Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
How To Manage Side Effects Of Amiodarone While On Diltiazem, Pantoprazole And Lisinopril?
Question: Hi my name is XXXXXXX XXXXXXX 67 yoa retired chiropractor overweight but loosing former body builder I am having problems with AF VA system former military and have been pleased with va care until now I have had approximately 4 episodes of AF and all have converted after a period of time. almost 2 months since the last one. My meds 40 mg lisinopril chlorthalidone 25 mg pantoprazole 40mg 2x daily diltiazem 180mg and now my dr wants to put me on amiodrone 200mg but I am concerned because of the possible side effects everything that I read about it is very negative . blood work is good no diabetes, thyroid or any other problem that I am aware of He puts me in the low risk of stroke etc I am taking 160 enteric aspirin for blood thinning I am on a 1.5 gram dose of magnesium chloride transdermally daily and that seems to be really helping me. My question is it really necessary to take the amiodrone my va cardiologist is convinced that I will go into non retractable AF some time but is not worried about it But I am very active exercise at least an hour a day every day Please advise
Brief Answer:
I would suggest as follows:
Detailed Answer:
Hello XXXX!
Welcome and thank you for asking on HCM!
I understand your concern and would like to explain that you are right about Amiodarone when mentioning potential adverse effects.
Though Amiodarone is not approved by FDA for AF, it is actually the most prescribed anti-arrhythmic drug for AF (up to 45%). In fact it is the most effective anti-arrhythmic drug, but has limitations regarding numerous potential side effects (deriving from the fact it has a long half-life of several weeks, its deposits in adipose tissue and other tissues, as well as its wide pharmacological properties and interactions).
Coming to the point that you are on perfect functional conditions, without any known cardiomyopathies, no clinical signs of heart failure, no impaired left ventricular performance, I would suggest alternative anti-arrhythmic options, which seem to be more safe regarding their side effects profile.
Drugs like Propafenone, or Flecainide, are preferred choices for maintaining sinus rhythm in AF patients without structural heart disease (such as in your case).
They have a more flexible pharmacokinetics profile, no tissue deposits, no risk for QT interval prolongation, no serious potential organs dysfunctions; nevertheless, they may in some individuals exert some extra-cardiac adverse effects, like dizziness, visual disturbances, metallic taste, etc.
I would suggest you to discuss with your cardiologist about the possibility of choosing any of them.
Even Diltiazem may be an acceptable option for controlling your heart rate.
You have to review every possible option with your attending physician, and find the best alternative which fits to you.
Hope to have been helpful!
Feel free to ask me whenever you need!
Greetings!
Dr. Iliri
I would suggest as follows:
Detailed Answer:
Hello XXXX!
Welcome and thank you for asking on HCM!
I understand your concern and would like to explain that you are right about Amiodarone when mentioning potential adverse effects.
Though Amiodarone is not approved by FDA for AF, it is actually the most prescribed anti-arrhythmic drug for AF (up to 45%). In fact it is the most effective anti-arrhythmic drug, but has limitations regarding numerous potential side effects (deriving from the fact it has a long half-life of several weeks, its deposits in adipose tissue and other tissues, as well as its wide pharmacological properties and interactions).
Coming to the point that you are on perfect functional conditions, without any known cardiomyopathies, no clinical signs of heart failure, no impaired left ventricular performance, I would suggest alternative anti-arrhythmic options, which seem to be more safe regarding their side effects profile.
Drugs like Propafenone, or Flecainide, are preferred choices for maintaining sinus rhythm in AF patients without structural heart disease (such as in your case).
They have a more flexible pharmacokinetics profile, no tissue deposits, no risk for QT interval prolongation, no serious potential organs dysfunctions; nevertheless, they may in some individuals exert some extra-cardiac adverse effects, like dizziness, visual disturbances, metallic taste, etc.
I would suggest you to discuss with your cardiologist about the possibility of choosing any of them.
Even Diltiazem may be an acceptable option for controlling your heart rate.
You have to review every possible option with your attending physician, and find the best alternative which fits to you.
Hope to have been helpful!
Feel free to ask me whenever you need!
Greetings!
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
