Amiodarone Boxed Warnings; Can You Name Them All?

Amiodarone is a medication that you need to pay attention to. It has numerous clinical quirks that can cause serious harm if one is not aware of them. Here’s a list of the amiodarone boxed warnings as well as some other clinical practice pearls.

Amiodarone Boxed Warning #1: Pro-Arrhythmic

Amiodarone is classified as an antiarrhythmic medication but can also exacerbate cardiac problems. Because of the pro-arrhythmic nature of amiodarone, there is a boxed warning to avoid its use in non-life-threatening situations.

Amiodarone Boxed Warning #2: Pulmonary Toxicity

One of the unique adverse effects of amiodarone is pulmonary toxicity. As a consultant pharmacist, this is definitely something I monitor for. When you see a patient who has notable breathing issues and is requiring medications like beta-agonists, inhaled anticholinergic, and/or inhaled corticosteroids, this is a good time to remind the team of the potential that amiodarone can contribute to respiratory problems and this needs to be ruled out.

Amiodarone Boxed Warning #3: Hepatoxicity

Liver failure is a potential problem with amiodarone use. Because of this, liver function should be monitored. While there are exceptions to every rule, recall that when LFTs are 3x the upper limit of normal, this is generally considered clinically significant.

Other Clinical Quirks

In addition to the amiodarone boxed warnings, there are numerous other clinical concerns when monitoring amiodarone that aren’t in the boxed warning category. Alterations in thyroid function, rare occurrences of eye issues, and neuropathy are all unique aspects of amiodarone.

In addition to a robust adverse effect profile, amiodarone is notorious for drug interactions. Digoxin and quinolone antibiotics are two interactions that I have seen and written about in the past. I go into much greater detail on drug interactions in my most recent book The Clinician’s Guide to Common Drug Interactions in Primary Care. If you’ve never tried an Audible book before, you can get your first one for free by following this link. It is also available in Paperback and Kindle forms.

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Written By Eric Christianson

May 24, 2020

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