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[Amiodarone--pro and con].

Abstract

OBJECTIVE: To compare and evaluate the data for and against the use of antiarrhythmic agent amiodarone in known cardiological indications. DATA SOURCES: A MEDLINE search was used to identify the articles dealing with amiodarone, published in the last 15 years. STUDY SELECTION: Articles and studies (uncontrolled retrospective and controlled prospective), as well as case reports speaking decidedly for or against amiodarone were scrutinized. DATA EXTRACTION: Simple search, no particular conditions. CONCLUSIONS: Despite very numerous and serious side effects amiodarone is an extraordinary drug and can be recommended for use, provided that the physician is very well acquainted with all implications of its use. Large number of studies on a significant number of patients has proven the efficacy of amiodarone in supraventricular and ventricular arrhythmias of various origin. The drug is particularly suitable for the treatment of ventricular arrhythmia in patients with serious heart failure and impaired function of the left ventricle. It was successfully used in the treatment of malignant ventricular arrhythmias. In patients after myocardial infarction, intravenously administered amiodarone improved the chances of survival as well as the condition of arrhythmia, preventing spreading of the infarction. It is very convenient against ventricular arrhythmia after the successful resuscitation. Short-lasting intravenous administration of amiodarone does not cause serious side effects.

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BibTeXRIS

V Tadić, Z Mijailović, S Filipović. [Amiodarone--pro and con].. https://pubmed.ncbi.nlm.nih.gov/9921080/

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Eighteen analogues of lidocaine, mexiletine, and procainamide were synthesized, replacing their aminoalkyl chains with the rigid and cumbersome quinolizidine nucleus. The target compounds were tested for antiarrhythmic, inotropic, and chronotropic effects on isolated guinea pig (gp) heart tissues and to assess calcium antagonist activity. Most compounds exhibited from moderate to high antiarrhythmic activity, and compounds 7, 9, and 19 were more active and potent than quinidine and lidocaine, while producing only modest inotropic, chronotropic, and vasorelaxant effects. These compounds were studied on spontaneously beating Langendorff-perfused gp heart. While quinidine and amiodarone produced a dose-dependent prolongation of all the ECG intervals, compounds 7, 9, and 19, even at concentrations 10-20 times higher than EC50 for the antiarrhythmic activity, only moderately prolonged the PR and QT intervals, leaving unchanged the QRS complex. Ether 7 deserves further investigations due to its interesting cardiovascular profile.

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A liquid chromatography-mass spectrometry assay method for simultaneous determination of amiodarone and desethylamiodarone in rat specimens.

A liquid chromatographic-mass spectrometry (LC/MS) assay method was developed for the determination of amiodarone and desethylamiodarone in rat specimens. Analytes were extracted using liquid-liquid extraction in hexane. The LC/MS system consisted of a Waters Micromass ZQtrade mark 4000 spectrometer with an autosampler and pump. A C(18) 3.5 microm (2.1 x 50 mm) column heated to 45 degrees C was used for separation. The mobile phase consisted of methanol and 0.2% aqueous formic acid pumped at 0.2 mL/min as a linear gradient. Components eluted within 12 min. The concentrations of ethopropazine (internal standard), desethylamiodarone and amiodarone were monitored for m/z of 313.10, combination of 546.9 and 617.73, and 645.83, respectively. In plasma (0.1 mL), linearity was achieved between the peak area ratios and concentrations over the range of 2.5-1000 ng/mL for both amiodarone and desethylamiodarone (r(2) > 0.999). The intraday and interday CV were equal or less than 18%, and mean error was <12%. Similarly, in homogenates containing 0.1 g of rat tissue, linearity was observed in standards ranging from 5 to 5000 ng/g. The method was successfully used to measure tissue and plasma concentrations of drug. The validated lower limit of quantitation was 2.5 ng/mL for drug and metabolite, based on 0.1 mL of plasma.

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Prophylactic therapy to prevent atrial arrhythmia after cardiac surgery.

PURPOSE OF REVIEW: Atrial fibrillation after cardiac surgery is associated with adverse outcomes and increased costs. Accordingly, therapy should be provided to prevent postoperative atrial fibrillation. The evaluation of therapies to do so is an area of active investigation with significant recent advances. The purpose of this review is to summarize these recent advances in the context of our previous knowledge base regarding the prevention of postoperative atrial fibrillation. RECENT FINDINGS: Recent evaluations of therapy to prevent postoperative atrial fibrillation have raised the prominence of prophylactic amiodarone, redefined the efficacy of prophylactic standard beta-blockers in contemporary cardiac surgical populations, provided further evidence for the use of prophylactic sotalol, magnesium, and atrial pacing, and identified new approaches, including the use of combination therapy, for the prevention of postoperative atrial fibrillation. SUMMARY: According to newly released ACC/AHA/ESC guidelines, use of standard beta-blockers or amiodarone to prevent postoperative atrial fibrillation have a level of evidence of A. Use of prophylactic sotalol has a level of evidence of B, while the use of prophylactic intravenous magnesium or atrial pacing has a lower level of evidence. The use of novel and combination therapies continues to be an area of active investigation.

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