Posts Tagged ‘Amiodarone’

It isn’t working

April 11, 2010

Durn it!

Dronedarone, the Atrial Fibrillation drug that has been highlighted here before, isn’t living up to the hype. It was already known that it is not as effective as Amiodarone, but it doesn’t have the side effects that drug has. The hope was that if you developed A-Fib at an early age, or have a milder form of A-Fib, you could be switched from Amiodarone to Dronedarone. Amiodarone is an effective suppressor of A-Fib but the side effects can be terrible.

In fact, the last time I wrote about Amiodarone, I was accused of using “scare tactics” to get my point across. I wouldn’t do that – Heart Defects are  scary things; As any parent/CHDer knows. I’m not going to add to the hysteria. Behind every link on this blog is more information about a subject; click and read for yourself. HERE is the link I used the last time, it’s written by a Cardiologist. Obviously, he knows more about this drug than I do, and he isn’t a fan of Amiodarone, either.

Further testing has shown that Dronedarone is only half as effective in humans and doubles the rate of death! Dronedarone is recommended only as a second or third choice for people who can’t tolerate Amiodarone. Britain’s National Institute for Health and Clinical Excellence (NICE) gave the drug its approval after originally turning it down, based on its limited effectiveness and its price.

So while Dronedarone doesn’t look like it can be the answer everyone was looking for, perhaps it does have a place in the “medical toolbox”. For right now, the first drug of choice is still Amiodarone, and Cardiac Ablation is still an option.

And other researchers will continue to search for better answers.


Flip the Switch

March 15, 2010

Nobody likes Amiodarone, not even the doctors who prescribe it. I recently wrote a post about it and all the side effects it can cause. A newer drug, Dronedarone, is usually recommended for younger patients. The longer you are on Amiodarone, the better the chances that the side effects will show. Dronedarone isn’t as effective as Amiodrone in controlling Atrial Fibrillation, but has less side effects.

New research released today at the ACC10 meeting in Atlanta shows that in two seperate trial studies, patients with controlled Atrial Fibrilation can safely switch from Amiodarone to Dronedarone in as little as two days.  If you have a slow heart rate (Bradyarrhythmia) or a long QT interval, the 48 hour guideline probably isn’t the best therapy for you. Your own cardiologist will be your best source of information.

The Devil’s Drug

February 27, 2010

Woe to the CHDer who develops an arrhythmia. (irregular heart beat) The problem is, it seems we all develop one sooner or later, and the choices we have to combat it are limited. Certainly pacemakers and ICDs are available, but those are expensive. So is an ablation; so often, we start with a drug regimen.

One of the best Antiarrhythmia drugs is Amiodarone, because it can control the irregular beats fairly well and there is less of a chance of a proarrhythmia. A proarrhythmia is a new or more frequently occurring arrhythmia that is triggered by the use of antiarrhythmia drugs. It’s diabolical – using the drugs that can calm down an irregular heartbeat can actually cause more irregular beats!

Oh, boy.

Amiodarone is pretty good about not causing proarrhythmia, but that is probably it’s one positive factor. Dr. Rich is convinced that Satan himself invented it – it’s that nasty!

For the drug to become effective, it has to saturate the body. So at first you are given a “loading dose” – a high dosage of the medication to get the patient to the proper level of the drug in their blood quickly.

Most of the time a drug is eliminated through the bloodstream, taken to the kidneys where it is filtered out, and the eliminated through the body’s natural waste disposal system. Not Amiodarone, no sir. The only way you get rid of it is by getting rid of cells. That’s a naturally occurring process, but it is slow and you can’t speed it up. Sometimes it takes a year for the Amio to completely clear your system.

And while it is in your system, it sets up shop in every organ of your body.

Possible liver damage? Yep!

Possible lung damage? Got you covered!

Thyroid damage? Amio is on top of that, too! In fact, you know that rough spot on the bottom of your left foot… well, you probably can’t blame Amiodarone for that one.

But every year you are on the drug, you’ll be visiting your eye doctor for an examination. Not the usual eye exam, mind you, but he’ll be looking for deposits in your eyes caused by the drug.

And you’ll have a lung function test every year, also. You’ll sit in a small walled in area that looks like a phone booth with a plastic tube in front of you. You’ll be asked blow as hard as possible into the tube, blow, blow, come’on empty your lungs! Then you’ll inhale as much as possible; you’ll hold your breath then blow it out – several different lung exercises. You’ll want to bring a friend with you – there’s no reason that you can’t drive home yourself, but you’ll be exhausted from the exercises. And they’ll repeat this test every year to make sure that your lungs aren’t being damaged by the Amiodarone.

If you haven’t guessed, this stuff isn’t very usuer friendly. There are newer drugs available that do not cause proarrhythmia (Yay!) and do not have the side effects of Amio (Yay again!) but isn’t as effective. (Aw, man!)

So if this drug is recommended to you by your doctor, you probably do need it. But have a long, honest discussion with your physician about the benefits and side effects of Amiodarone.


October 2, 2008

A recent appointment with my Adult Congenital Heart Defect Cardiologist in Atlanta was going wonderfully, right up to the moment I got the ECG. (ECG stands for Electrocardiogram; it used to be popular to refer to it as an EKG, but ECG seems to be the favored term now.) The doc came back into the examining room carrying the ECG sheet, stroking his chin and saying “Hmmm….”

I cringed. Long ago, I learned that “Hmmm…” is doctor-speak for “Ut-oh.” Finally after a few moments, he says, “Looks like you are the proud owner of an Atrial Flutter.”

Proud owner? Yeah, right! Normally, the Atriums (the two top chambers of the heart) contract a few milliseconds before the ventricles do. With a Flutter – you can have an Atrial Flutter if the problem is in the top chambers of the heart, or a Ventricular Flutter if it is confined to the lower chambers – the two cycles become unsynchronized. One is slightly faster than the other, and the two halves of the heart aren’t working in tandem anymore. When it is mild it is a Flutter, and when it is more pronounced, it is a Fibrillation. Flutters can turn into Fibrillation, and a Fibrillation can be deadly.

“Double your dose of Amiodarone and have another ECG in two weeks,” the doctor instructed. “Have them fax the results to me. If it’s good, we’ll set up an appointment in six months.”

And if it is not?

“Be prepared to come down within a week, and perhaps stay a few days.”

There’s no need to worry about an ECG because nothing you do can affect the test. So in two weeks, I get the test done and have the results faxed to the ACHD Doctor. Later that day, the telephone rings: Be in his office on Thursday, I’m scheduled to see the Electrophysiologist.

I have no idea what an Electrophysiologist does, so I look it up. According to the dictionary, he “studies the electrical system of the body, concentrating on the heart.” Ok, but there is no description of exactly how he conducts his studies. I’d like to know if he is going to plug an extension cord into a live power source and then hand me the bare wire ends. “Here, hold this,” he tells me as he watches all of my hair stand on end. Things like that you just need to know.

Thankfully it isn’t that bad. Electro-Doc (my nickname for him, since Electrophysiologist ties my tongue in knots) starts by giving me a 12 lead Electrocardiogram. It works just like a regular ECG does, but there are a few more little wires running to your body. He also listens to my heart for a while longer than the usual exam, and questions me pretty closely about my health. After about half an hour, he excuses himself to consult with my regular Adult Congenital Cardiologist. The Adult Cardiology Clinic normally sees patients on Mondays and Wednesdays, but Electro-Doc is only in area on Thursdays. And on Thursdays, my doc is in an entirely different hospital. Thanks to the cell phone, this fact really isn’t a problem.

The minutes later he is back, and admits that he’s in a bit of a quandary. With an Atrial Flutter I should feel dizzy and lightheaded when the Flutter kicks in. I don’t. And I should be able to feel a Flutter when my heartbeat changes. I can’t. So after putting their heads together, he and my Adult Congenital doc have decided (drum roll, please) not to do anything at this time.

That may sound like a cop-out, but I don’t see it that way. Electro-Doc is going to proceed by how I’m feeling, not what the ECG tells him. The evidence – the ECG, his training, and what he’s hearing through his stethoscope – tell him that I am having an Atrial Flutter. But I’m telling him that I don’t even feel it. so instead of paying attention to the machinery, he’s going to pay attention to me…what a novel idea!

“Since it doesn’t seem to be affecting your heart rate, stop taking the Amiodarone,” he says. “Get an ECG in two weeks, if it looks the same, we’ll just drop that drug altogether.”

With that statement, Electro-Doc has just become my new best friend! Amiodarone is a very effective anti-arrhythmia drug… but it has some nasty side effects. It can cause damage to your eyes, your liver, your lungs, and your thyroid.

Every year that you are on Amiodarone, you must get an eye exam to determine if it has started to damage your eyes. Take a friend with you; they will put those drops in your eyes that cause your pupils to expand. They only expand your pupils for a few hours but during that time you are very sensitive to light and your close-in vision is worthless. Good luck reading a book or a magazine – or a dashboard, for that matter.

You’re also due for a breathing test every year if you are taking Amiodarone. You sit in a small circular box- actually a tube – about the size of a phone booth. (Remember those?) There is a breathing tube mounted in front of you; usually adjusted to be about a half inch higher than your mouth, so you have to sit up nice and tall to place your mouth on it. The technician will tell you to do various breathing exercises. A favorite one is “Take a deep breath and hold it, and when I tell you blow it out as hard as you can. Ready? Deep breath… hold it, hold it… now BLOW! Keep blowing, empty your lungs!” You actually blow out so much air that you involuntarily begin to cough before you can draw a breath. You’ll also see the computer generate many cool-looking graphs and charts while you are doing your breathing exercises, but you won’t have a clue what they mean. Take a friend to this test, also; after an hour and a half of various breathing exercises you are usually exhausted. It’s not unusual to nap in the car while heading home.

Your liver and thyroid are checked by blood tests. That’s nothing new to a ACHD patient, so you just roll up your sleeve a few more times a year.

My two-week ECG reading was the same as it was before Electro-Doc told me to quit taking the Amiodarone, so I no longer take that drug. But that doesn’t mean it’s gone. It can take as much as 100 days (over 3 months!) from the time you stop taking it for it to be completly gone from your system. By my count I’ve got about two more weeks, and then that nasty stuff is gone… hopefully forever!