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Author: Admin | 2025-04-28
It is lipid soluble, allowing it to reach many tissues in the body, and has a long half-life of approximately 40 to 55 days.5 Corneal deposits or keratopathy with amiodarone therapy is both time- and dose-dependent and is seen in 69% to 100% of patients.6 Amiodarone keratopathy occurs in three stages after at least 1 month of treatment.4 The first stage is described as the appearance of a horizontal line in the cornea in patients on dosages of 200 to 400 mg. Higher daily doses can result in stage 2 and 3 effects, which are characterized as a cat-whisker pattern and a whorl-like (verticillata) pattern in the cornea, respectively.7 Formation of deposits seems to be a result of complexes formed with the drug and phospholipids that cannot be metabolized. The deposits usually occur bilaterally and normally do not result in visual impairment; however, the colored halos appearing around lights may be linked to these deposits. Following amiodarone discontinuation, it can take from 3 to 20 months for the deposits to completely resolve.4 Optic neuropathy occurs less frequently (6 Amiodarone-associated optic neuropathy has a gradual onset with slow progression that can ultimately result in bilateral vision loss and disc swelling. The exact mechanism is unknown, but may be related to accumulation in optic nerve axons. If optic neuropathy is suspected, discontinuation of amiodarone should be considered, if possible, as visual loss can be permanent.6 Cases of eyelid irritation, eyelid cysts, and dry eyes have also been seen with amiodarone therapy.4 Due to the high frequency of ocular toxicity with amiodarone, it is recommended that patients receive a baseline ophthalmic examination prior to initiation of therapy, with repeat examinations every 6 months in the first year and every 12 months thereafter.3,6 Antiepileptic Agents Topiramate can be used as adjunctive or monotherapy for
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