Amiodarone

Ameoderone

by AgentX86 - 2023-08-31 19:48:08

Yes, I've been on it several times.  It's extremely effective - the most effective antiarrhythmic.  Unfortunately, it's also the most toxic (that's they way antiarrhythmics go).  My EP would only leave me on it for a few monts at a time because the many, many, side effects are so dangerous.  He would have kept me on it if I was 80 because, well...  As it was, it damaged my thyroid.  Fortunately, I recovered.

I'm not one to question drugs, much more than to look up general information and side-effects. Ameoderone is different.  I recommend that you look it up on several respectable drug side-effect sites (e.g. drugs.com), ask your pharmacist, and read the packaging insert before taking this one. Make sure you understand what you're getting into and to be able to recognize the side-effects.

Amiodarone

by Happygirl8 - 2023-08-31 19:56:52

I do not tolerate meds very well, I'm very sensitive! Is this a drug for short term use? Or is that up to the doctor?  Before I take it, the doctor told me I need to get bloodwork  for a baseline! When I heard that , it made me nervous! Is there a less toxic, more safe drug they can use? 

Amiodaron

by Happygirl8 - 2023-08-31 20:15:03

@AGENT X86

what was your dosage? How long did you take it? 

Amiodarone and other treatments for tachy arrhythmias

by Gemita - 2023-09-01 04:55:50

Happygirl8,  I was offered Amiodarone or an AV Node ablation for Atrial Fibrillation (AF) with a rapid ventricular response rate in 2016.  I chose Flecainide (not recommended for VT since may be pro arrhythmic), Digoxin, Bisoprolol and a pacemaker instead.  I am now only taking Bisoprolol for AF rate control and am having some success with dual chamber pacing therapies as well.  Atrial pacing for me has been such an effective treatment for my AF and bradycardia-induced tachy arrhythmias and I can hardly believe my luck, but of course it isn’t the same for everyone.

Amiodarone is one of the most “effective” anti arrhythmic meds out there which is why they use it when most other anti arrhythmics haven’t helped “control” a tachy arrhythmia.  Blood levels of Amiodarone have to be monitored carefully but it can safely be used for short periods according to my doctors.  It is not only up to your doctor Happygirl how long you remain on it.  You should be guided primarily by its "effectiveness" and any symptoms/side effects you might get.  You alone will know what you can and cannot tolerate.   200 mg x 2 daily I recall was the starting dose recommended for me too, although maintenance dose is lower at around 100 mg x 2 daily.

Looking at your situation, clearly you want to avoid having a ventricular tachycardia (VT) episode, leading to another ICD shock and syncope episode.  I suppose it depends on how frequently you are getting VT symptoms, whether you are getting any warning signs of an imminent attack, whether your ICD settings can be adjusted to give you time to reach a place of safety, or to lie down before you are shocked and fall down?  Whether your shocks are “appropriate or inappropriate”?

Perhaps it is worth exploring all your other options before going down the Amiodarone route.  I would ask your team whether any changes to your current meds would help, or whether lifestyle changes, electrolyte checks and checks for other health conditions need to be assessed again?  Also whether ICD settings adjustments like anti tachycardia pacing therapies or time delays before ICD therapies, could be better utilised, since some, if not many VT episodes will spontaneously terminate without ICD intervention.  It is worth finding out what they have tried? 

You have the ICD to protect you, so you have time to consider all your options and I personally wouldn’t go rushing into anything.  You are in control, remember that, even though it doesn’t always feel like it.  To help with any decision, you might find the attached link of interest, particularly with regard to adjusting ICD settings, adjustment or addition of specific medication or timing of any VT ablation.  Stay calm, stay safe and stay a Happygirl!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528055/#:~:text=Appropriate%20shocks%20can%20be%20minimised,of%20VT%20will%20spontaneously%20terminate.

Amiodarene

by Happygirl8 - 2023-09-01 07:18:56

Thank you Gemita! I'm not rushing into more meds.  I need to get bloodwork first to check electrolyte levels and thyroid tests.  The doctor isn't persistent but doesn't want this to happen again and this is his drug of choice!  I don't think modifying my current meds is an option.  He wants to add another to the mix.  Good point about ICD. I need to find out if they can adjust the settings so I can safely sit down if there is another episode.  I will cautiously weigh all the options before making a decision. I so appreciate your input! 

AMIODARONE

by freightdog - 2023-09-01 14:20:38

Happygirl8 .....Avoid the amiodarone if at all possible.  It is a toxic drug with a very long shelf-life. I had a bad experience with it this summer which, in my opinion, led to my having a PM implanted a few days ago.  I was on a "loading dose" about twice as much as your 200mg 2x day.  If I had known more about the drug prior to taking it I would have refused ...... or possibly, if the doctor had insisted, I would have consented to 100mg 2x day as I was only on it for about 11-12 days.

My EP's nurse said that the doctor has had success with amiodarone but only prescribes it for as short a duration as possible due to its side effects.

dosage

by AgentX86 - 2023-09-01 16:39:34

I took 2 x 200mg.

Another problem with ameoderone that I didn't mention is that its half-life is measured in months.  IIRC, it's fat soluable so stays in the body and is not metabolized as are most drugs.   It takes a while to build up in the system, unless it's pre-loaded (massive dose to start - did that once too), then it takes, perhaps, six to nine months to clear out of the system.

Nasty stuff.  If you do take it, demand blood tests to check for all of the things listed on the side-effects, I'd say, every three months.

Edit: I took it three times, IIRC. Each time I took it for between three and six months.  I took it right after my CABG/maze, tuning Afib into Aflutter. Then twice during the blanking period after two of my ablations. 

My EP didn't say to tell him "if" I had any of the (long list) side-effects, but "when".

Amiodarene

by Happygirl8 - 2023-09-01 19:26:00

Is there any other drug thsts tolerable but not as toxic? I'm already on beta blocker (Coreg) My cardiologist said amiodarene is the "most effective"

Ameoderone

by AgentX86 - 2023-09-01 21:06:29

No, there are no antiarrhythmics that aren't toxic.  Their toxicity can be ranked in about the same as their effectivity.  Typically, patients are stepped up the chain from one to the next until one works.  Some will lose their effectiveness or become proarrhythmic after some time. Antiarrhythmics aren't just any other drugs.

Ameoderone is normally the last choice.  However, since your problem is ventricular, putting a lid on it is of primary importance. Ameoderone may be the best choice but go into it with full knowledge of what you're getting into.

Amiodarene

by Happygirl8 - 2023-09-01 21:28:04

Can you get off amiodarene cold turkey or do you have to wean yourself off of it slowly ? 

Weaning off Ameoderone

by AgentX86 - 2023-09-01 23:30:45

I don't remember being weaned off of it.  It dissipates from the body so slowly (half-life = two months) that I don't think it's needed.

Anti-arrhythmic

by Daedalus - 2023-09-02 01:14:45

FWIW, I've been on Sotalol for 18 months and haven't felt any ill effects.  Blood work ok.  
Maybe I'm a lucky one.  Or maybe it's still early.  Either way, so far, so good. 

Sotalol

by AgentX86 - 2023-09-02 02:35:00

Sotalol is #2 or #3 on the antiarrhythmic list (the other, tikosyn).  That one gave me tacky/Brady, asystoles, and a pacemaker. Of course, the risks were known and the potential upside was worth the risk (life is all about risk/reward).  I couldn't sleep.  I would have done nearly anything at that point. The next step was an AV ablation, which happened about nine months later, anyway.

Also note that sotalol is a beta blocker so it will have HR implications.  The EP needs to be really careful using it with Bradycardia (or tachy/Brady, by extension).  By the time you get here, an EP is critical. A cardiolotgist would in over his head.

Again, know what you're getting into. Antiarrhythmics are a special class of drugs with potential side-effects that need to be respected.

A difficult decision

by Gemita - 2023-09-02 04:08:07

Happygirl, my experience of using anti arrhythmic meds for several years is that they will either work for long periods to give us respite from our symptoms or they may not help at all.  Some anti arrhythmic meds may even become “pro arrhythmic” (causing new arrhythmias) making our total arrhythmia burden worse.  Also many anti arrhythmic meds can quickly lead to dependency, where stopping gradually or quickly will either lead to a return of your original condition (arrhythmia), or even to a worsening of it, requiring yet more in the way of medication and higher dosages to be effective.  This situation can quickly spiral out of control especially if the medication at higher doses causes other symptoms. 

I note you are on Valsartan which has the potential to increase potassium levels, which is why your electrolytes need checking.  Higher levels are more likely to occur if you have kidney problems and your kidneys aren’t clearing the med effectively from your body, or if you have heart failure.  It is good that your ejection fraction has improved, so this should help ease VT episodes.  Remember rate control meds (like your beta blocker Carvedilol or your calcium channel blocker, Amlodipine) will always be a safer option to help control a high atrial or ventricular heart rate than an anti arrhythmic med, at least this is what I am always being told by my doctors and which has been my personal experience.

In the end however, you have the ultimate tool to control/stop your VT episodes which is your ICD.  You now need to find a way to make any shock therapy more tolerable and less frequent, if that is ever possible and I have already given you my thoughts on this.  Perhaps in the meantime, pacing yourself “exercise wise” might help too however well you feel between bouts of VT.

If an arrhythmia can be tamed by other, safer methods, this is always preferable to going down the ever increasing need for more and more in the way of anti arrhythmic meds or invasive treatments.  Only you and your doctor can decide whether your symptoms and the frequency of your VT episodes warrant a firmer hand?   A hard decision to make, I know

antiarrhythmics

by islandgirl - 2023-09-06 23:48:33

I took amiodorone for 1 month after several shocks for vtach runs.  My EP changed me to sotalol, and I have had great success with that.  My dose was 160 mg 2x/day, and was recently reduced to 120 mg in the morning and 160 mg in the evening due to QT wave elongation.  It is borderline now, so my only option will be amiodorone.  I also had a upgrade to a 3rd lead and have had no vtach or shocks since January 2022.  

Amiodarene

by Happygirl8 - 2023-09-07 04:23:28

@island girl 

Do you know what caused your V tach runs? Were there any triggers? Stress, exercise, chocolate ? It seems mine may have been triggered by these!  The EP is not sure why I had the episode.  He's ordering genetic testing now.  The exercise was earlier in the day but left me very tired throughout the day! I'm not sure how much exercise is too much? Since the episode, I have not exercised! I've had no issues! Heart is back to normal rhythm.  This is certainly a puzzle