Clinical considerations for the allied professional: Translating knowledge about amiodarone into education for the patient

Abstract

i c 1. What category of drug is amiodarone? Answer: Amiodarone is an iodine containing benzofuran erivative that initially was developed as an antianginal rug but is used essentially for its antiarrhythmic effects. lassified as a potent class III antiarrhythmic agent, amioarone is unique in that it encompasses properties from all our Vaughan Williams classes. At the cellular level it nhibits the cardiac sodium, calcium, and potassium chanels and possesses antiadrenergic properties. This translates nto its electrophysiologic effects that include lengthening f action potential duration resulting in prolongation of efractory periods of both the atria and ventricles, and reuction in sinus node and atrial automaticity and AV nodal onduction. Amiodarone does not possess negative inotroic effects and, therefore, can be used with greater safety in atients with congestive heart failure. Common trade names for amiodarone include Cordarone nd Pacerone. Guidelines note that individual response to ifferent formulations can vary. 2. For what indications is amiodarone prescribed, nd what evidence supports its use? Answer: Amiodarone has received approval from the ood and Drug Administration (FDA) for use in the adult atient for treatment of life-threatening ventricular arrhythias. Amiodarone also has been widely used for non–FDAabeled indications, including treatment of supraventricular rrhythmias such as atrial fibrillation. In the pediatric poplation, although not FDA approved, it has been used for any years in the management of both ventricular and atrial achyarrhythmias. It has been recommended in the Adanced Cardiac Life Support (ACLS) guidelines for treatent of pulseless ventricular tachyarrhythmias in both adult nd pediatric patients. In patients surviving myocardial infarction, two randomzed, double-blind prospective trials—the Canadian Amioarone Myocardial Infarction Trial (CAMIAT) and the Euopean Myocardial Infarct Amiodarone Trial (EMIAT)— emonstrated the safety of use of amiodarone. In these rials, amiodarone reduced arrhythmic but not overall morality in patients at high risk for sudden cardiac death. In eart failure patients, use of amiodarone was shown to mprove survival in the Grupo de Estudio de la Sobrevisa en