Arrhythmias: amiodarone caused pulmonary toxicity.
Clinical bottom line (level 4)
Around 6% of patients on high doses of amiodarone developed pulmonary toxicity.
Dusman et al:
for confounding factors,
validated in an independent set of patients.
Setting: university medical centre, USA
range 5 to 88 years; mean 58,
80% with VT or VF, remainder with SVT
heart failure, infection or malignancy
Treated with amiodarone for > 3 days. Patients initially received 800 mg/day loading dose for 6-8 weeks, then later 1600 mg/day for one week, followed by 800 mg/day for one month. Maintenance therapy dose ranged from 50 to 800 mg/day.
at least 2 years
diagnosed by 2 or more of: new onset of pulmonary symptoms (dyspnoea, cough or pleuritic chest pain); new chest radiographic abnormality such as interstitial or alveolar infiltrate; decrease in DLCO of 20% from pretreatment value (or < 80% predicted); abnormal lung uptake from gallium-67 radioisotope; characteristic histologic changes from bronchoscopy and lung biopsy samples.
||time to outcome
||number of patients/total number
| pulmonary toxicity
||at least 2 years
- Three patients with pulmonary toxicity died (all within a month of diagnosis).
- No toxicity was seen in patients younger than 40 years old.
- Inconsistent use of BAL may skew results.
- Patients were on higher doses than currently used.
Contributor: Chris Ball and Clare Wotton,
WM, et al:
Clinical features of amiodarone-induced pulmonary toxicity.
Reviewer: William Rhoton
|Intervention or Exposure