Amiodarone

NICE BNF Amiodarone

Monitoring

Rationale: 
  • Both hypothyroidism and hyperthyroidism can occur (common to very common) 
  • Hypothyroidism: Can be treated with levothyroxine - does NOT require amiodarone withdrawal
  • Hyperthyroidism: Decision to stop amiodarone is more complex, on per-patient basis. 

Timing 
  • Before treatment 
  • During treatment: 6-monthly 
  • After treatment: for several months (especially in elderly)

Rationale
  • Hepatotoxic medication 
  • If severe LFT abnormalities OR clinical signs of liver disease develop ⇒ Stop amiodarone 

Timing 
  • Before treatment 
  • During treatment: 6-monthly

Rationale: 
  • Pulmonary toxicity: especially pulmonary fibrosis (common to very common) 
  • Pulmonary toxicity is usually reversible if amiodarone is stopped promptly

Timing:
  • Before treatment (baseline)
NB - If pulmonary toxicity suspected during treatment a repeat CXR or CT scan should be conducted 

Rationale 
  • Normal potassium levels maximises the therapeutic benefit of amiodarone, and decreases its pro-arrhythmic risk    

Timing 
  • Before treatment: Serum potassium 

  • Ensure ECG monitoring and available resuscitation facilities 
  • Close LFT monitoring 

Summary Table

Test Timing
TFTs
  • Before
  • During: 6-monthly
  • After: several months (esp in elderly)
LFTs 
  • Before 
  • During: 6-monthly 
CXR 
  • Before 
  • During: Consider repeat CXR (or CT) if pulmonary toxicity suspected 
Electrolytes (K+)
  • Before treatment