Amiodarone

Amiodarone is a medicine used to treat abnormal heart rhythms called arrhythmias. This information sheet from Great Ormond Street Hospital describes how this medicine is given and some of its possible side effects.Amiodarone is usually given twice or three times a day to begin with, and then reduced to once a day. It is available as 100mg and 200mg tablets. If your child can swallow tablets, they can swallow them whole with water. If not, disperse the tablet(s) in a small amount of water and give it to your child to drink, or use an oral syringe to squirt the dose gently into the side of your child’s mouth.

If your child needs a proportion of the tablet, disperse it in a specific volume of water (for instance 10ml) and then draw up the correct proportion of the liquid using the oral syringe provided. These instructions will be on the medicine label.

For example, if your child needs to take a 60mg dose each day:

• Disperse a 100mg tablet in 10ml of water
• Draw up 6ml of the liquid and give to your child
• Throw the rest of the liquid away

People with the following conditions should discuss taking amiodarone with their doctor:

• Pregnant, could be pregnant, planning to become pregnant or breastfeeding
• Hypersensitivity to amiodarone or iodine. Amiodarone contains iodine
• Slow heart rate called bradycardia
• History of thyroid dysfunction
• Taking medication that prolongs the QT interval (see below under amiodarone and other medicines)

• Nausea and vomiting (feeling or being sick), loss of appetite or constipation
• A metallic taste in the mouth
• Bradycardia (slow heart rate)
• Reversible micro corneal deposits, halo or blurred vision.
• Photophobia or visual impairment: If vision becomes impaired whilst taking amiodarone, please tell us.
• Skin rash, discoloration or photo sensitivity (skin can become sensitive to sunlight). People taking amiodarone should protect themselves from the sun by wearing protective clothing and using a wide spectrum sun block.
• Abnormal thyroid function: If tiredness, heat or cold intolerance, weight gain or loss, heart pounding, light-headedness, restlessness or poor concentration develops whilst taking amiodarone, please tell us.
• Lung fibrosis or pneumonitis: If cough, wheezing or difficulty breathing develops while taking amiodarone, please tell us.
• Liver impairment: Please tell us if your child’s skin develops a yellow tinge, they are passing brown or dark coloured urine, sweating or weight loss.

Some medicines can interact with amiodarone. Always check with your prescriber or pharmacist before giving your child any other medicines, including herbal or complementary medicines. The following are known to interact with amiodarone

• Grapefruit juice: This can increase in amount of amiodarone absorbed from the stomach so is best avoided while taking amiodarone.
• St John’s Wort
• Medicines that can slow the heart rate: betablockers, verapamil, diltiazem. These are sometimes prescribed alongside amiodarone but careful monitoring will be needed.
• Warfarin: Amiodarone may increase the effect of warfarin. Additional blood tests are needed when amiodarone is started, increased or decreased or stopped.
• Anti-arrhythmic medicines
• Digoxin: The dose of digoxin will need to be adjusted if amiodarone is started
• Medicines that prolong the QT interval: other medicines that are used to control heart rhythms may need to be adjusted. 

• Keep medicines in a safe place where children cannot reach them.
• Keep medicines in a cool, dry place out of direct sunlight and away from heat.
• If your doctor decides to stop treatment with amiodarone, return any unused medicine to the pharmacist. Do not flush down the toilet or throw it away.
• If you forget to give your child a dose, give it as soon as you remember. Do not give a double dose.
• If you child vomits after taking the medicine, do not give a double dose.
• Your family doctor (GP) will need to give you a repeat prescription for amiodarone. Some medicines will need to be ordered by your community pharmacy (chemist) so arrange this in plenty of time.