MedWorm: Amiodarone

  ACC Feature: Multaq may be feasible in AF patients soon after stopping Cordarone

ATLANTA--Patients with atrial fibrillation (AF) or atrial flutter (AFL) who transition to dronedarone (Multaq, Sanofi-Aventis) following prior treatment with amiodarone (Cordarone, Wyeth) were not associated with adverse events, according to a post-hoc analysis of pooled data from the EURIDIS and ADONIS trials presented Monday at the ACC.10 conference. (Source: Cardiovascular Business News)

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  Safely Switch From Amiodarone to Dronedarone in Two Days, Suggests Analysis

Most patients, at least, who are in sinus rhythm after cardioversion from atrial fibrillation and for whom a transition from the old drug to the new one is planned can switch in two days. The post hoc analysis points to two signals that waiting longer might be safer, according to researchers. Heartwire (Source: Medscape Today Headlines)

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  Safely switch from amiodarone to dronedarone in two days, suggests analysis

Most patients, at least, who are in sinus rhythm after cardioversion from atrial fibrillation and for whom a transition from the old drug to the new one is planned can switch in two days. The post... For complete story visit theheart.org. (Source: theHeart.org)

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  Dronedarone: A Safety Comparison to Amiodarone.

This article reviews the chemistry, antiarrhythmic effects, pharmacokinetics, efficacy, adverse effects and drug interactions of dronedarone. PMID: 20210734 [PubMed - as supplied by publisher] (Source: Current Drug Safety)

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  Dronedarone Is Superior to Placebo: The Case for Optimism

I read with interest the study by Piccini et al. () that evaluated dronedarone for treating atrial fibrillation (AF). I agree with the primary conclusion that amiodarone is more effective than dronedarone for maintenance of sinus rhythm, as would be expected on the basis of the DIONYSOS (Efficacy and Safety of Dronedarone versus Amiodarone for the Maintenance of Sinus Rhythm in Patients with Atrial Fibrillation) trial (). However, I have concern about the dronedarone data that might have mistakenly led to an overly negative appraisal of its effect. (Source: Journal of the American College of Cardiology)

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  Reply

We appreciate the opinions of Dr. Lewalter regarding our methodology (), particularly the use of intention-to-treat populations. The meta-analysis was constructed with conservative assumptions to reduce the risk of type I error. From this perspective, when estimating potential differences among treatments, biases that make the treatments seem more similar (including crossovers or failure to receive treatment) are conservative assumptions. Intention-to-treat provides the best pragmatic estimate of a given therapeutic strategy (in this case, therapy with dronedarone vs. amiodarone) (). Often disagreement arises over the exact definition of intention-to-treat in an individual trial. In our meta-analysis we attempted to include patients in the denominator according to treatment allocation at t...

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  Comparative Efficacy of Dronedarone and Amiodarone for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation

In ATHENA (A Trial With Dronedarone to Prevent Hospitalization or Death in Patients With Atrial Fibrillation), dronedarone was shown to reduce morbidity and cardiovascular mortality in patients with atrial fibrillation (AF) who had additional risk factors for death (). Available antiarrhythmic drugs are limited by a lack of effect on reducing morbidity and their potential for serious proarrhythmia or extracardiac toxic effects. However, no morbidity and mortality end point trial is available for a direct comparison. (Source: Journal of the American College of Cardiology)

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  Cardioversion of atrial fibrillation: the use of antiarrhythmic drugs

Atrial fibrillation (AF) is the commonest atrial arrhythmia and represents a large burden on modern health services. Large multicentre randomised trials have demonstrated that a rhythm control strategy (using antiarrhythmic drugs and direct current (DC) cardioversion) has no morbidity or mortality advantage over rate control. Therefore, for most patients, attempts to cardiovert AF to sinus rhythm (SR) should be reserved for those patients who are symptomatic despite adequate rate control. For recent-onset AF (<24 h) the use of agents like flecainide can be highly successful to pharmacologically cardiovert AF, although caution should be exercised in patients who have the potential for structural or coronary artery disease because of the risk of proarrhythmia. If there any is doubt a...

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  Amiodarone: Long QT syndrome in an elderly patient, treated with isoprenaline: case report

(Source: Reactions)

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  Amiodarone: Skin pigmentation and basal cell cancers in a elderly patient: case report

(Source: Reactions)

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  Mechanism of the Synergistic Effect of Amiodarone and Fluconazole in Candida albicans.

Authors: Gamarra S, Rocha EM, Zhang YQ, Park S, Rao R, Perlin DS The antiarrhythmic drug amiodarone has been found to have fungicidal activity. In S. cerevisiae, its antifungal activity is mediated by calcium overload stress, which leads to a rapid nuclear accumulation of the calcineurin-regulated transcription factor CRZ1. In addition, low doses of amiodarone have been reported to be synergistic with fluconazole in fluconazole-resistant C. albicans. To establish its mechanism of toxicity in C. albicans, we used expression profiling of key pathway genes to examine cellular responses to amiodarone alone and in combination with fluconazole. Gene expression profiling of 59 genes was done in five C. albicans strains (3 fluconazole-susceptible and 2 fluconazole-resistant strains) after amio...

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  Amiodarone-induced liver cirrhosis and parkinsonism: a case report.

Conclusions: This is the first case in which the accumulation of amiodarone in the brain was morphologically observed. Amiodarone accumulation in the brain may play a role in neurotoxicity inducing parkinsonism. PMID: 20175957 [PubMed - in process] (Source: Clinical Neuropathology)

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  FDA Reports: Clinical Trial Data Suggest the Combination of Invirase (Saquinavir) and Norvir (Ritonavir) May Affect the Electrical Activity of the Heart

“The U.S. Food and Drug Administration (FDA) is reviewing clinical trial data about a potentially serious effect on the heart from the use of Invirase (saquinavir) in combination with Norvir (ritonavir). The data suggest that together the two drugs may affect the electrical activity of the heart. “The changes to the electrical activity of the heart possibly associated with these drugs, known as prolonged QT or PR intervals, can be seen on an electrocardiogram (EKG). A prolonged QT interval can increase the risk for abnormal heart rhythms, including a serious abnormal rhythm called torsades de pointes. … “FDA's analysis of these data is ongoing. However, healthcare professionals should be aware of this potential risk for changes to the electrical activity of the heart. Invirase an...

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  Fatal caffeine overdose

2.5 out of 5 stars A case of fatal caffeine poisoning. Rudolph T et al Acta Anaesthesiol Scand 2010 Jan 21. (Epub ahead of print). This case report, from Sweden, describes a 21-year-old woman who overdosed on 10,000 mg of caffeine (the equivalent of approximately 83 cups of brewed coffee.)  She suffered multiple occurrences of v. fib arrest which initially responded to countershock, epinephrine, and amiodarone.  On arrival at hospital she was found to have a profound metabolic acidosis (pH 6.47, lactate 33 mmol/l) and a serum potassium of 2.3 mmol/l.  Despite supportive care, potassium repletion, and hemodialysis, she suffered permanent anoxic brain damage and died on the 11th hospital day. This potentially interesting case reported is weakened by the lack of any serum caffeine level, a...

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  FDA safety review of saquinavir and ritonavir interaction

Source: FDA Area: News The U.S. Food and Drug Administration (FDA) has notified healthcare professionals and patients that it is reviewing clinical trial data about prolonged QT or PR intervals from the use of saquinavir (InviraseT) in combination with ritonavir (Norvir T), given together to treat HIV infection.   Preliminary data show that when saquinavir boosted with ritonavir (1000mg/100mg) was given to healthy patients, ages 18 to 55 years, there was a dose-dependent prolongation of the QT and PR intervals.   The magnitude of the effect and clinical implications of QT and PR interval prolongation are still being reviewed by the FDA. However, the FDA recommend that saquinavir and ritonavir should not be used in patients already taking medications known to cause QT int...

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  Atrial-selective sodium channel block as a novel strategy for the management of atrial fibrillation

Safe and effective pharmacologic management of atrial fibrillation (AF) is one of the greatest challenges facing an aging society. Currently available pharmacologic strategies for rhythm control of AF are associated with ventricular arrhythmias and in some cases multi-organ toxicity. Consequently, drug development has focused on atrial-selective agents such as IKur blockers. Recent studies suggest that IKur block alone may be ineffective for suppression of AF and may promote AF in healthy hearts. Recent experimental studies have demonstrated other important electrophysiologic differences between atrial and ventricular cells, particularly with respect to sodium channel function, and have identified sodium channel blockers that exploit these electrophysiologic distinctions. Atrial-selective ...

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  Amiodarone/flunarizine: Progressive supranuclear palsy-like syndrome in an elderly patient: case report

(Source: Reactions)

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  Amiodarone: Fatal fulminant hepatic failure: case report

(Source: Reactions)

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  Amiodarone/iodine-131/thyrotropin : Hyperthyroidism and atrial fibrillation in elderly patients: 2 case reports

(Source: Reactions)

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  Amiodarone - A Broad Spectrum Antiarrhythmic Drug

(Source: Cardiovascular & Haematological Disorders - Drug Targets(Formerly Current D rug Targets - Cardiovascular & Hematological Disorders))

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  Amiodarone: Hyperthyroidism: case report

(Source: Reactions)

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  Psychosis and depression associated with alteration to amiodarone therapy

Presented is a case study of a seventy five year old man who experienced psychosis and depression related to the onset and termination of amiodarone therapy. The study looks at the pharmacology of amiodarone and the mechanisms that may have led to the emergence of these symptoms. It also raises the issue of making a careful assessment of a patient’s life event history in that life events that may not be classically regarded as significant life events may be important in the precipitation of mental illness. (Source: Journal of Psychopharmacology)

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  Dronedarone for atrial fibrillation

Source: No information given Area: Evidence > Drug Specific Reviews Dronedarone is a multi-channel blocking, anti-arrhythmic benzofuran derivative. Dronedarone is licensed for clinically stable adult patients with a history of, or current non-permanent atrial fibrillation (AF) to prevent recurrence of AF or to lower ventricular rate.   There are 7 efficacy trials, 6 have been fully published and two combined into one publication.  The 6 month active comparator trial with amiodarone (DIONYSOS) is yet to be fully published. Dronedarone is less effective than amiodarone, as shown by the results of the DIONYSOS trial and probably more effective than other anti-arrhythmic drugs but direct head to head comparisons are not available.   Dronedarone is associated with fewer ...

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  Scapular facture following cardiopulmonary resuscitation

An apparently healthy 40-year-old man with no past history of cardiovascular pathology or skeletal injuries was presented to the emergency room with an acute onset of anterior wall myocardial infarction. Around 45min earlier, he had called an ambulance service and complained of severe chest pain, sweating and vomiting. The patient collapsed immediately after the arrival of the medical staff to his home. An electrocardiographic monitor demonstrated ventricular fibrillation (VF), and cardiopulmonary resuscitation (CPR) was started immediately. During CPR, the patient was intubated, and received intravenous heparin, lidocaine and amiodarone. VF was recorded 15 times and converted to sinus rhythm each time a direct current shock was delivered, with no need for chest compressions. During the 3r...

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  Amiodarone raises pulmonary toxicity risk in real world

(Source: Reactions)

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  Amiodarone-Induced Loculated Pleural Effusion: Case Report and Review of the Literature

We describe a 70-year-old woman who came to the emergency department with bilateral pleuritic chest pain and malaise 4 weeks after her amiodarone dose was increased from 200 mg/day to 600 mg/day. She had bilateral exudative pleural effusions without associated pneumonitis. She was diagnosed with amiodarone-induced pleural effusions after a thorough workup during her hospitalization excluded other causes for the effusions. Due to intractable arrhythmias, the patient's amiodarone was not discontinued, and she was discharged home. Four days later at a follow-up visit at the pulmonary clinic, the patient complained of worsening chest pain as well as dyspnea and cough. A computed tomography scan showed left-sided pleural effusion with multiple loculations. She underwent a pulmonary vein isolati...

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  Peri-Operative Amiodarone for Post-Operative Atrial Fibrillation Prophylaxis in Valve Surgery Patients

Conclusions: Peri-operative Amiodarone utilization in valve patients does not reduce the incidence of post-operative AF despite existing evidence for such benefit in CABG patients. (Source: Journal of Surgical Research)

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  Combined amiodarone and low-dose carvedilol treatment for severe heart failure in childhood

(Source: Pediatrics International)

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  AMIODARONE HYDROCHLORIDEinjection [Teva Parenteral Medicines, Inc]

Updated Date: Jan 21, 2010 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  A case of fatal caffeine poisoning

Caffeine is a natural alkaloid methylxanthine that is found in various plants such as coffee or tea. Symptoms of a severe overdose may present with hypokalemia, hyponatremia, ventricular arrhythmias, hypertension followed by hypotension, respiratory failure, seizures, rhabdomyolysis, ventricular fibrillation and finally circulatory collapse. A 21-year-old woman called for the ambulance herself soon after the ingestion of about 10,000 mg of caffeine. At the arrival of the ambulance, the patient went into cardiac arrest almost immediately. After a total resuscitation period of 34 min including seven counter-shocks and 2 mg epinephrine, the patient was stable enough to be transferred to the hospital. The patient soon went into VF again and received two more counter-shocks and 1 mg epinephrine...

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  The amiodarone derivative KB130015 activates hERG1 potassium channels via a novel mechanism.

Authors: Gessner G, Macianskiene R, Starkus JG, Schönherr R, Heinemann SH Human ether à go-go related gene (hERG1) potassium channels underlie the repolarizing I(Kr) current in the heart. Since they are targets of various drugs with cardiac side effects we tested whether the amiodarone derivative 2-methyl-3-(3,5-diiodo-4-carboxymethoxybenzyl)benzofuran (KB130015) blocks hERG1 channels like its parent compound. Using patch-clamp and two-electrode voltage-clamp techniques we found that KB130015 blocks native and recombinant hERG1 channels at high voltages, but it activates them at low voltages. The activating effect has an apparent EC(50) value of 12microM and is brought about by an about 4-fold acceleration of activation kinetics and a shift in voltage-dependent activation by ...

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  QTc prolongation during therapeutic hypothermia: are we giving it the attention it deserves?

Conclusion Our series illustrates QTc prolongation during TH. This carries potential for refibrillation. Guidelines on ECG monitoring during TH are needed, especially since hypothermic myocardium is intrinsically prone to arrhythmias and commonly used antiarrythmic drugs such as amiodarone can prolong the QTc. (Source: Europace)

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  Optimization of Repolarization during Biventricular Pacing: A New Target in Patients with Biventricular Devices?

Conclusions: Patients with biventricular devices may be prone to development of ventricular arrhythmias depending on programmed V-V interval. We suggest that optimization of repolarization may be performed in patients with biventricular pacemakers in the absence of backup ICD and those with frequent episodes of ventricular tachyarrhythmias, although this finding deserves further study. Ann Noninvasive Electrocardiol 2010;15(1):36[ndash]42 (Source: Annals of Noninvasive Electrocardiology)

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  Amiodarone: Pulmonary toxicity: 6 case reports

(Source: Reactions)

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  Amiodarone: Non-alcoholic steatohepatitis leading to cirrhosis in an elderly patient: case report

(Source: Reactions)

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  DIONYSOS study comparing dronedarone with amiodarone

(Source: BMJ Online First)

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  Osborn waves and incessant ventricular fibrillation during therapeutic hypothermia

A 33-year-old man suddenly collapsed and presented with ventricular fibrillation (VF) when the emergency team arrived. Conversion to sinus rhythm and return of spontanous circulation was achieved with a single shock from a defibrillator. The patient was admitted to hospital comatose, mechanically ventilated but haemodynamically stable. Therapeutic hypothermia was initiated using the Arctic Sun (www.medivance.com) external cooling system. Initial ECG and echocardiography were quite normal. Coronary artery disease was excluded by angiography. Clinical and laboratory examination revealed no pathology. While the patient was hypothermic (33°C/91.4°F) progressive ECG changes appeared. The heart rate decreased to 35/min and the QRS complexes became wide with the appearance of a prominent J wave...

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  Thin Is In: AFib and Anticoagulants

This article was first published in the Fall 2009 edition of DukeMed Magazine. (Source: DukeHealth.org: Duke Health Features)

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  Potential drug–drug interactions in prescriptions dispensed in community pharmacies in Greece

Conclusions Our results indicate that patients in Greece are at risk of ADRs caused by medications due to potential DDIs. An appropriate surveillance system for monitoring such interactions should be implemented and physicians should be more aware of potentially harmful DDIs. Pharmacists can contribute to the detection and prevention of drug-related injuries, especially of clinically meaningful DDIs that pose a potential risk to patient safety. Content Type Journal ArticleCategory Research ArticleDOI 10.1007/s11096-010-9365-1Authors Anna Chatsisvili, Aristotle University of Thessaloniki Department of Pharmacy Thessaloniki 54124 GreeceIoakeim Sapounidis, Aristotle University of Thessaloniki Department of Pharmacy Thessaloniki 54124 GreeceGeorgia Pavlidou, Aristotle University of The...

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  An Evaluation of the Early Pharmacodynamic Response After Simultaneous Initiation of Warfarin and Amiodarone.

The objective of this study was to assess whether simultaneous initiation of warfarin and amiodarone results in early alteration of the international normalized ratio (INR) response to warfarin. Patients initiated on warfarin and amiodarone during the same hospitalization were included in the amiodarone (AMIO) group. Patients initiated on warfarin alone (n = 42) were identified for the CONTROL group. The AMIO and CONTROL groups were matched based on age, gender, and ejection fraction <40% using propensity score matching (final n = 18 patients per group). Total and average daily warfarin dose was lower in the AMIO group, yet INR values were similar on each day between the 2 groups. More patients in the AMIO group had an INR greater than 2 during the 5-day observation period as compared t...

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  AMIODARONE HYDROCHLORIDEinjection, Solution [Bioniche Pharma USA LLC]

Updated Date: Jan 14, 2010 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Do medicines with the same or similar brand names contain identical active ingredients in different countries?

Source: Wessex Drug and Medicines Information Centre Area: Evidence > Medicines Q & A The US (United States) Food and Drug Administration (FDA) has warned healthcare professionals and the public about the risks of having US prescriptions dispensed in another country.  This is because foreign drugs may have identical or very similar brand names as US products but contain different active ingredients.  This could result in serious adverse effects from taking the wrong active ingredient, without any health benefits.   For example Amyben® is a UK brand name for amiodarone, which is used to treat abnormal heart rhythms.  Supplying Amyben® instead of Ambien,® a US brand name for zolpidem, a sleeping tablet, could have a serious adverse outcome.    The FD...

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  AMIODARONE HYDROCHLORIDEtablet [TEVA Pharmaceuticals USA Inc]

Updated Date: Jan 13, 2010 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Amiodarone: Cutaneous leukocytoclastic vasculitis in an elderly patient: case report

(Source: Reactions)

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  Bilateral lung transplantation with closure of ventricular septal defect in a patient with Eisenmenger syndrome

We report the first case with Eisenmenger syndrome secondary to an isolated perimembranous ventricular septal defect (VSD) in a patient who underwent bilateral lung transplantation and closure of the VSD in Japan. This male patient was diagnosed as having a VSD associated with severe pulmonary hypertension at the age of 7, and right unilateral pulmonary artery banding was performed at age 9. At 38 years of age, we performed bilateral cadaveric lung transplantation with patch closure of the VSD. Explant pathology revealed grade 3 for the right lung and grade 4 for the left lung by the Heath-Edwards classification. The ventricular contractility had gradually improved, and ventricular arrhythmia requiring amiodarone prior to lung transplantation had disappeared. When cardiac function is...

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  Altered cytosolic Ca(2+) dynamics in cultured guinea pig cardiomyocytes as an in vitro model to identify potential cardiotoxicants.

Authors: Qian JY, Guo L Altered intracellular calcium (Ca(2+)(i)) handling by cardiomyocytes has been implicated in drug-induced cardiomyopathy and arrhythmogenesis. To explore whether such alterations predict cardiotoxicity, Ca(2+)(i) imaging was conducted in cultured, spontaneously contracting guinea pig cardiomyocytes to characterize the effects of 13 cardiotoxicants and 2 safe drugs. All cardiotoxicants perturbed Ca(2+)(i) at therapeutically relevant concentrations. The cytotoxic chemotherapeutics doxorubicin and epirubicin, known to cause cardiomyopathy, preferentially reduced Ca(2+)(i) transient amplitude and sarcoplasmic reticulum (SR) Ca(2+) content, whereas Torsade de Pointes (TdP) inducers and potent hERG channel blockers (amiodarone, cisapride, dofetilide, E-4031 and terfena...

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  Drug alert: amiodarone hydrochloride

The MHRA, via the Central Alerting System, has issued a drug... (Source: PCCAS: Full newsfeed)

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  Drug alert: amiodarone hydrochloride

The MHRA, via the Central Alerting System, has issued a drug... (Source: Public Health Newsfeed)

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  Pradaxa 75mg and 110mg capsules (dabigatran) - Revised SPC

Source: Manufacturer notification Area: Other Library Updates > SPC Changes SPCs have been updated to include new recommendations for patients on concomitant verapamil or clarithromycin, based on drug-drug interactsion studies in healthy adults.  Plasma concentrations of dabigatran might be elevated when co-administered with strong P-glycoprotein inhibitors eg verapamil, amiodarone. Dosing should be reduced to 150mg daily in patients receiving concomitant verapamil.  If patients are also renally impaired, a reduction to 75mg should be considered. For patients on concomitant dabigatran and clarithromycin the SPC recommends close monitoring for signs of bleeding, without dose reduction.  (Source: NeLM - Cardiovascular Medicine)

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  Class 3 Drug Alert (Action within 5 days): Aurum Pharmaceuticals - Amiodarone Hydrochloride 50 mg/ml Concentrate - PL 12064/0123 - EL (10)A/01

Source: Defective Medicines Report Centre Area: Other Library Updates > Drug Alerts Dear Healthcare Professional,   Aurum Pharmaceuticals   Amiodarone Hydrochloride 50 mg/ml Concentrate   PL 12064/0123   Batch Number            Expiry Date             Pack Size                    First Distributed 80593                            09/2010          &n...

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  AMIODARONE HYDROCHLORIDE (Amiodarone Hydrochloride) Tablet [Cadila Healthcare Limited]

Updated Date: Jan 4, 2010 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  AMIODARONE HYDROCHLORIDE (Amiodarone Hydrochloride) Tablet [Zydus Pharmaceuticals (USA) Inc.]

Updated Date: Jan 4, 2010 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  NICE issues preliminary recommendations (ACD) on the use of dronedarone for atrial fibrillation

Source: NICE Area: News NICE has published an appraisal consultation document (ACD) on the use of dronedarone for the treatment of atrial fibrillation (AF) within the NHS in England and Wales.    The preliminary recommendation is that dronedarone is not recommended for the treatment of atrial fibrillation.  The Appraisal Committee concluded that the use of dronedarone as an alternative to amiodarone, class 1c agents, or sotalol for anti-arrhythmic treatment of AF could not be considered a cost-effective use of NHS resources.    The consultation closes on the 28th January 2010 and the second Appraisal Committee meeting will be held on the 24th February 2010.  (Source: NeLM - Cardiovascular Medicine)

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  Cardiovascular Drugs Inducing QT Prolongation: Facts and Evidence.

Authors: Taira CA, Opezzo JA, Mayer MA, Höcht C Acquired QT syndrome is mainly caused by the administration of drugs that prolong ventricular repolarization. On the other hand, the risk of drug-induced torsades de pointes is increased by numerous predisposing factors, such as genetic predisposition, female sex, hypokalemia and cardiac dysfunction. This adverse reaction is induced by different chemical compounds used for the treatment of a variety of pathologies, including arrhythmias. As it is known, antiarrhythmic agents and other cardiovascular drugs can prolong the QT interval, causing this adverse reaction. Of the 20 most commonly reported drugs, 10 were cardiovascular agents and these appeared in 348 of the reports (46%). Class Ia antiarrhythmic agents have frequently been li...

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  NICE Leans Away from Dronedarone for Atrial Fib

The UK agency, which advises the country's National Health Service, says the drug is far costlier than amiodarone and appears to be less effective; it has yet to make a final recommendation. Heartwire (Source: Medscape Medical News Headlines)

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  NICE leans away from dronedarone for atrial fib

The UK agency, which advises the country's National Health Service, says the drug is far costlier than amiodarone and appears to be less effective; it has yet to make a final recommendation, however. For complete story visit theheart.org. (Source: theHeart.org)

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  Perioperative Intravenous Amiodarone Does Not Reduce the Burden of Atrial Fibrillation in Patients Undergoing Cardiac Valvular Surgery

Background: Atrial fibrillation is a common complication after cardiac surgery. Postoperative atrial fibrillation is associated with increased risks of morbidity and mortality, and, therefore, preventive strategies using oral amiodarone have been developed but are often unpractical. Intravenous amiodarone administered after the induction of anesthesia and continued postoperatively for 48 h could represent an effective strategy to prevent postoperative atrial fibrillation in patients undergoing cardiac valvular surgery. Methods: Single-center, double-blinded, double-dummy, randomized controlled trial in patients undergoing valvular surgery. Patients received either an intravenous loading dose of 300 mg of amiodarone or placebo in the operating room, followed by a perfusion of 15 mg [middle...

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  AMIODARONE HYDROCHLORIDEinjection, Solution [Bedford Laboratories]

Updated Date: Dec 24, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Class 4 Drug Alert (Caution in use): Aurum Pharmaceuticals - Amiodarone Hydrochloride 50 mg/ml - PL 12064/0123 - EL(09)/A36

Source: Defective Medicines Report Centre Area: Other Library Updates > Drug Alerts Dear Healthcare Professional,   Aurum Pharmaceuticals   Amiodarone Hydrochloride 50 mg/ml                   PL 12064/0123 Concentrate for solution for injection or infusion   Batch Number           Expiry Date            Pack Size                 First Distributed 80593                      &nb...

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  Cardiome Announces Investigational Candidate, Vernakalant, Meets Primary Endpoint in European Comparator Study

VANCOUVER, Dec. 17 /CNW/ - Cardiome Pharma Corp. (NASDAQ: CRME / TSX: COM) today announced that the recently-completed Phase 3 European Comparator Study (the AVRO study) evaluating vernakalant (iv) versus amiodarone for the acute conversion of... (Source: Drugs.com - Clinical Trials)

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  Amiodarone: Myopathy and hypothyroidism in an elderly patient: case report

(Source: Reactions)

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  AMIODARONE HYDROCHLORIDEinjection, Solution [Bedford Laboratories]

Updated Date: Dec 11, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Stroke? or Lidocaine Toxicity?

3 out of 5 stars LIDOCAINE TOXICITY MISINTERPRETED AS A STROKE Bursell B et al. West J Emerg Med Nov 2009;10:292-294. Article This interesting case reports describes an 87-yeard-old, 49-kg woman who suddenly became unresponsive with fixed pupils after receiving a total of 811-mg lidocaine over 200 minutes, along with amiodarone.  Although the diagnosis of cerebrovascular accident was initially entertained, lidocaine toxicity was suspected, and the patient’s mental status returned to baseline when the drug was stopped.  Serum lidocaine level drawn approximately 1 hour after the deterioration of mental status was 7.9 mg/: (reference range 1.5-6.0 mg/L). The authors make several important points. Lidocaine — a doium-channel blocker — can cause neurologic and cardiac advers...

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  AMIODARONE HYDROCHLORIDEtablet [American Health Packaging]

Updated Date: Dec 2, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Longitudinal analysis of the depressive effects of intravenous amiodarone on depolarization and repolarization: A case report.

Authors: Yoshioka K, Amino M, Matsuzaki A, Shima M, Fujii T, Kanda S, Deguchi Y, Kodama I, Tanabe T Intravenous amiodarone (AMD) induces multiple antiarrhythmic effects via blocking of Na(+), Ca(2+), and IKr channels, and beta receptors. A patient on chronic dialysis was administered AMD for nonsustained ventricular tachycardia after successful cardiopulmonary resuscitation. QT prolongation occurred 5h after AMD administration. AMD was withdrawn at 24h because of prolonged QTc interval (716ms), which persisted for a further 48h (661ms). Ventricular premature contraction (VPC) was significantly decreased at 7h; however, VPC increased again after discontinuing AMD. Depolarization changes induced by the Na(+)-channel blocking action of AMD were analyzed. There was increasing filtered QRS-...

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  [New antiarrhythmic drugs for atrial fibrillation.]

Authors: Drici MD The development of new antiarrhythmic drugs is mainly aimed to treat atrial fibrillation, because of its prevalence and major consequences in terms cerebral vascular thrombosis. Specific blockade of I(Na) et I(K), even if efficacious, have previously shown to be proarrhythmogenic, with a global impairment of the cardiac patient's outcome. This lead to the development of new drugs, selectively targeting atrial currents such as I(Kur) ou I(KAch). The efficacy of amiodarone in treatment of atrial fibrillation has also yielded a whole array of new antiarrhythmic drugs targeting both these atrial currents but also sharing amiodarone pharmacodynamics properties. This renders the Vaughan-Williams classification ill-adapted for such drugs. PMID: 20103186 [PubMed - as supp...

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  [New antiarrhythmic drugs for atrial fibrillation]

Authors: Drici MD The development of new antiarrhythmic drugs is mainly aimed to treat atrial fibrillation, because of its prevalence and major consequences in terms cerebral vascular thrombosis. Specific blockade of I(Na) et I(K), even if efficacious, have previously shown to be proarrhythmogenic, with a global impairment of the cardiac patient's outcome. This lead to the development of new drugs, selectively targeting atrial currents such as I(Kur) ou I(KAch). The efficacy of amiodarone in treatment of atrial fibrillation has also yielded a whole array of new antiarrhythmic drugs targeting both these atrial currents but also sharing amiodarone pharmacodynamics properties. This renders the Vaughan-Williams classification ill-adapted for such drugs. PMID: 20103186 [PubMed - in proc...

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  Amiodarone and thyroid

Assessment of TSH and TPO-Ab before starting amiodarone (AM) treatment is recommended. The usefulness of periodic TSH measurement every 6 months during AM treatment is limited by the often sudden explosive onset of AIT, and the spontaneous return of a suppressed TSH to normal values in half of the cases. AM-induced hypothyroidism develops rather early after starting treatment, preferentially in iodine-sufficient areas and in females with TPO-Ab; it is due to failure to escape from the Wolff–Chaikoff effect, resulting in preserved radioiodine uptake. AM-induced thyrotoxicosis (AIT) occurs at any time during treatment, preferentially in iodine-deficient regions and in males. AIT can be classified in type 1 (iodide-induced thyrotoxicosis, best treated by potassium perchlorate in combination...

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  Appropriate Evaluation and Treatment of Heart Failure Patients After Implantable Cardioverter-Defibrillator Discharge: Time to Go Beyond the Initial Shock

Multiple clinical trials support the use of implantable cardioverter-defibrillators (ICDs) for prevention of sudden cardiac death in patients with heart failure (HF). Unfortunately, several complicating issues have arisen from the universal use of ICDs in HF patients. An estimated 20% to 35% of HF patients who receive an ICD for primary prevention will experience an appropriate shock within 1 to 3 years of implant, and one-third of patients will experience an inappropriate shock. An ICD shock is associated with a 2- to 5-fold increase in mortality, with the most common cause being progressive HF. The median time from initial ICD shock to death ranges from 168 to 294 days depending on HF etiology and the appropriateness of the ICD therapy. Despite this prognosis, current guidelines do not p...

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  PACERONE (Amiodarone Hydrochloride) Tablet [Upsher-Smith Laboratories, Inc.]

Updated Date: Nov 19, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Mortality and drug exposure in a 5-year cohort of patients with chronic liver disease.

CONCLUSIONS: Drug exposure in general was not associated with higher mortality except for a few categories. Mortality in patients with chronic liver disease was high and is associated with simple laboratory values. PMID: 19924579 [PubMed - as supplied by publisher] (Source: Swiss Medical Weekly)

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  Impact of Implantable Cardioverter-Defibrillator, Amiodarone, and Placebo on the Mode of Death in Stable Patients With Heart Failure. Analysis From the Sudden Cardiac Death in Heart Failure Trial.

Conclusions-ICD therapy reduced cardiac mortality and sudden death presumed to be ventricular tachyarrhythmic in SCD-HeFT and had no effect on heart failure mortality. Amiodarone had no effect on all-cause mortality or its cause-specific components. Clinical Trial Registration Information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000609. PMID: 19917887 [PubMed - as supplied by publisher] (Source: Circulation)

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  Review: Cardioversion of atrial fibrillation and the use of antiarrhythmic drugs

Source: Heart Area: News This review on the treatment of atrial fibrillation (AF) looks at the following:   . Indications for cardioversion of AF . Anti-arrhythmic drugs used for cardioversion or prevention of AF recurrence (digoxin, beta-blockers, non-dihydropyridine calcium antagonists, quinidine, disopyramide, propafenone, procainamide, dofetilide, amiodarone, sotalol, flecainide, dronedarone) . Non-anti-arrhythmic agents . Optimal management of patients with AF requiring rhythm control   The authors note that large RCTs have shown that a rhythm control strategy (using antiarrhythmics and DC cardioversion) has no morbidity or mortality advantage over rate control in patients with AF. Therefore, cardioversion is currently only indicated in those pat...

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  Ability of Amiodarone and Propranolol Alone or in Combination to Prevent Post-coronary Bypass Atrial Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in coronary artery bypass grafting (CABG) patients. The purpose of this study was to determine the best prophylaxis for AF prior to CABG. In this double-blind randomized study, 240 consecutive patients underwent elective CABG. They were then divided randomly into three groups to receive propranolol (n = 80), amiodarone (n = 80), or both drugs (n = 80). All groups received their medications from preoperative day 7 to post-CABG day 5. The patients were well matched for age, sex, risk factors, comorbidities, ejection fraction, and cardioplegic technique. Post-CABG AF developed in 22 patients (9.2%) of whom 13 (16.3%) had received propranolol, 5 (6.3%) had received amiodarone, and 4 (5%) had received both drugs. The difference between the ...

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  Implementation of an amiodarone ambulatory care clinic.

Authors: Tafreshi J, Chui MA, Riley AB PMID: 19890081 [PubMed - in process] (Source: American Journal of Health-System Pharmacy : AJHP)

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  Prescriber compliance with black box warnings in older adult patients.

CONCLUSIONS: Administrative claims analysis identified low rates of prescriber compliance with BBWs in managing patients age >or=65 years. Claims analysis may be a cost-effective strategy to monitor prescriber compliance with BBWs in older patients at higher risk. PMID: 19895180 [PubMed - in process] (Source: The American Journal of Managed Care)

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  Amiodarone: Hepatotoxicity in an elderly patient: case report

(Source: Reactions)

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  Amiodarone use in therapeutic hypothermia following cardiac arrest due to ventricular tachycardia and ventricular fibrillation

(Source: Europace)

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  Dofetilide is safe and effective in preventing atrial fibrillation recurrences in patients accepted for catheter ablation

Conclusion Dofetilide appears safe and effective in preventing AF in patients refractory to other AADs undergoing catheter ablation. (Source: Europace)

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  Arrhythmic death in implantable cardioverter defibrillator patients: a long-term study over a 10 year implantation period

Conclusion In this unselected group of ICD recipients, at least 16% of patients died from arrhythmic causes. Risk factors associated with arrhythmic mortality were a history of spontaneous or inducible VT, higher NYHA class, and amiodarone use. (Source: Europace)

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  CORDARONE (Amiodarone Hydrochloride) Tablet [Wyeth Pharmaceuticals Company]

Updated Date: Oct 30, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Life-Threatening Cardiac Toxicity After Chewing Inverted Nut (Pinang-Wang)

A 51-year-old man collapsed after chewing a pinang-wang due to curiosity. He was transported to our emergency department (ED) presenting with out-of-hospital cardiac arrest. Quick paddle look showed ventricular fibrillation and the patient received repetitive defibrillation, epinephrine, vasopressin, amiodarone, lidocaine and magnesium sulphate. After 20 minutes, it changed to wide QRS complex tachycardia. Intravenous sodium bicarbonate (1 mEq/kg, total dose: 70 mEq) was administered and the arrhythmia was successfully terminated. His blood pressure increased to 126/71 mmHg. Electrocardiogram showed ST segment elevation over precordial leads (V1-V6). Primary percutaneous coronary intervention revealed normal coronary arteries. However, the electrocardiogram remained ST elevation post-percu...

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  Amiodarone: Hypothyroidism in an elderly patient: case report

(Source: Reactions)

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  Risk prediction by heart rate turbulence and deceleration capacity in postinfarction patients with preserved left ventricular function retrospective analysis of 4 independent trials

Conclusion: In postinfarction patients with preserved left ventricular function, SAF identifies a subgroup with increased mortality risk equivalent to patients with LVEF of 30% or less. (Source: Journal of Electrocardiology)

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  Effect of tecarfarin, a novel vitamin K epoxide reductase inhibitor, on coagulation in beagle dogs

Conclusions and implications: Overall, the data presented herein indicate that tecarfarin, via a vitamin K-dependent mechanism, causes changes in key parameters of haemostasis in beagle dogs that are consistent with effective anticoagulation. Compared to warfarin it has a decreased potential to interact metabolically with drugs that inhibit CYP450 enzymes and, therefore, may offer an improved safety profile for patients. (Source: British Journal of Pharmacology)

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  ACP Journal Club. Review: Amiodarone reduces risk for sudden cardiac death but not all-cause mortality in cardiomyopathy.

Authors: Homoud MK PMID: 19841450 [PubMed - in process] (Source: Annals of Internal Medicine)

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  Cardiovascular safety in treatment of bronchial asthma

Nowadays interdisciplinary problems become more and more important in medicine. Most, if not all the patients in real world are treated not on one isolated disease but two or more serious concomitant diseases. Therefore, it happens more and more often that medications used in treatment of one disease have adverse effects or are even harmful in the treatment of another disease. In the patients with cardiovascular and respiratory diseases medications acting on beta receptors are problematic. It is known that b-blockers, one of the main group of cardiac drugs, have beneficial effects on the heart but might cause bronchospasm in “respiratory” patients. On the other hand b-mimetics used in treatment of bronchial asthma might cause harmful tachycardia in cardiac patients. These compl...

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  Amiodarone: Hypothyroidism leading to renal failure in an elderly patient: case report

(Source: Reactions)

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  Drug-Induced Steatohepatitis Leading to Cirrhosis: Long-Term Toxicity of Amiodarone Use

Semin Liver Dis 2009; 29: 423-428DOI: 10.1055/s-0029-1240011ABSTRACTNonalcoholic steatosis/steatohepatitis is the most common cause for abnormal liver chemistries. Apart from metabolic syndrome, drugs may also lead to development of steatohepatitis that may, rarely, progress to cirrhosis and portal hypertension. We discuss a case of amiodarone-induced steatohepatitis with advanced fibrosis, presenting with hepatic decompensation and portal hypertension manifesting as ascites and recurrent esophageal variceal hemorrhage. Amiodarone is a lipophilic drug that concentrates in the liver and usually, over a period of time, leads to toxicity related to drug accumulation. There is marked histological similarity between amiodarone-induced liver disease and alcoholic and nonalcoholic steatohepatitis...

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  Amiodarone: Cirrhosis in elderly patients: 2 case reports

(Source: Reactions)

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  Vanoxerine: Cellular Mechanism of a New Antiarrhythmic

Conclusions: Vanoxerine (1) is a potent blocker of cardiac hERG, Na and Ca channels; (2) block is strongly frequency-dependent especially for Na and Ca channels; and (3) transmural dispersion of ventricular repolarization is unaffected. The multichannel block and repolarization uniformity resemble the effects of amiodarone, the exemplar atrial fibrillation drug. Vanoxerine is a completely different chemical and has none of amiodarone's toxic effects. Vanoxerine has characteristics of a potentially effective and safe antiarrhythmic. (J Cardiovasc Electrophysiol, Vol. pp. 1[ndash]10) (Source: Journal of Cardiovascular Electrophysiology)

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  Age-Related Increase in Atrial Fibrillation Induced by Transvenous Catheter-Based Atrial Burst Pacing: An In Vivo Rat Model of Inducible Atrial Fibrillation

Conclusions: Transvenous catheter-based AF is significantly longer in middle-aged than in young rats and is markedly reduced by treatment with antiarrhythmic drugs. This rat model of AF is simple, reproducible, and reliable for examining pharmacologic effects on AF and studying the process of atrial remodeling. (J Cardiovasc Electrophysiol, Vol. pp. 1[ndash]6) (Source: Journal of Cardiovascular Electrophysiology)

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  Cardiovascular Drugs Inducing QT Prolongation: Facts and Evidence.

Authors: Taira CA, Opezzo JA, Mayer MA, Höcht C Acquired QT syndrome is mainly caused by the administration of drugs that prolong ventricular repolarization. On the other hand, the risk of drug-induced torsades de pointes is increased by numerous predisposing factors, such as genetic predisposition, female sex, hypokalemia and cardiac dysfunction. This adverse reaction is induced by different chemical compounds used for the treatment of a variety of pathologies, including arrhythmias. As it is known, antiarrhythmic agents and other cardiovascular drugs can prolong the QT interval, causing this adverse reaction. Of the 20 most commonly reported drugs, 10 were cardiovascular agents and these appeared in 348 of the reports (46%). Class Ia antiarrhythmic agents have frequently been li...

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  Amiodarone/ciprofloxacin/clarithromycin interaction: Prolonged QT interval and ventricular tachycardia in an elderly patient: case report

(Source: Reactions)

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  Evaluation of the Effects of PM101, a Cyclodextrin-Based Formulation of Intravenous Amiodarone, on Blood Pressure in Healthy Humans

In conclusion, the results of this study demonstrate that PM101 is devoid of hypotension in healthy human subjects. The absence of a hypotensive effect of AIV in this population suggests that further evaluation is needed in a patient population with cardiac disease. (Source: The American Journal of Cardiology)

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  Amiodarone and miltefosine act synergistically against Leishmania mexicana and can induce parasitological cure in a murine model of cutaneous leishmaniasis.

Authors: Serrano-Martín X, Payares G, De Lucca M, Martinez JC, Mendoza-León A, Benaim G Leishmaniasis is parasitic disease that is an important problem of public health worldwide. Intramuscular-administered glucantime and pentostam are the most common drugs used for treatment of this disease, but they have significant limitations due to toxicity and increasing resistance. A recent breakthrough has been the introduction of orally administered miltefosine for the treatment of visceral, cutaneous and muco-cutaneous leishmaniasis, but the relative high cost and concerns about teratogenicity have limited the use of this drug. Searching for alternative drugs, we have previously demonstrated that the antiarrhythmic drug amiodarone is active against Leishmania mexicana promastigotes ...

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  Amiodarone: Organising pneumonia and sinus arrest in an elderly patient: case report

(Source: Reactions)

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  The hypotensive effect of intravenous amiodarone is sustained throughout the maintenance infusion period.

Authors: Cushing DJ, Cooper WD, Gralinski MR, Lipicky RJ SUMMARY 1. Hypotension frequently occurs with use of intravenous amiodarone and is managed by slowing the rate of administration. This response has been attributed to the cosolvents in the formulation and is believed to be solely related to the initial loading dose. The present study was performed to determine whether intravenous amiodarone-induced hypotension persists beyond the loading dose and into the maintenance infusion period and also whether hypotension occurs with maintenance level dosing alone. 2. Anesthetized beagle dogs (n=7/group) were instrumented to assess hemodynamics. Animals were treated with the human-equivalent dosing regimen (loading dose followed by maintenance infusion) of intravenous amiodarone or Control ...

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  Prediction of phospholipidosis-inducing potential of drugs by in vitro biochemical and physicochemical assays followed by multivariate analysis.

Authors: Kuroda Y, Saito M An in vitro method to predict phospholipidosis-inducing potential of cationic amphiphilic drugs (CADs) was developed using biochemical and physicochemical assays. The following parameters were applied to principal component analysis, as well as physicochemical parameters: pKa and clogP; dissociation constant of CADs from phospholipid, inhibition of enzymatic phospholipid degradation, and metabolic stability of CADs. In the score plot, phospholipidosis-inducing drugs (amiodarone, propranolol, imipramine, chloroquine) were plotted locally forming the subspace for positive CADs; while non-inducing drugs (chlorpromazine, chloramphenicol, disopyramide, lidocaine) were placed scattering out of the subspace, allowing a clear discrimination between both classes of CA...

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  Long QT syndrome and torsades de pointes induced by acute sulpiride poisoning

We report a case of long QT syndrome and torsades de pointes induced by ingestion of 1.5 g of sulpiride. Ventricular arrhythmia was initially treated with amiodarone, without success. Eventually, lidocaine and magnesium sulfate successfully terminated the ventricular arrhythmia. The patient was discharged uneventfully after 3 days of hospitalization. This case illustrates the fact that acute sulpiride poisoning may lead to life-threatening ventricular arrhythmia. Early recognition followed by effective therapy is crucial. Intensive cardiac monitoring is recommended for sulpiride poisoning. (Source: The American Journal of Emergency Medicine)

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  The human cardiac K2P3.1 (TASK-1) potassium leak channel is a molecular target for the class III antiarrhythmic drug amiodarone

The objective of this study was to investigate acute effects of the class III antiarrhythmic drug amiodarone on human K2P3.1 channels. Potassium currents were recorded from Xenopus oocytes using the two-microelectrode voltage clamp technique. Amiodarone produced concentration-dependent inhibition of hK2P3.1 currents (IC50 = 0.40 µM) with maximum current reduction of 58.1%. Open rectification properties that are characteristic to hK2P3.1 currents were not altered by amiodarone. Channels were blocked in open and closed states in reverse frequency-dependent manner. hK2P3.1 channel inhibition was voltage-independent at voltages between −40 and +60 mV. Modulation of protein kinase C activity by amiodarone does not contribute to hK2P3.1 current reduction, as pre-treatment wit...

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  Treatment of new-onset atrial fibrillation in noncardiac intensive care unit patients: a systematic review of randomized controlled trials

Source: DARE Area: Evidence > Disease Focused Reviews CRD Summary: The authors found insufficient evidence to make recommendations about standard treatment of noncardiac critically ill patients with new-onset atrial fibrillation. Despite some concerns about the risk of language and publication bias, this was generally a well-conducted review and the authors' conclusions were likely to be reliable. [The included studies compared procainamide, flecainide, magnesium, amiodarone, verapamil, diltiazem and esmolol with each other. ] CRD Commentary: The review question was clearly stated and inclusion criteria were specified. Although the review focus was on patients with atrial fibrillation some patients with other atrial tachycardias were also included. Several relevant sources were searc...

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  Mixed Start to Planned MARVEL Trial of Post-MI Autologous Skeletal-Myoblast Therapy

A pilot analysis suggests the cell therapy can improve functional capacity, but amiodarone may be needed to prevent ventricular arrhythmias; its investigators say they plan to switch gears on the remainder of the study. Heartwire (Source: Medscape Medical News Headlines)

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  Avloclor (chloroquine) Tablets - Revised SPC

Source: eMC (electronic Medicines Compendium) Area: Other Library Updates > SPC Changes Section 4.5 (interactions) has been updated. This section now contains the following information: If the patient is taking amiodarone then chloroquine and hydroxychloroquine may increase the risk of cardiac arrhythmias including ventricular arrhythmias, bradycardias and cardiac conduction defect. Concurrent use is contraindicated. Antacids (aluminium, calcium and magnesium salts) and adsorbents (e.g. kaolin) may reduce the absorption of chloroquine, so should be taken well separated from Avloclor (at least four hours apart). (Source: NeLM - SPC Changes)

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  Systematic review: Dronedarone vs. amiodarone for maintenance of sinus rhythm in patients with atrial fibrillation

Source: J Am Coll Cardiol Area: News The efficacy and safety of dronedarone, a non-iodinated amiodarone congener, for the prevention of recurrent atrial fibrillation (AF) has been compared with that of amiodarone in a systematic review published in the J of the American College of Cardiology.   The researchers identified 4 placebo-controlled trials of dronedarone, 4 placebo-controlled trials of amiodarone, and 1 trial of dronedarone versus amiodarone. The effect of amiodarone vs. dronedarone was summarised by the use of indirect comparison meta-analysis and normal logistic meta-regression models. The following findings were reported:   . Random-effects modelling found a significant estimated reduction in recurrent AF with amiodarone vs. placebo (odds ratio, 0.12; 95...

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  Dronedarone may reduce stroke risk in patients with AF

Source: Circulation Area: News A post-hoc analysis of a controlled trial suggests that dronedarone may reduce the risk of stroke in patients with atrial fibrillation (AF), and thus controlled trials to investigate this are warranted.   Patients with AF are at increased risk for stroke and are often treated with anti-thrombotic agents to reduce this risk. Studies with older anti-arrhythmic drugs have not shown any significant reduction in stroke risk despite reductions in arrhythmias. Dronedarone is a new drug related to amiodarone, and in the ATHENA trial was shown to reduce adverse cardiovascular outcomes compared to placebo in patients with AF. This post hoc analysis aimed to determine whether it had any effect on stroke.   ATHENA was a double-blind, randomised control...

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  Dronedarone in Atrial Fib Trades Efficacy for Safety in Meta-Analysis

The finding, based on eight randomized trials, supports the view that dronedarone is less effective than amiodarone at preventing the arrhythmia's recurrence but doesn't have the older drug's serious toxicities, as suggested by the DIONYSOS trial. Heartwire (Source: Medscape Medical News Headlines)

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  Comparative amiodarone, dronedarone benefits in AF remain uncertain

Indirect comparative meta-analysis results indicate that amiodarone is more effective than dronedarone for maintenance of sinus rhythm in patients with atrial fibrillation, but is associated with more adverse effects. (Source: MedWire News - Cardiology)

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  Dronedarone in atrial fib trades efficacy for safety in meta-analysis

The finding, based on eight randomized trials, supports the view that dronedarone is less effective than amiodarone at preventing the arrhythmia's recurrence but doesn't have the older drug's serious toxicities, as suggested by the DIONYSOS trial. (Source: theHeart.org)

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  Cut-off values and significance of Oil Red O-positive cells in bronchoalveolar lavage fluid

Conclusion: Significantly increased numbers of ORO-PM were associated with various lung pathologies. However, the higher numbers observed in HIV patients require further investigations. (Source: Cytopathology)

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  Comparative Efficacy of Dronedarone and Amiodarone for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation

Conclusions: Dronedarone is less effective than amiodarone for the maintenance of sinus rhythm, but has fewer adverse effects. For every 1,000 patients treated with dronedarone instead of amiodarone, we estimate approximately 228 more recurrences of AF in exchange for 9.6 fewer deaths and 62 fewer adverse events requiring discontinuation of drug. (Source: Journal of the American College of Cardiology)

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  Amiodarone or Dronedarone for Atrial Fibrillation: Too Early to Know the Winner?⁎

Atrial fibrillation (AF) is estimated to affect >10 million patients by 2050 in the U.S. () and is associated with significant rates of morbidity and an increased risk of mortality. Health care costs due to AF are enormous at >$2 billion annually. Restoration of sinus rhythm in patients with AF has been demonstrated to improve left ventricular ejection fraction, left atrial size, and quality of life both in patients with congestive heart failure and normal ejection fraction, even when optimal ventricular rate control during AF has been achieved (). Furthermore, many patients with AF are troubled by symptoms that persist despite adequate rate control. Therefore, maintenance of sinus rhythm often is desirable in patients with AF. (Source: Journal of the American College of Cardiology)

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  The role of negatively charged lipids in lysosomal phospholipase A2 function [Research Articles]

Lysosomal phospholipase A2 (LPLA2) is characterized by increased activity toward zwitterionic phospholipid liposomes containing negatively charged lipids under acidic conditions. The effect of anionic lipids on LPLA2 activity was investigated. Mouse LPLA2 activity was assayed as C2-ceramide transacylation. Sulfatide incorporated into liposomes enhanced LPLA2 activity under acidic conditions and was weakened by NaCl or increased pH. Amiodarone, a cationic amphiphilic drug, reduced LPLA2 activity. LPLA2 exhibited esterase activity when p-nitro-phenylbutyrate (pNPB) was used as a substrate. Unlike the phospholipase A2 activity, the esterase activity was detected over wide pH range and not inhibited by NaCl or amiodarone. Presteady-state kinetics using pNPB were consistent with the formation o...

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  Journal Scan: Comparative Efficacy of Dronedarone and Amiodarone for the Maintenance of Sinus Rhythm in Patients With Atrial Fibrillation (J Am Coll Cardiol 2009;54:1089-1095.)

All randomized clinical trials (RCTs) that compared amiodarone or dronedarone to a placebo or amiodarone to dronedarone in patients with AF were subjected to meta-analysis. Indirect comparison meta-analysis was performed to compare amiodarone to dronedarone. (Source: Cardiosource)

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  Association of Polymorphism at Position 49 in Exon 1 of the Cytotoxic T-Lymphocyte-Associated Factor 4 Gene with Graves' Disease Refractory to Medical Treatment, but Not with Amiodarone-Associated Thyroid Dysfunction

Thyroid Sep 2009, Vol. 19, No. 9: 975-981. (Source: Thyroid)

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  Effects of Intravenous Nifekalant as a Lifesaving Drug for Severe Ventricular Tachyarrhythmias Complicating Acute Coronary Syndrome.

Conclusions: An intravenous bolus injection and subsequent continuous infusion of NIF at a relatively low dosage were effective in treating severe ventricular tachyarrhythmias complicating ACS, reducing the potential risk of proarrhythmia. PMID: 19724153 [PubMed - as supplied by publisher] (Source: Circulation Journal)

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  AMIODARONE HYDROCHLORIDEtablet [TEVA Pharmaceuticals USA Inc]

Updated Date: Sep 1, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  [The effects of amiodarone on the thyroid.]

Conclusions. In our study, amiodarone induced thyrotoxicosis was more frequent than hypothyroidism (59% vs 41%) because Navarre is an iodine-deficient area. It is necessary to control the thyroid function after 2-3 years of amiodarone treatment. PMID: 20094097 [PubMed - in process] (Source: Anales del Sistema Sanitario de Navarra)

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  Med Sci Monit 2009; 15(9):CR494-498 "Statins and amiodarone improve freedom from recurrence of atrial fibrillation after successful cardioversion"

Conclusions: Our study shows that adding statins to amiodarone significantly decreases the recurrence rate of AF after successful EC in patients with persistent AF. Our findings urge for prospective randomized studies to be performed in order to confirm these results and elucidate the role of statins in AF prevention. (Source: Medical Science Monitor)

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  A Randomized Trial Evaluating Amiodarone for Prevention of Atrial Fibrillation After Pulmonary Resection [ORIGINAL ARTICLES: GENERAL THORACIC]

Conclusions Amiodarone prophylaxis significantly reduces the incidence of AF after anatomic pulmonary resection, and is associated with a significant reduction in length of intensive care unit stay. (Source: The Annals of Thoracic Surgery)

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  Use of ECMO to Temporize Circulatory Instability During Severe Brugada Electrical Storm [CASE REPORTS]

We describe the use of extracorporeal membrane oxygenation to temporize circulatory instability during almost incessant ventricular fibrillation in a patient with Brugada syndrome who had electively discontinued chronic amiodarone therapy. The extracorporeal membrane oxygenation was continued for 3 days after emergent delivery of the neonate, during which time the number of ventricular fibrillation episodes and internal defibrillations markedly decreased concomitant with administration of intravenous amiodarone and verapamil. Oral anti-arrhythmic therapy was subsequently reinstituted, and the remainder of the patient's hospital course was uneventful. (Source: The Annals of Thoracic Surgery)

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  [The efficacy of class III D,L sotalol in treatment of left atrial tachycardia after pulmonary vein isolation.]

Conclusion: In prevention of left atrial tachycardia occurred after PV isolation, sotalol is not more effective than 1C class propafenone. Otherwise, III D,L sotalol seems to be effective in antiarrhytmic treatment of developed postablation in late left atrial tachycardias. PMID: 19709984 [PubMed - in process] (Source: Orvosi Hetilap)

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  Preventive Effect of Amiodarone During Acute Period in Isoproterenol-Induced Myocardial Injury in Wistar Rats.

Authors: Albayrak F, Bayir Y, Halici Z, Kabalar E, Bayram E, Ozturk C, Suleyman H, Keles MS, Kurt M, Bakan E The ability of amiodarone to prevent pathological changes and oxidative stress after isoproterenol (ISO)-induced myocardial injury was investigated in rats. A better understanding of the processes involved in the pathophysiology of myocardial infarction has led to the search for drugs that can limit the extent of myocardial injury. Amiodarone was administered to groups of rats groups once per day for 30 days. On days 29 and 30, the rats of the ISO control and drug treatment groups were administered 180 mg/kg ISO subcutaneously at an interval of 24 h for two consecutive days. In the control groups, clinical indicators, such as creatine kinase-isoenzymes and troponin-I, were found...

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  Clinical presentation and treatment of atrial fibrillation in Wolff-Parkinson-White syndrome

A case of Wolff-Parkinson-White syndrome with atrial fibrillation (AF) is reported in a patient who presented with syncope, tachycardia, and hypotension. The electrocardiogram (ECG) showed a fast irregular rhythm with wide polymorphic QRS tachycardia without the QRS twisting around the isoelectric baseline, diagnostic of AF and Wolff-Parkinson-White syndrome. The patient did not respond to intravenous amiodarone. Elective cardioversion restored sinus rhythm, and the ECG showed a wide QRS complex, short PR interval, and delta wave, indicating the presence of an accessory pathway and pre-excitation. AF was easily induced during the electrophysiologic study, requiring electrical cardioversion for severe hypotension. Successful radiofrequency ablation of the accessory pathway completely preven...

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  A randomized trial evaluating amiodarone for prevention of atrial fibrillation after pulmonary resection.

CONCLUSIONS: Amiodarone prophylaxis significantly reduces the incidence of AF after anatomic pulmonary resection, and is associated with a significant reduction in length of intensive care unit stay. PMID: 19699916 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

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  Use of ECMO to temporize circulatory instability during severe Brugada electrical storm.

We describe the use of extracorporeal membrane oxygenation to temporize circulatory instability during almost incessant ventricular fibrillation in a patient with Brugada syndrome who had electively discontinued chronic amiodarone therapy. The extracorporeal membrane oxygenation was continued for 3 days after emergent delivery of the neonate, during which time the number of ventricular fibrillation episodes and internal defibrillations markedly decreased concomitant with administration of intravenous amiodarone and verapamil. Oral anti-arrhythmic therapy was subsequently reinstituted, and the remainder of the patient's hospital course was uneventful. PMID: 19699933 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

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  Amiodarone: Alveolar haemorrhage in an elderly patient: case report

(Source: Reactions)

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  Amiodarone/benzyl alcohol/polysorbate 80 overdose: Various acute toxicities in a neonate following inadvertent IV administration (including first reports with polysorbate 80)?: case report

(Source: Reactions)

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  Fetal arrhythmia: Prenatal diagnosis and perinatal management

The importance of managing fetal arrhythmia has increased over the past three decades. Although most fetal arrhythmias are benign, some types cause fetal hydrops and can lead to fetal death. With the aim of improving the outcome in such cases, various studies for prenatal diagnosis and perinatal management have been published. Detailed analysis of the type of arrhythmia in utero is possible using M-mode and Doppler echocardiography. In particular, a simultaneous record of Doppler waveform at the superior venous cava and the ascending aorta has become an important and useful method of assessing the interval between atrial and ventricular contractions. Common causes of fetal tachycardia (ventricular heart rate faster than 180 bpm), are paroxysmal supraventricular tachycardia (SVT) with 1:1 a...

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  Dual atrioventricular-nodal physiology, elicited by pacing and leading to a reversible cardiomyopathy.

Authors: Catanzaro JN, Makaryus J, Vafai J, Makaryus AN, Jadonath R, Beldner S Atrioventricular nodal re-entry tachycardia is the most common form of regular paroxysmal tachycardia in the adult population. This tachycardia is a re-entrant rhythm that uses the anatomic location of the atrioventricular node and its surrounding perinodal atrial tissue. The simplest concept regarding the atrioventricular nodal physiology that allows re-entry is founded upon the postulated existence of 2 atrioventricular nodal pathways with different conduction velocities and refractory periods. Herein, we present the case of a 64-year-old man who had a history of paroxysmal atrial fibrillation; he had a permanent pacemaker for sick-sinus syndrome. He developed a tachycardia-induced cardiomyopathy with a pe...

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  Atrial-selective sodium channel block as a novel strategy for the management of atrial fibrillation

Abstract: Pharmacological management of atrial fibrillation (AF) remains an important unmet medical need. Because available drugs for rhythm control of AF are often associated with a significant risk for development of ventricular arrhythmias or extracardiac toxicity, recent drug development has focused on agents that are atrial selective. Inhibition of the ultrarapid delayed rectifier potassium current (IKur), a current exclusive to atria, is an example of an atrial-selective approach. Recent studies, however, have shown that loss-of-function mutations in KCNA5, the gene that encodes KV1.5, the α subunit of the IKur channel, is associated with the development of AF and that inhibition of IKur can promote the induction of AF in experimental models. Another potential atrial-selective appro...

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  The Year in Review of Clinical Cardiac Electrophysiology

Previous randomized controlled clinical trials of atrial fibrillation (AF) patients have failed to demonstrate a benefit of a rhythm control strategy (using cardioversions and/or drugs) over a rate control strategy (with atrioventricular [AV]-nodal blocking drugs and anticoagulation) (). This year brought the first report of a similar trial in AF patients with heart failure (), a particularly important group given data from observational studies that heart failure patients with AF have an especially poor prognosis compared with similar patients in sinus rhythm (). These investigators enrolled 1,376 patients in a multicenter, randomized unblinded trial comparing a rhythm control strategy with a rate control strategy in AF patients with a left ventricular ejection fraction (LVEF) ≤35% and ...

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  Dronedarone.

This article will review evidence of safety and effectiveness of dronedarone in patients with atrial fibrillation. PMID: 19687370 [PubMed - in process] (Source: Circulation)

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  Using explicit criteria to evaluate the quality of prescribing in elderly Italian outpatients: a cohort study

Conclusion: Via the developed criteria, the study corroborates that PIP among elderly outpatients is a substantial issue in Parma Local Health Unit, Italy. Knowledge of the prevalence of PIP and associated factors should gear efforts to develop strategies to reduce PIP in outpatient settings in Italy. (Source: Journal of Clinical Pharmacy and Therapeutics)

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  Amiodarone overdose: Ataxia in an elderly patient due to a medication error: case report

(Source: Reactions)

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  Amiodarone: Neurological disorders : 20 case reports

(Source: Reactions)

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  Dronedarone: A Promısıng Alternatıve for the Management of Atrıal Fıbrıllatıon

Conclusion  Further clinical trials (including head to head comparison with other conventional anti-arrhythmics) are still required to determine the place of dronedarone in the management of AF. The present review focuses on basic and clinical aspects of dronedarone, a novel agent for the management of AF. Content Type Journal ArticleDOI 10.1007/s10557-009-6189-0Authors Kenan Yalta, Cumhuriyet University Cardiology Department Sivas 58100 TurkeyOkan Onur Turgut, Cumhuriyet University Cardiology Department Sivas 58100 TurkeyMehmet Birhan Yılmaz, Cumhuriyet University Cardiology Department Sivas 58100 TurkeyAhmet Yılmaz, Cumhuriyet University Cardiology Department Sivas 58100 TurkeyIzzet Tandogan, Cumhuriyet University Cardiology Department Sivas 58100 Turkey Jou...

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  Asbestosis: demonstration of distinctive interstitial fibroelastosis: A pilot study

Abstract: Asbestosis has long been defined as a diffuse interstitial “fibrotic” process, in similarity to other chronic interstitial pulmonary diseases. To address the hypothesis (which was based on morphological nuances) that the interstitial connective tissue response in asbestosis may be fibroelastotic rather than fibrotic, a comparative characterization of the connective response in cases of asbestosis and other forms of interstitial lung disease was performed. Archival open lung biopsies or autopsy specimens of pulmonary diseases featuring interstitial connective tissue abnormalities (15 of asbestosis, 21 of organizing pneumonia, 15 usual interstitial pneumonitis/idiopathic pulmonary fibrosis [IPF], 9 organizing diffuse alveolar damage, 9 “nonspecific” interstitial pneumonitis...

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  Efficacy of Antiarrhythmic Drugs in Arrhythmogenic Right Ventricular Cardiomyopathy: A Report From the North American ARVC Registry

Conclusions: In a cohort of well-characterized ARVC subjects, neither beta-blockers nor sotalol seemed to be protective. Evidence from a small number of patients suggests that amiodarone has superior efficacy in preventing ventricular arrhythmias. (Source: Journal of the American College of Cardiology)

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  Empiric Antiarrhythmic Drug Therapy in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: Pragmatism or Anachronism?⁎

In this issue of the Journal, Marcus et al. () present an observational study of ventricular tachycardia (VT)/ventricular fibrillation (VF) outcomes associated with use of specific empiric antiarrhythmic drug (AAD) therapies in a well-documented population of patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) from the prospectively collected North American ARVC Registry. The ARVC/D patients from this registry who had received an implantable cardioverter-defibrillator (ICD) were followed up for the subsequent occurrence of VT/VF. For each analysis, outcomes during periods of time patients received a specific AAD therapy were compared with periods of time that patients did not receive that AAD therapy and with periods of time that patients did not receive any AA...

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  Amiodarone: Pulmonary fibrosis in an elderly patient: case report

(Source: Reactions)

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  Amiodarone: Facial hyperpigmentation in an elderly patient: case report

(Source: Reactions)

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  How frequently should a patient taking amiodarone be screened for thyroid dysfunction?

Authors: Pazin-Filho A, de Jesus AM, Magalhães PK, Melato LH, Campos D, Maciel BC, Maciel LM Amiodarone-induced thyroid dysfunction (AITD) is a common complication of amiodarone therapy and its prevalence varies according to iodine intake, subclinical thyroid disorders and the definition of AITD. There is no consensus about the frequency of screening for this condition. We evaluated 121 patients on chronic regular intake of amiodarone (mean intake = 248.5 +/- 89 mg; duration of treatment = 5.3 +/- 3.9 years, range = 0.57-17 years) and with stable baseline cardiac condition. Those with no AITD were followed up for a median period of 3.2 years (range: 0.6-6.7) and the incidence rate of AITD, defined by clinical and laboratorial findings as proposed by international guidelines, was o...

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  The effects of intra-operative amiodarone loading on the systemic inflammatory response syndrome induced by cardiopulmonary bypass.

CONCLUSION: The results indicate that intraoperative loading of amiodarone, which is used for atrial fibrillation prophylaxis, does not seem to alter inflammatory response during CPB. PMID: 19666435 [PubMed - in process] (Source: Anadolu Kardiyol Der...)

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  Amiodarone as a First-Line Therapy for Postoperative Junctional Ectopic Tachycardia [ORIGINAL ARTICLES: PEDIATRIC CARDIAC]

Conclusions Amiodarone as the first-line treatment was effective in almost half of the patients with postoperative junctional ectopic tachycardia. Higher arteriovenous oxygen saturation difference and lower body temperature were associated with failure of amiodarone therapy, and their presence may suggest more aggressive initial approach consisting of amiodarone combined with hypothermia. (Source: The Annals of Thoracic Surgery)

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  Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia.

CONCLUSIONS: Amiodarone as the first-line treatment was effective in almost half of the patients with postoperative junctional ectopic tachycardia. Higher arteriovenous oxygen saturation difference and lower body temperature were associated with failure of amiodarone therapy, and their presence may suggest more aggressive initial approach consisting of amiodarone combined with hypothermia. PMID: 19632422 [PubMed - in process] (Source: The Annals of Thoracic Surgery)

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  PACERONE (Amiodarone Hydrochloride) Tablet [Upsher-Smith Laboratories, Inc.]

Updated Date: Jul 23, 2009 EST (Source: DailyMed Drug Label Updates for the last seven days (since May 20, 2007 EST))

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  Glucocorticoids are preferable to thionamides as first-line treatment for amiodarone-induced thyrotoxicosis due to destructive thyroiditis: a matched retrospective cohort study.

CONCLUSIONS: Glucocorticoids are the first-line treatment in type 2 AIT while thionamides play no role in this destructive thyroiditis. PMID: 19622616 [PubMed - as supplied by publisher] (Source: The Journal of Clinical Endocrinology and Metabolism)

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  Amiodarone: Torsade de pointes in an elderly patient with liver cirrhosis and ischaemic heart disease: case report

(Source: Reactions)

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  Amiodarone: Torsade de pointes in a man with Wolff-Parkinson-White syndrome: case report

(Source: Reactions)

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