others) certainly eased my anxiety.

Many thanks to all of you.

 


4 Comments

Amiodarone

by Gemita - 2022-09-30 13:52:50

Beni, I am very sorry to hear about your VT episode.  I see you have a CRT device with a defibrillator for your heart condition.  I expect your doctors gave Amiodarone because it is a very effective treatment for an arrhythmia like VT and hopefully will only be used to help prevent an episode of VT while you are healing, so that you will not experience the trauma of a shock should VT reoccur. 

Although Amiodarone is a very effective medication, one of the best according to my doctor, it does come with potentially serious side effects and needs to be monitored closely for you to stay safe and only used for short periods of time if possible.  I was offered this medication because it is so effective at stopping an arrhythmia, where many other meds may fail.  I declined the medication for the reasons that concern you, choosing another anti arrhythmic med instead.  However, in your case with a defibrillator I would speak to your doctors and ask how long you will need to stay on Amiodarone, or whether another medication could be safely/effectively used instead, particularly if medication is needed long term?

I note you have hypothyroidism so your thyroid med doses may need to be reassessed too while on Amiodarone.

My 80 year mother was given Amiodarone for three months at 200 mg per day but she had to have regular blood tests. She tolerated the med very well I recall.  It was certainly extremly effective at stopping her arrhythmia (Atrial Fibrillation).

Ameoderone

by AgentX86 - 2022-09-30 15:20:01

Ameoderone is the nastiest of the nasty antiarrhythmics. You're right, the side effect list reads like a Seven King novel and they ain't kidding.  However, VT isn't very healthy either and will get you long before ameoderone.

I've been on it four times.  Once just for a few days as a chemical cardioversion.  After seven years of AF going into "remission" it hit hard so I was admitted to the hospital and they gave me a megadose of ameoderone to stop it.

Soon after, I had bypass surgery and a maze procedure to attempt to stop the AF permanently.  It did but left me in permanent atypical flutter.  My cardiologist, then EP, tried ameoderone three times along with ablations to try to stop the flutter.  Neither doctor would let me stay on ameoderone more than six months at a time because of the probability of side effects. My cardiologist said he'd keep me on it if I were 15-20 years older because it wouldn't likely be the ameoderone that would kill me (seriously).

Even at only six months at a time, ameoderone damaged my thyroid.  Fortunately, it recovered after a couple of years and it's fine now.

Gemita is right on the money.  It's a very effective drug but also very dangerous. I'd be concerned about your current thyroid problems, along with ameoderone.  Like I said above, VT isn't anything to play around with either.  It comes down to a lesser of evils.  Gemita mentioned other drugs.  All of them in this class are toxic, some more than others.  Unfortunately, if you ranked the most effective to the least in one column and the most dangerous to the least in the next column, the two columns would indistinguishable.

 

Amiodarone

by Rch - 2022-09-30 18:56:04

Amiodarone is a life saving drug especially for ventricular tachyarrhythmias, although also used off-label for A. Fibrillation in an emergency setting. I haven't taken it but I do know friends on it and they seem to be doing fine with periodic monitoring with blood tests, chest Xray and Pulmonary function tests etc.  That said, one of the most feared complications of Amiodarone is the one least talked about, that is the drug interactions. So, be more vigilant, and any time a provider prescribs you a medication in the urgent care settings or dental office etc, be sure to check with the provider or the pharmacist as to the compatibility of the drug with Amiodarone. Also, the drug has a relatively long half life and the drug interactions can last for several days even after a dosage adjustment. 

Amiodarone feedback

by Beni - 2022-10-01 14:51:00

Thanks Gemita, Agent X86 and Rch for your feedback.

Gemita, you are right about monitoring the hypothyroidism with regualr blood tests.  I had my thyroid function test just before surgery. I also had my potassium and magnesium levels checked at the same time.  I understand amiodarone can interfere with those two mineral levels and, as I understand it, both are essential for proper heart function.  My GP follows those issues for me and issues blood work requistions as needed.  I can access the blood lab reports on line and I print them off for comparison purposes.  We also eat rather simply and consume a lot of vegetables (what else can you do when you grow them?) and fruit as well as fish and chicken. 

I will ask how often I need to have these factors monitored.

And you are absolutely right,  Agent X86, when it comes to dealing with VT and choosing an antiarrythmia medications.  The list of possible candidates to replace amiodarone look startlingly simliar in the side effects department.  A list of what one might call "no win" choices.  Six of one thing; half a dozen of the other.  Slim choice.  But I shall pursue the issue further with the EP.

And, Rch, after I read the the information print out I received when I got the amiodarone script filled, I immediately called the pharmacy to ask about a couple of OTC meds I take - an antihistamine and aTylenol product that has a mild muscle relaxant in it for those days I get a little too keen about weeding the garden.  They were both considered safe to take with the amiodarone.  The only other thing I take is a multi vitamin which was okayed by the pharmacist at the issuing hospital.  For our day-to-day refills, we use only our local pharamcy to avoid any confusion.  Amiodarone is the 9th prescription med I take so I am very cautious and always have an up-to-date list of medications on my person.  

I will ask about other issues that need to be monitored.

What I am hoping is the nightly reports the MyMerlinPulse app is transmitting to my EP from my device will be able to provide enough insight as to what is happening (vis a vis my cardiac issues) that he might be able to do as you suggest, Gemita.  Perhaps the VT was a one off thing.  One of the cardiac nurses at the time told me that the VT occurred as the leads were being attached.  She said my heart had a sort of "WTF" (her words, not mine) moment and reacted.  I know the episode caught the EP off guard which suggests that it had not registered in any of the myriad of tests (angios, echoes, ekgs, holters, MUGA, persantine stress tests, etc.) I have had over the years leading right up to the surgery.  I can only hope that is the case although all of you may think it is a hope being held in vain. 

I will be seeing my EP on October 31st.  By that time, he will have had slightly over 5 weeks of data to review.  I have had absolutely no issues thus far.  My shortness of breathe is improving and my legs do not feel quite so leaden.  I sleep well at night, something I did not do before.  (And no, I do not experience any shortness of breathe when laying down.  Never have.)

Again, all of you gave me some things to think and ask about.  And I appreciate each of you for taking the time to do so.  Thank you.

Beni

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