Can amiodarone (Amloyd) cause hypothermia?

Amiodarone and Hypothermia

Amiodarone (Amloyd) does not directly cause hypothermia as a known adverse effect, but it can interact with hypothermic conditions during cardiac arrest management and resuscitation. 1

Known Adverse Effects of Amiodarone

Amiodarone has numerous documented adverse effects, but hypothermia is not among them:

• Pulmonary toxicity: The most serious adverse effect, presenting as subacute cough and progressive dyspnea 1
• Thyroid dysfunction: Both hypothyroidism (more common) and hyperthyroidism can occur 1
• Liver toxicity: Manifested by elevated liver transaminases 1
• Neurologic effects: Including ataxia, paresthesias, tremor, and peripheral neuropathy 1
• Cardiovascular effects: Bradycardia, heart block, QT prolongation 1, 2
• Dermatologic effects: Photosensitivity and bluish skin discoloration 1
• Ocular effects: Corneal microdeposits, optic neuropathy 1
• Gastrointestinal effects: Nausea, anorexia, constipation 1
• Hypotension: Particularly with intravenous administration 3

Amiodarone and Therapeutic Hypothermia

While amiodarone does not cause hypothermia, there are important interactions to consider when using amiodarone in patients undergoing therapeutic hypothermia:

• Therapeutic hypothermia prolongs the QT interval, and amiodarone can further prolong QT, potentially increasing arrhythmia risk 4
• In experimental models, amiodarone combined with hypothermia has shown:
  • Increased dispersion of repolarization during ischemia 5
  • Slowed conduction velocity during ischemia 5
  • Abolished beneficial effects of therapeutic hypothermia on ischemia-induced parameters 5

Clinical Implications

• For cardiac arrest management: When using amiodarone during therapeutic hypothermia, be aware that:

  • Amiodarone may suppress rearrest caused by ventricular fibrillation but not pulseless electrical activity 5
  • The hypothermic heart may have altered response to cardiovascular drugs including amiodarone 1
  • Drug metabolism may be reduced in hypothermia, with theoretical concern for medication accumulation 1

• For monitoring: When using amiodarone in hypothermic patients:

  • Monitor QTc interval closely as both conditions can prolong it 4
  • Be vigilant for hypotension, which can be sustained throughout amiodarone infusion 3
  • Consider that amiodarone may interact with anesthetic agents to produce hypotension and atropine-resistant bradycardia 6

Conclusion

Amiodarone does not cause hypothermia as a direct adverse effect. However, when used in patients with hypothermia (accidental or therapeutic), there are important interactions to consider regarding cardiac electrophysiology, drug metabolism, and hemodynamic effects that require careful monitoring and management.