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Amiodarone - Interactions and Warnings

Amiodarone is a structural analogue of thyroid hormone and some of its anti-arrhythmic properties and toxicity may be attributable to interactions with nuclear thyroid hormone receptors.
- Expert Opin Pharmacother 2001 Nov;2(11):1877-90 -- Amiodarone -- waxed and waned and waxed again. -- Doggrell SA.

A patient with mechanical heart valves developed bleeding, after the introduction of amiodarone and azithromycin. Though the anticoagulant effect could be neutralized, the patient succumbed to heart failure. Any new drug prescribed to patients on anticoagulant must be assessed for its potential for interaction and warrants frequent prothrombin time testing.
- J Assoc Physicians India 2000 Jul;48:746-7 -- Bleeding complication during coumarin therapy due to amiodarone and azithromycin. -- Bharat V, Mohanty B.

Antineoplastic therapy can be associated with drug-induced lung toxicity. With the increasing use of amiodarone for cardiac dysrhythmias there is an increasing possibility of its combined use with chemotherapies for various malignancies. We report a patient on long-term amiodarone who developed biopsy-proven drug-induced lung toxicity after receiving high-dose cyclophosphamide, at a time-frame much shorter than would have been predicted with cyclophosphamide alone. The potential for enhanced lung toxicity secondary to combination of amiodarone and cyclophosphamide is discussed.
- Bone Marrow Transplant 2001 May;27(10):1109-11 -- Amiodarone and cyclophosphamide: potential for enhanced lung toxicity. -- Bhagat R, Sporn TA, Long GD, Folz RJ.

Numerous medications interfere with the anticoagulant response of warfarin. The most powerful potentiating drugs are those that interfere with the metabolism of (S)-warfarin. Examples include amiodarone, trimethoprim-sulfamethoxazole, and metronidazole. These drugs should be prescribed with caution in the elderly and mandate frequent INR monitoring during the induction period.
- Clin Geriatr Med 2001 Feb;17(1):1-13 -- Oral anticoagulants. Pharmacologic issues for use in the elderly. -- Hylek EM.

Amiodarone is a potent antidysrhythmic drug that is associated with severe pulmonary toxicity. Toxicity from amiodarone was significantly reduced by alpha-tocopherol (alpha-TOC) and prevented any evidence of toxicity to the amiodarone-treated cells. Although the specific mechanism of action remains unclear, alpha-TOC affords nearly complete protection in vitro from the cellular injury induced by amiodarone.
- J Pharmacol Exp Ther 1990 Sep;254(3):1107-12 -- Amiodarone-induced injury of human pulmonary artery endothelial cells: protection by alpha-tocopherol. -- Kachel DL, Moyer TP, Martin WJ 2nd.

Grape seed proanthocyanidins have been reported to possess a broad spectrum of pharmacological and medicinal properties against oxidative stress including amiodarone-induced pulmonary toxicity. These results demonstrate that Grape seed proanthocyanidins are highly bioavailable and may serve as a potential therapeutic tool in protecting multiple target organs from structurally diverse drug- and chemical-induced toxicity.
- Ann N Y Acad Sci 2002 May;957:260-70 -- Cellular protection with proanthocyanidins derived from grape seeds. -- Bagchi D, Bagchi M, Stohs S, Ray SD, Sen CK, Preuss HG.

last update: November 2008

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