There are no official guidelines to assist in answering this question. I will search for relevant research papers instead.
From the FDA Drug Label
Patients with hypokalemia or hypomagnesemia should have the condition corrected whenever possible before being treated with amiodarone HCl injection, as these disorders can exaggerate the degree of QTc prolongation and increase the potential for TdP Special attention should be given to electrolyte and acid-base balance in patients experiencing severe or prolonged diarrhea or in patients receiving concomitant diuretics.
Amiodarone does not cause hypokalemia. However, patients with hypokalemia should have the condition corrected before being treated with amiodarone, as hypokalemia can increase the risk of QTc prolongation and TdP. 1 1
From the Research
Amiodarone and Hypokalemia
- Amiodarone is an antiarrhythmic medication that can have various effects on the body, including interactions with potassium levels 2, 3, 4.
- There is evidence to suggest that hypokalemia, or low potassium levels, can affect the efficacy and safety of amiodarone therapy 2, 4.
- A case report described a patient who developed long QT interval and polymorphous ventricular tachycardia while taking amiodarone and having hypokalemia secondary to chronic diuretic therapy 2.
- Another case report described a patient with amiodarone-induced thyrotoxicosis presenting as hypokalemic periodic paralysis, highlighting the potential for amiodarone to contribute to hypokalemia 3.
- An animal study found that diet-induced hypokalemia inhibited the antiarrhythmic efficacy of amiodarone and disopyramide, and altered their electrophysiological actions 4.
Effects of Hypokalemia on Amiodarone
- Hypokalemia may reverse the antiarrhythmic effects of amiodarone, as suggested by a case report where hyperkalemia was associated with the recurrence of ventricular tachycardia despite amiodarone therapy 5.
- The combination of amiodarone and hypokalemia may be dangerous, as hypokalemia can increase the risk of arrhythmias and amiodarone can exacerbate this risk 2.
- However, it is not clear whether amiodarone directly causes hypokalemia, as the evidence suggests that hypokalemia can be a contributing factor to the development of arrhythmias in patients taking amiodarone 2, 6, 4.