(Circulation. 1999;100:2025-2034.)
© 1999 American Heart Association, Inc.
Cardiovascular Drugs |
Evidence-Based Analysis of Amiodarone Efficacy and Safety
From McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada.
Key Words: Cardiovascular Drugs • amiodarone • ventricular tachycardia • atrial fibrillation
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Introduction |
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Amiodarone was initially developed 3 decades ago for angina. On the basis of the number of prescriptions filled in retail pharmacies, amiodarone was the most-often-prescribed antiarrhythmic agent, accounting for 24.1% of the total antiarrhythmic prescriptions in 1998. Amiodarone accounted for 34.5% of prescriptions in Europe, 32.8% in North America, 73.8% in Latin America, and 0.3% in Japan and the Philippines. Amiodarone use has increased globally in 1998 at a rate greater than that of the whole antiarrhythmic market, with striking growth in North America, a 20.0% increase from 1997 to 1998 (according to International Medical Statistics, Medical Data Index, and Scott Levin drug and diagnosis audit, obtained with the assistance of J. Jones, Sanofi Pharma Inc, Paris, France). Amiodarone is used to manage virtually all forms of supraventricular and ventricular tachycardia. This review focuses on the arrhythmias most commonly requiring antiarrhythmic therapy—sustained ventricular tachycardia (VT), ventricular fibrillation (VF), and atrial fibrillation (AF)—because they are the most clinically significant and have been the focus of most studies published. This review will analyze the evidence that amiodarone is a safe and effective antiarrhythmic drug.
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Pharmacokinetics |
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To exploit the antiarrhythmic properties of amiodarone fully, the clinician needs to be familiar with its pharmacokinetics, because they differ markedly from those of other cardiac drugs. Amiodarone is markedly lipophilic, which may account for some of its unusual pharmacokinetic features.1 It is incompletely absorbed (35% to 65%) after oral administration.2 3 4 It is taken up very extensively by tissue, with marked interindividual variation.5 Estimates of the elimination half-life
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