Can Amiodarone Cause Shakiness?
Yes, amiodarone commonly causes tremor and other neurologic side effects including shakiness, which occurred in 52 of 70 patients (74%) in one clinical series, making it one of the most frequent adverse effects of this medication. 1
Mechanism and Incidence of Neurologic Effects
- Tremor and ataxia are among the most common neurologic side effects of amiodarone, affecting the majority of patients on therapy 1
- Neurologic adverse effects are part of amiodarone's diverse toxicity profile that involves multiple organ systems 2, 3
- The mechanism appears related to amiodarone's effects on the nervous system, though the exact pathophysiology remains uncertain 4
Clinical Presentation
- Shakiness typically manifests as tremor, often accompanied by ataxia (unsteady gait or coordination problems) 1
- Other neurologic symptoms may include peripheral neuropathy and polyneuropathy 5
- These symptoms can occur alongside other common side effects like gastrointestinal disturbances (constipation being most frequent) and corneal microdeposits 1
Dose-Related Considerations
- Many adverse effects, including neurologic symptoms, appear to be dose-dependent and may respond to dosage reduction within days to weeks 4
- In one study, maintenance doses were reduced from 572 mg/day at 45 days to 372 mg/day at 6 months specifically because of frequent side effects 1
- The lowest effective maintenance dose (ideally ≤200 mg/day) should be used to minimize all adverse effects 6
- Lower maintenance doses (200 mg daily or less) are associated with fewer side effects while maintaining efficacy 5
Management Approach
- If shakiness/tremor develops, consider dose reduction as the first-line management strategy 4, 1
- The response to dose reduction can occur relatively quickly (days to weeks), despite amiodarone's long tissue half-life of up to 100 days 5, 4
- Continuous attempts at using the lowest effective dosage should be made throughout therapy 4
- Regular monitoring and clinical assessment are essential, as side effects occur in essentially all patients with close monitoring 4
Clinical Context
- While shakiness is a common and bothersome side effect, it is generally less serious than potentially fatal complications like interstitial pneumonitis or hepatitis 2
- The high incidence of neurologic side effects (74% in one series) makes tremor/shakiness an expected rather than rare occurrence 1
- Most neurologic side effects are well tolerated and manageable with dose adjustment, though they may limit the drug's usefulness in some patients 7