From the Guidelines
Chronic use of amiodarone and hydroxychloroquine together places patients at increased risk for QT interval prolongation and potentially life-threatening arrhythmias, particularly Torsades de Pointes. Both medications independently can cause QT prolongation, and when used concurrently, this risk is significantly amplified through additive effects. Amiodarone, an antiarrhythmic medication, blocks potassium channels in cardiac cells, while hydroxychloroquine, used for autoimmune conditions and malaria, also affects cardiac repolarization 1. Patients on this combination should undergo regular electrocardiogram monitoring to assess QT intervals, with particular vigilance in those with additional risk factors such as electrolyte abnormalities (especially hypokalemia or hypomagnesemia), bradycardia, female gender, advanced age, or heart disease. Some key points to consider when monitoring patients on amiodarone include:
- Close surveillance of heart rate, especially during the first week of treatment 1
- Regular monitoring of lung, liver, and thyroid function 1
- Monitoring for suspected pulmonary toxicity, with chest radiograph and pulmonary function tests as needed 1 Clinicians should consider alternative medications when possible, maintain electrolyte balance, and educate patients to report symptoms like palpitations, dizziness, or syncope immediately. If QTc exceeds 500 ms or increases by more than 60 ms from baseline, medication adjustment or discontinuation may be necessary to prevent potentially fatal arrhythmias. It's also important to note that hydroxychloroquine can cause retinal toxicity with long-term use, and periodic ophthalmologic assessment is recommended during treatment 1. Overall, the combination of amiodarone and hydroxychloroquine requires careful monitoring and management to minimize the risk of adverse effects.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Chronic Amiodarone and Hydroxychloroquine Use Risks
- Chronic use of hydroxychloroquine can result in an acquired lysosomal storage disorder, leading to a drug-induced cardiomyopathy characterized by concentric hypertrophy and conduction abnormalities associated with increased adverse clinical outcomes and mortality 2.
- Amiodarone use is accompanied by risks of non-cardiac toxicity, including pulmonary toxicity, which can be fatal and non-reversible 3, 4.
- The development of lung complications from amiodarone appears to be associated with older age, duration of treatment, and cumulative dosage 4.
- Amiodarone-induced pulmonary toxicity can present in various ways, including lipoid pneumonia, eosinophilic pneumonia, and acute respiratory distress syndrome (ARDS) 4, 5.
- Discontinuation of amiodarone and control of risk factors may be of therapeutic value in managing pulmonary toxicity, with corticosteroids and supportive measures potentially necessary in severe cases 4, 6.
- Patients treated with amiodarone require close supervision by the treating physician, with serial screening for thyroid, liver, and pulmonary toxicity 3.
- Chronic amiodarone and hydroxychloroquine use places patients at risk for cardiomyopathy and pulmonary toxicity, among other adverse effects 2, 3, 4, 6, 5.