What Replacement Medication Can Be Given When Amiodarone Causes Drowsiness, Weakness And Hand Tremors?

Posted on Tue, 8 Feb 2022

Question: My mother is 94. Recently we went to her neurologist because her hands shake when she grabs items . He didn't think
It was Parkinson's. She told him she was , in the last 3 months ,switched from taking Multaq and Plavix TO taking 200 mg Amiodarone and blood thinner Eliquis. The neurologist thought the current shaking of hands ( tremors) and the drooling from mouth and the sleepiness and loss of energy might be due to the new 200 mg of Amiodarone she is taking for atrial fibrillation .
We see her cardiologist 6 days from now. What other type of drug can we ask about that would replace Amiodarone??? --- so that she might not be so sleepy and lack of energy AND not shake so much BUT still fight off the atrial fibrillation???

Answered by Dr. Sagar Makode (1 hour later)

Brief Answer:
Metoprolol, if heart rate rises

Detailed Answer:
Hello,

Amiodarone should be withhold for some time as neurologist is suspecting the toxicity and the response should be seen to withdrawal. If there is response then it should be restarted in lower dose of 100 mg after symptoms resolve. Also, get her thyroid test done, chest x-ray and pulmonary function test as well for other possible toxicities.

The best alternative at the moment is to get her started on Metoprolol if her heart rate is on higher side or rises. Although it's not a complete alternative, will be very helpful. Later, you may get her started on flecainide or another antiarrhythmic from Cardiologist, which are given in the hospital under cardiologist supervision for the first time.

So, please discuss with the local doctor regarding Metoprolol or even diltiazem for rate control.

Hope this helps you and get back if you have any doubts.
Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Sagar Makode (1 hour later)

If I could give history. For a long time she took multaq and plavix. Also metoprolol 50 along with the multaq and plavix. Then about 2 1/2 months ago, she began to have more frequent afib and even had a TIA at that time. We went to ER and a CT of head was ok.. that's when they changed to amiodarone 200 and Eliquis 5mg. He also took away all metoprolol. That's when the tremors and sleepiness and lethargy began. We go see cardiologist Thursday. It's strange but she is actually having afib ( 115 is the top rate) now. I just gave her the other half of the Amiodarone ... I hope I am doing the right thing .no symptoms other than the rate high

Answered by Dr. Sagar Makode (3 hours later)

Brief Answer:
Okay, should be restarted to restarted to Metoprolol or diltiazem

Detailed Answer:
Okay..
Amiodarone is basically given to keep sinus rhythm, it will not prevent tia, for tia eliquis is given. Now, considering the fact, she is still in AFib, Amiodarone is not doing much job. So there is no additional benefit of Amiodarone other than what is provided by Metoprolol or diltiazem. Also, if toxicity is suspected then better to avoid it and reintroduce rate control medicines like Metoprolol or diltiazem and eliquis to continue.
Regards

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Above answer was peer-reviewed by : Dr. Raju A.T