Amiodarone baseline testing and monitoring for side effects

Area of interest for monitoring	Monitoring		Possible adverse effect
	Baseline testing	Follow-up testing
Cardiac	ECG (at baseline and during loading dose)	Yearly After adding medications that interact with amiodarone or prolong the QT interval	QT prolongation; torsades de pointes
			Symptomatic sinoatrial or conduction system impairment
Implantable cardioverter-defibrillators	Defibrillation threshold testing (if clinically indicated)	As needed for signs/symptoms	Increased defibrillation threshold
Dermatologic	Physical examination	As needed for signs/symptoms	Photosensitivity to UV light
			Blue-gray skin discoloration
Endocrine	TSH (with reflex testing if abnormal)	3 to 4 months after starting drug, then yearly As needed for signs/symptoms	Hyperthyroidism, hypothyroidism
Hepatic	AST and ALT	6 months after starting drug, then yearly	AST or ALT elevation ≥2× upper limit of reference range
Ophthalmologic	Eye examination	Yearly	Corneal microdeposits
			Optic neuropathy
Pulmonary	Chest radiograph, PFTs*	Yearly for surveillance Along with PFTs (including DLCO) and chest computed tomography for signs/symptoms	Pulmonary toxicity (cough, fever, dyspnea)

Refer to UpToDate topics on pulmonary toxicity, thyroid toxicity, and clinical uses of amiodarone for additional information.

ECG: electrocardiogram; UV: ultraviolet; TSH: thyroid-stimulating hormone; AST: aspartate aminotransferase; ALT: alanine transaminase; PFTs: pulmonary function tests; DLCO: diffusing capacity of the lungs for carbon monoxide.
* There are differing opinions, and no concensus, of obtaining formal PFTs with assessment of diffusion capacity (ie, DLCO) as baseline testing in all patients. Some experts obtain baseline PFTs with DLCO prior to starting amiodarone, particularly among patients with underlying lung disease, while other experts rarely or never obtain baseline PFTs.

Graphic 126072 Version 4.0

خرید پکیج

Amiodarone baseline testing and monitoring for side effects