Amiodarone 'surveillance'

Why Surveillance?

Amiodarone is widely used because despite having a lot of potentially serious side effects, it is one of the most effective drugs we have to manage atrial and ventricular heart rhythm disorders such as

  • Atrial fibrillation
  • Atrial Flutter
  • Ventricular Tachycardia

Where patients remain of the medication for longer than a year it is usual to institute annual monitoring. 

Audits indicate poor take up, so Cardiologists and GPs need to work together with their patients to make sure it happens.

There are more that a handful of patients who have had alterations in lung transfer factor, and CT changes reversed (potentially heading for irrerversible fibrotic lung disease) by detection and cessation of the drug in good time.

Annual check up visit (GP or Cardiology clinic)

Enquire about

  1. Weight changes indicating altered metabolism due to Thyroid disturbance
  2. Sleep and balance disturbance - although both are common in the eledrely, they are also uncommon side effects from the drug and if developed since starting the drug, should lead to a review. 

Examine:

  1. Pulse check and if erratic- check ECG since if Amiodarone is being taken to prevent recurrence of Atrial Fibrillation, and the patient slips out into atrial fibrillation, it may not be necessary to take the medication.
  2. BP check
  3. Listen to chest- if fine crepitations = investigate!

Tests

    1. Consider a CXR if any creps heard, soboe or many years of use
    2. Consider annual Lung Function test at local Hospital- including Transfer Factor (KCO)
    3. Blood tests: LFTs and TSH/ T3

Related information

Protocol




Written by

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Edward Leatham is a Consultant Cardiologist in Surrey and a Trustee of Haste and Haste Academy.

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