Amiodarone and Tremors
Yes, amiodarone can cause tremors, which are a recognized neurologic side effect of the medication that often improves when the dosage is reduced. 1
Neurological Side Effects of Amiodarone
Amiodarone is associated with several neurologic toxicities, including:
- Tremors - one of the most common neurologic side effects
- Ataxia (impaired coordination)
- Paresthesias (abnormal sensations)
- Peripheral neuropathy (occurs at a rate of 0.3% annually) 1
These neurologic side effects are often dose-related and can be significant enough to require medication adjustment or discontinuation. In fact, neurologic toxicity has been reported in up to 54% of patients taking amiodarone and was the most common reason for altering or discontinuing therapy in one study 2.
Clinical Presentation and Onset
Tremors from amiodarone can present as:
- Bilateral tremors affecting various muscle groups
- Myoclonic jerks
- Balance impairment 3
The onset of neurologic symptoms can occur:
- Within days to months of starting amiodarone
- Sometimes as quickly as 4-10 days after initiating therapy 4, 5
Management of Amiodarone-Induced Tremors
When tremors develop:
- Dose reduction - First-line approach as tremors are often dose-related 1
- Discontinuation - If symptoms are severe or persist despite dose reduction
- Monitoring for resolution - Neurologic side effects typically improve or resolve within 2 days to 4 weeks after decreasing or discontinuing amiodarone 2
Risk Factors and Monitoring
Patients should be monitored for neurologic symptoms during:
- Initial loading phase (when drug concentrations are highest)
- Regular follow-up visits (every 6 months) 1, 6
Special attention should be paid to:
- Elderly patients who may be more susceptible to neurologic side effects
- Patients on higher maintenance doses
- Patients with pre-existing neurologic conditions 4
Other Important Considerations
When prescribing amiodarone, remember that it has numerous other potential adverse effects requiring monitoring:
- Pulmonary toxicity (most serious)
- Thyroid abnormalities
- Liver dysfunction
- Cardiovascular effects (bradycardia, heart block)
- Ophthalmic effects 1, 6
Clinical Pearls
- Tremors may be mistaken for other neurologic conditions, leading to unnecessary diagnostic workups 2
- Symptoms typically improve with dose reduction but may require discontinuation in severe cases
- The risk of neurologic side effects should be weighed against the benefits of amiodarone in controlling potentially life-threatening arrhythmias
- Baseline and periodic neurologic assessments should be part of routine care for patients on amiodarone
When tremors or other neurologic symptoms develop in a patient taking amiodarone, consider the medication as a potential cause before pursuing extensive neurologic workup.