Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Ritonavir (Norvir) can inhibit the
enzyme that is responsible for the metabolism (break-down) of amiodarone.
Although no clinical problems have been recognized as a result of this
interaction, it would be prudent to avoid this combination for fear of the
potential for amiodarone toxicity.
Amiodarone also can interact with tricyclic
antidepressants (for example, amitriptyline
[Endep, Elavil]), or phenothiazines (for example, chlorpromazine [Thorazine]) and potentially cause serious arrhythmias.
Amiodarone interacts with warfarin (Coumadin) and increases the risk of
bleeding. The bleeding can be serious or even fatal. This effect can occur as
early as 4-6 days after the start of the combination of drugs or can be delayed
by a few weeks. Clotting studies probably should be done early during treatment
with amiodarone among patients taking warfarin.
Amiodarone can interact with
some cholesterol-lowering medicines of the statin class, such as simvastatin (Zocor),
atorvastatin (Lipitor), and lovastatin (Mevacor), increasing the side effects of
statins which include severe muscle breakdown, kidney failure or liver disease.
This interaction is dose-related, meaning that lower doses of statins are safer
than higher doses when used with amiodarone. An alternative statin, pravastatin
(Pravachol), does not share this interaction and is safer in patients taking
amiodarone.
Amiodarone inhibits the metabolism of dextromethorphan, the cough
suppressant found in most over-the-counter (and some prescription)
cough and
cold medications (for example, Robitussin-DM). Although the significance of the
interaction is unknown, these two drugs probably should not be taken together if
possible.
Grapefruit juice may reduce the breakdown of amiodarone in the stomach
leading to increased amiodarone blood levels. Grapefruit juice should be avoided
during treatment with amiodarone.
PREGNANCY: Amiodarone should not be used during
pregnancy because it
can cause fetal harm. There have been reports of congenital hypothyroidism or
hyperthyroidism when amiodarone was administered during pregnancy.
NURSING MOTHERS: Amiodarone is excreted in
breast milk and may cause
adverse effects in the infant. Breastfeeding should be discontinued by mothers
receiving amiodarone.
Congestive heart failure (CHF) is a condition in which the heart's function as a pump is inadequate to meet the body's needs. A poor blood supply resulting from congestive heart failure may cause the body's organ systems to fail, leading to a weakened heart muscle and fluid accumulation in the lungs and body tissue. There are many diseases that can impair pumping efficiency and symptoms of congestive heart failure including fatigue, diminished exercise capacity, shortness of breath, and swelling. Treatments include lifestyle modifications, medications, heart transplant, and therapy.
Palpitations are unpleasant sensations of irregular and/or forceful beating of the heart. Palpitations can be relieved in many patients by stress reduction, stopping cigarettes, and reduction of caffeine and alcohol.
Premature ventricular contractions (PVCs) are premature heartbeats originating from the ventricles of the heart. PVCs are premature because they occur before the regular heartbeat. There are many causes of premature ventricular contractions to include: heart attack, high blood pressure, congestive heart failure, mitral valve prolapse, hypokalemia, hypoxia, medications, excess caffeine, drug abuse, and myocarditis.
Heart rhythm disorders vary from minor palpitations, premature atrial contractions (PACs), premature ventricular contractions (PVCs), sinus tachycardia, and sinus brachycardia, to abnormal heart rhythms such as tachycardia, ventricular fibrillation, ventricular flutter, atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia (PSVT), Wolf-White-Parkinson syndrome, brachycardia, or heart blocks. Treatment is dependant upon the type of heart rhythm disorder.
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