Low-dose Amiodarone Is Safe: A Systematic Review and Meta-analysis.

Ronpichai Chokesuwattanaskul,Zhigang Liu,Ranjan Thakur,Nupur Shah,Susama Chokesuwattanaskul

doi:10.19102/icrm.2020.110403

Abstract

Amiodarone is commonly used for a variety of arrhythmias and, in some parts of the world, is the only available antiarrhythmic drug (AAD). Yet, amiodarone is known to have a wide range of potential side effects, many of which are dose- and duration-dependent. We sought to study the incidence of side effects leading to the discontinuation of low-dose amiodarone, arbitrarily defined as 200 mg/day or less, and very-low-dose amiodarone, defined as 100 mg/day or less. In this study, literature databases were searched through June 2019. Studies that reported the incidence or prevalence of side effects of amiodarone were included. Effect estimates from individual studies were extracted and combined using the random-effects generic inverse variance method of DerSimonian and Laird. A total of 10 observational cohort studies involving 901 patients were included in the analysis. The pooled estimated incidence of overall side effects for low-dose amiodarone was 0.17 [95% confidence interval (CI): 0.12–0.22]. In addition, the pooled estimated incidence of side effects requiring medication discontinuation was 0.06 (95% CI: 0.03–0.11). As compared with 200 mg/day of amiodarone, the pooled estimated incidence of overall side effects was 0.11 (95% CI: 0.04–0.27), while the incidence of side effects requiring medication discontinuation was 0.02 (95% CI: 0.01–0.06) for the dose of 100 mg/day. In conclusion, very-low-dose amiodarone displays a low incidence of significant side effects requiring medication discontinuation.

Highlights

IntroductionAmiodarone is commonly utilized for treating both supraventricular and ventricular arrhythmias
Amiodarone is commonly utilized for treating both supraventricular and ventricular arrhythmias. While this drug is a very effective antiarrhythmic agent, it leads to many well-known side effects involving a variety of organs such as the thyroid, liver, lungs, and eyes including many that are dose- and duration-dependent.[1]
After the exclusion of 2,283 articles, which included case reports, correspondences, review articles, in vitro studies, animal studies, and interventional studies, 29 articles were left for further full-length review

Summary

Introduction

Amiodarone is commonly utilized for treating both supraventricular and ventricular arrhythmias. While this drug is a very effective antiarrhythmic agent, it leads to many well-known side effects involving a variety of organs such as the thyroid, liver, lungs, and eyes including many that are dose- and duration-dependent.[1]. The use of amiodarone must be balanced between the drug’s potentially serious adverse effects and its antiarrhythmic effects. Some known adverse effects of amiodarone may be related to the dose and duration. In 1997, a meta-analysis of low-dose amiodarone, defined as less than 400 mg/ day, reported a higher rate of drug discontinuation as compared to placebo (22.9% versus 15.4%).[3] With the development of new therapeutic agents, catheter ablation, and implantable cardioverter-defibrillators (ICDs) for the management of arrhythmias, a lower dose of

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Conclusion