From the Research
Amiodarone should be tapered gradually when discontinuing long-term therapy, typically by reducing the dose by 50% for 2-4 weeks, then decreasing to 100-200 mg daily for another 2-4 weeks before complete discontinuation. For patients on standard maintenance doses (200-400 mg daily), consider reducing to 200 mg daily for 2-4 weeks, then to 100 mg daily for 2-4 weeks before stopping. The specific tapering schedule should be individualized based on the patient's arrhythmia risk, duration of therapy, and clinical response.
Key Considerations
- During tapering, patients should be monitored closely for recurrence of arrhythmias, as the long half-life of amiodarone (40-55 days) means the drug remains in tissues for weeks to months after discontinuation 1.
- This gradual approach is necessary because abrupt discontinuation can lead to breakthrough arrhythmias, especially in patients with underlying structural heart disease or those who have been on amiodarone for extended periods.
- Patients should continue regular follow-up during and after tapering, with ECG monitoring and assessment of thyroid, liver, and pulmonary function, as amiodarone's effects and potential toxicities can persist long after the medication is stopped 2, 1.
Tapering Regimen
- Reduce the dose by 50% for 2-4 weeks
- Decrease to 100-200 mg daily for another 2-4 weeks before complete discontinuation
- Individualize the tapering schedule based on the patient's arrhythmia risk, duration of therapy, and clinical response