From the Guidelines
Amiodarone is contraindicated in patients with sinus or AV conduction disease (in absence of pacemaker), inflammatory lung disease, hepatic dysfunction, hypothyroidism, hyperthyroidism, peripheral neuropathy, abnormal gait/ataxia, optic neuritis, and in patients taking certain medications that interact with amiodarone.
Contraindications to Amiodarone
- Sinus or AV conduction disease (in absence of pacemaker)
- Inflammatory lung disease
- Hepatic dysfunction
- Hypothyroidism
- Hyperthyroidism
- Peripheral neuropathy
- Abnormal gait/ataxia
- Optic neuritis
- Certain medications that interact with amiodarone, such as warfarin, digoxin, and others listed in the table 1
Important Considerations
- Amiodarone can be useful in controlling heart rate in patients with atrial fibrillation when other measures are unsuccessful or contraindicated 1
- Amiodarone should be used with caution in patients with severe heart failure, and is recommended as the drug of choice in these patients 1
- The dose of amiodarone should be adjusted based on the patient's response and potential side effects, with a typical maintenance dose of 100-200 mg per day 1
- Amiodarone has a number of potential side effects, including bradycardia, QT prolongation, torsades de pointes, gastrointestinal upset, constipation, hypothyroidism, hyperthyroidism, pulmonary fibrosis, hepatic toxicity, corneal deposits, optic neuritis, peripheral neuropathy, photosensitivity, and adult respiratory distress syndrome after cardiac or noncardiac surgery 1
From the FDA Drug Label
CONTRAINDICATIONS Amiodarone HCl injection is contraindicated in patients with known hypersensitivity to any of the components of amiodarone HCl injection, including iodine, or in patients with cardiogenic shock, marked sinus bradycardia, and second- or third-degree AV block unless a functioning pacemaker is available. The contraindications to Amiodarone are:
- Hypersensitivity to any of the components of amiodarone, including iodine
- Cardiogenic shock
- Marked sinus bradycardia
- Second- or third-degree AV block unless a functioning pacemaker is available 2
From the Research
Contraindications to Amiodarone
The following are contraindications to the use of Amiodarone:
- Bradycardia
- Sinoatrial block
- Severe disturbances of conduction
- Second or third degree atrio-ventricular blocks
- Hypotension
- Severe respiratory failure
- Hepatocellular failure
- Hyperthyroidism 3 Note that these contraindications are specifically mentioned for the intravenous injection of amiodarone.
Additional Considerations
While not explicitly listed as contraindications, the following conditions may require cautious use of amiodarone:
- Left ventricular dysfunction: amiodarone does not usually produce clinically significant cardiodepression in these patients 4
- Patients taking certain medications, such as HMG-CoA reductase inhibitors, class I antiarrhythmic agents, and other drugs that contribute to prolong QT interval, digoxin, oral anticoagulants, and general anesthesia, as these may interact with amiodarone 3, 5
Monitoring and Precautions
Regular monitoring and precautions are necessary when using amiodarone, including: