Sqad - And Anyone Else With Knowledge - Amiodarone

[sunny-dave]

Hi Sqad

A relative of gness has had problems with atrial fibrillation for some years now - it has been managed with various medications (including beta blockers and calcium channel antagonists), but without much success - what used to be an occasional inconvenience has now become a life-altering series of attacks lasting up to ten or twelve hours.

According to a phone call which gness had today, it seems that a consultation with a cardiologist has moved things up a gear and anti-arrythmia drugs are being considered - with Amiodarone as the first choice. The relative is quite concerned as the cardiologist listed some 'things to watch out for', which included some worrying possibilities.

A scan of the patient info leaflet and a cheeky look at the advice for medical professionals has led us to wonder what regular tests should to be done by the relative's GP (not the brightest lamp in the fitting) to ensure that the benefit is not outweighed by the potential side-effects - which seem to be many and varied and sometimes serious.

Informed advice welcome.

Dave & Gness

[Sqad]

Big question Dave and I am not sure that I am the man for the job, but these are my thoughts.

I assume that he/she has had a Cardiological work up and there has been no underlying cause for the AF and I am sure that has been done.

It would seem that anti-arrythmic drugs haven't been used as I do not consider betablockers or calcium channel blockers to be anti-arrythmic drugs.

Your relative it seems has two choices, an AA drug such as Amiodorine or a pacemaker and from what you have described i would go for the drug.
Yes, all drugs may, for some people have side effects but in this case I would recommend Amiodirone and take my chance.

[sunny-dave]

Thanks sqad - as always your input is valuable.

[jourdain2]

I'm sorry to hear about this, sunny-dave, and I'm afraid that I can't help with any advice about the specific drug you mention. What I can offer is that a couple of years ago Mr.J2 awoke in the early hours with chest pain etc. and several hours later he woke me and I called an ambulance. It was a serious arrhythmic attack. He has a triple heart bypass, but al had been under control - or seemed to be.

This attack, however (which led to time in hospital and stress tests - doing one of these he officially 'died' for a short while) was eventually resolved by a complete overhaul of his medication. This took into account all the new drugs etc. which had been added gradually over the years. Once the new regime was properly established he stabilised and is now living a perfectly normal life, gardening, driving etc.. I don't know if this will help, but I hope it does.

[sunny-dave]

Thanks Jourdain - more useful input to pass on.

[Sqad]

Jourdain........Castle Hill?

[jourdain2]

Scarborough, actually - with input from Castle Hill. :)

[Sqad]

LOL........I was a Consultant at Scarborough Hospital and had a couple of mates at Castle Hill.

[Hopkirk]

My Mother has just been put on amiodarone for similar problems (I won't go into detail).

The consultant said that GPs don't like giving it because of potential side effects, but if he prescribed it they will accept it and monitor it. I have seen the letter he sent to her GP, and it particularly seems they have to monitor her thyroid and liver functions. I believe it can also affect the lungs so she has to watch out for symptoms of that.

She feels better for taking this drug, and had already been on a beta blocker (bisoprolol).

[sunny-dave]

Thanks Hoppy - that is very helpful ineed

[Hopkirk]

They 'top load' it by getting the patient to take 3 a day for a week, then 2 a day for a week, then stick on one a day.

In my mother's case they are preparing her for a second attempt at a procedure called a cardioversion.

[Peter Pedant]

Long list of side effects
https://www.nps.org.au/australian-prescriber/articles/amiodarone-in-the-aged

it is up to the patient

[sunny-dave]

I understand that a cardioversion isn't suitable for this case - the surgical option is an ablation which no-one wants to risk unless drug options are exhausted.

I don't know the dosage regime, but 'front loading' (?) was apparently mentioned.

[sunny-dave]

Useful article in understandable language - thanks PP - will pass the link on.

[Hopkirk]

You are right, front loading.

[Hopkirk]

I think Sqad and the cardiologist are right. There may be side effects, which can be monitored. However you have to compare those with the effect of not taking the drug.