Amiodarone and its Pulmonal Toxicity
Abstract
Amiodarone is an antiarrhythmic agent commonly used to treat supraventricular and ventricular arrhythmias. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients. This drug is an iodine-containing compound that tends to accumulate in several organs, including the lungs. It has been associated with a variety of adverse events. Of these events, the most serious is amiodarone pulmonary toxicity. Although the incidence of this complication has decreased with the use of lower doses of amiodarone, it can occur with any dose. Because amiodarone is widely used, all clinicians should be vigilant of this possibility. Pulmonary toxicity usually manifests as an acute or subacute pneumonitis, typically with diffuse infiltrates on chest x-ray and high-resolution computed tomography. Other, more localized, forms of pulmonary toxicity may occur, including pleural disease, migratory infiltrates, and single or multiple nodules. With early detection, the prognosis is good. Most patients diagnosed promptly respond well to the withdrawal of amiodarone and the administration of corticosteroids, which are usually given for four to 12 months. It is important that physicians be familiar with amiodarone treatment guidelines and follow published recommendations for the monitoring of pulmonary as well as extrapulmonary adverse effects.Downloads
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References
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Kudenchuk PJ, Pierson DJ, Green HL, Graham EL, Sears GK, Trobaugh GB. Prospective evaluation of amiodaron pulmonary toxicity. Chest 1984;86;541-8.
Martin WJ, Rosenow EC. Amiodaron pulmonary toxicity: Recognition and pathogenesis (Part 1) Chest. 1988;93:1067–75.
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Dusman MD, Stanton MS, Miles WM, Klein LS, Zipes DP, Fineberg NS, et. al . Clinical features of amiodarone induced pulmonary toxicity. Circulation. 1990;82:51-9.
Goldschlager N, Epstein AE, Naccarelli GV, et al. A practical guide for clinicians who treat patients with Amiodaron: 2007. Heart Rhythm. 2007;4:1250–9.
Ott MC, Khoor A, Leventhal JP. Pulmonary toxicity in patients receiving low-dose Amiodaron. Chest. 2006;123:646–51.
Polkey MI, Wilson PO, Rees PJ. Amiodaron pneumonitis: No safe dose. Respir Med. 1995;89:233–5.
Yamada Y, Shiga T, Matsuda N. Incidence and predictors of pulmonary toxicity in Japanese patients receiving low-dose amiodaron. Circ J. 2007;71:1610–6.
Ashrafian H, Davey P. Is Amiodaron an underrecognized cause of acute respiratory failure in the ICU. Chest. 2001;120:275–82.
Saussine M, Colson P, Auauzen M. Post-operative acute respiratory distress syndrome: A complication of Amiodaron associated with 100 percent oxygen ventilation. Chest. 1992;102:980–1.
Malhotra A, Muse VV, Mark EJ. An 82 year old man with dyspnea and pulmonary abnormalities. Case records of the Massachusetts General Hospital. N Engl J Med. 2003;348:1574–85.
Myers JL, Kennedy JI, Plumb VJ. Amiodaron lung: Pathologic findings in clinically toxic patients. Hum Pathol. 1987;18:349–54.
Kuhlman JE, Teigen C, Ren H. Amiodaron pulmonary toxicity: CT findings in symptomatic patients. Radiology. 1990;177:121–5.
Oyama N, Oyama N, Yokoshiki H. Detection of amiodaron-induced pulmonary toxicity in supine and prone positions: High resolution computed tomography study. Circ J. 2005;69:466–70.
Zhu YY, Botvinick E, Dae M. Gallium lung scintigraphy in amiodaron pulmonary toxicity. Chest. 1988;93:1126–31.
Azzam I, Tov N, Elias N. Amiodaron toxicity presenting as a pulmonary mass and peripheral neuropathy: The continuing diagnostic challenge. Postgrad Med J. 2006;82:73–5.
Van Mieghem W, Coolen L, Malysse I. Amiodaron and the development of ARDS after lung surgery. Chest. 1994;105:1642–5.
Handschin AE, Lardinois D, Schneiter D. Acute amiodaron-induced pulmonary toxicity following lung resection. Respiration. 2003;70:310–2.
Okayasu K, Takeda Y, Kojima J. Amiodaron pulmonary toxicity: A patient with three recurrences of pulmonary toxicity and consideration of the probable risk of relapse. Intern Med. 2006;45:1303–7.
Ernawati DF, Stafford L, Hughes FD. Amiodaron – Induced pulmonary toxicity. BR J Clin Pharmacol. 2008;66:82–7.
Zimetbaum P. Amiodaron for atrial fibrillation. N Engl J Med. 2007;356:935–41.
Siddoway L. Amiodaron: Guidelines for use and monitoring. Am Fam Physician. 2003;68:2189–96.
Wolkove N, Baltzan M. Amiodaron pulmonary toxicity. Can Respir J. 2009;16:43-8.
Roy D, Talajic m, Dorian P. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Eng J Med. 2000;342:913-20.
Kudenchuk PJ, Pierson DJ, Green HL, Graham EL, Sears GK, Trobaugh GB. Prospective evaluation of amiodaron pulmonary toxicity. Chest 1984;86;541-8.
Martin WJ, Rosenow EC. Amiodaron pulmonary toxicity: Recognition and pathogenesis (Part 1) Chest. 1988;93:1067–75.
Martin WJ, Rosenow EC. Amiodaron pulmonary toxicity: Recognition and pathogenesis (Part 2) Chest. 1988;93:1242–8.
Dusman MD, Stanton MS, Miles WM, Klein LS, Zipes DP, Fineberg NS, et. al . Clinical features of amiodarone induced pulmonary toxicity. Circulation. 1990;82:51-9.
Goldschlager N, Epstein AE, Naccarelli GV, et al. A practical guide for clinicians who treat patients with Amiodaron: 2007. Heart Rhythm. 2007;4:1250–9.
Ott MC, Khoor A, Leventhal JP. Pulmonary toxicity in patients receiving low-dose Amiodaron. Chest. 2006;123:646–51.
Polkey MI, Wilson PO, Rees PJ. Amiodaron pneumonitis: No safe dose. Respir Med. 1995;89:233–5.
Yamada Y, Shiga T, Matsuda N. Incidence and predictors of pulmonary toxicity in Japanese patients receiving low-dose amiodaron. Circ J. 2007;71:1610–6.
Ashrafian H, Davey P. Is Amiodaron an underrecognized cause of acute respiratory failure in the ICU. Chest. 2001;120:275–82.
Saussine M, Colson P, Auauzen M. Post-operative acute respiratory distress syndrome: A complication of Amiodaron associated with 100 percent oxygen ventilation. Chest. 1992;102:980–1.
Malhotra A, Muse VV, Mark EJ. An 82 year old man with dyspnea and pulmonary abnormalities. Case records of the Massachusetts General Hospital. N Engl J Med. 2003;348:1574–85.
Myers JL, Kennedy JI, Plumb VJ. Amiodaron lung: Pathologic findings in clinically toxic patients. Hum Pathol. 1987;18:349–54.
Kuhlman JE, Teigen C, Ren H. Amiodaron pulmonary toxicity: CT findings in symptomatic patients. Radiology. 1990;177:121–5.
Oyama N, Oyama N, Yokoshiki H. Detection of amiodaron-induced pulmonary toxicity in supine and prone positions: High resolution computed tomography study. Circ J. 2005;69:466–70.
Zhu YY, Botvinick E, Dae M. Gallium lung scintigraphy in amiodaron pulmonary toxicity. Chest. 1988;93:1126–31.
Azzam I, Tov N, Elias N. Amiodaron toxicity presenting as a pulmonary mass and peripheral neuropathy: The continuing diagnostic challenge. Postgrad Med J. 2006;82:73–5.
Van Mieghem W, Coolen L, Malysse I. Amiodaron and the development of ARDS after lung surgery. Chest. 1994;105:1642–5.
Handschin AE, Lardinois D, Schneiter D. Acute amiodaron-induced pulmonary toxicity following lung resection. Respiration. 2003;70:310–2.
Okayasu K, Takeda Y, Kojima J. Amiodaron pulmonary toxicity: A patient with three recurrences of pulmonary toxicity and consideration of the probable risk of relapse. Intern Med. 2006;45:1303–7.
Published
2014-03-04
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How to Cite
Darisan, K., Zaini, J., & Yuniadi, Y. (2014). Amiodarone and its Pulmonal Toxicity. Indonesian Journal of Cardiology, 34(2), 113-25. https://doi.org/10.30701/ijc.v34i2.329
Section
Review Article
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