From the Guidelines
Amiodarone can cause a variety of painful side effects, including gastrointestinal upset, constipation, peripheral neuropathy, and photosensitivity, as well as more severe complications like pulmonary fibrosis, hepatic toxicity, and optic neuritis, as noted in the 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia 1.
Common Painful Side Effects
- Gastrointestinal discomfort, including abdominal pain, nausea, and vomiting
- Neurological pain, such as headaches, peripheral neuropathy with burning or tingling sensations in the extremities, and muscle pain or weakness
- Photosensitivity reactions leading to painful sunburns, skin rashes, or bluish skin discoloration
Less Common but Serious Complications
- Pulmonary fibrosis, which can cause chest pain and difficulty breathing
- Hepatic toxicity, which may present as right upper quadrant pain
- Optic neuritis, leading to eye pain or visual disturbances
- Thyroid dysfunction, potentially causing neck pain or discomfort
Importance of Monitoring
Patients taking amiodarone should be closely monitored for these side effects, as some can be severe and require immediate medical attention or adjustment of the medication, as cautioned in the guidelines 1. It is essential for patients to report any new pain symptoms to their healthcare provider promptly to prevent long-term complications.
From the FDA Drug Label
In patients receiving recommended dosages of amiodarone HCl injection, there have been postmarketing reports of the following injection site reactions: pain, erythema, edema, pigment changes, venous thrombosis, phlebitis, thrombophlebitis, cellulitis, necrosis, and skin sloughing Other treatment-emergent possibly drug-related adverse events reported in less than 2% of patients receiving amiodarone HCl injection in controlled and uncontrolled studies included the following: ... respiratory disorder, ... dyspnea, cough, hemoptysis, wheezing, hypoxia, pulmonary infiltrates and/or mass Pulmonary Disorders Early-onset Pulmonary Toxicity There have been postmarketing reports of acute-onset (days to weeks) pulmonary injury in patients treated with intravenous amiodarone. Findings have included pulmonary infiltrates and/or mass on X-ray, bronchospasm, wheezing, fever, dyspnea, cough, hemoptysis, and hypoxia.
Pains that can be caused by amiodarone include:
- Injection site pain
- Chest pain (associated with pulmonary disorders such as pulmonary infiltrates, bronchospasm, and ARDS)
- Muscle weakness and myopathy which can cause muscle pain
- Rhabdomyolysis which can cause muscle pain 2 2
From the Research
Amiodarone-Induced Pains
- Bilateral leg pain and weakness, as reported in a case study of an 87-year-old woman with amiodarone-induced neuromyopathy 3
- Muscle weakness, as observed in a 69-year-old woman who developed myopathy during amiodarone treatment 4
- Pain and weakness in the lower extremities, associated with a neuromyopathic process affecting the lower extremities 3
Other Side Effects
- Thyroid abnormalities, pulmonary fibrosis, and transaminitis, for which routine monitoring is recommended 5
- Interactions with several medications, such as warfarin, simvastatin, and atorvastatin, and many HIV antiretroviral medications 5