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Author: Admin | 2025-04-28
Agents: examples of clinically significant interactions* (continued)Dofetilide, ibutilide, torsades quinidine, sotalolAdditive effect, which increases risk of QT prolongation and de pointes. Effects can be rapid.Withhold amiodarone for at least 3 half-lives before administering dofetilide or sotalol.Withhold amiodarone for 5 half-lives before and 4 hours after administering ibutilide.Quinidine concentrations can increase by 33% with concurrent amiodarone use; decrease quinidine dose by 30% to 50%.Lidocaine, procainamide, flecainide, propafenoneAmiodarone increases serum levels of each agent.Monitor for lidocaine-induced CNS toxicity and adjust lidocaine dose.Monitor for procainamide-induced hypotension and arrhythmias; procainamide dose may need to be reduced by one third.Monitor for flecainide-induced proarrhythmias; reduce flecainide dose by 50%.Monitor for propafenone-induced GI and CNS effects; reduce propafenone dose as needed.CV, cardiovascular; INR, international normalized ratio; AV, atrioventricular. *These are examples only. See current texts and reviews for further informationTable 2 - Amiodarone and antimicrobial agents: examples of clinically significant interactions*Quinolones,Additive effect, which increases risk of QT prolongation and torsades de pointes. Delayed onset.Consider another antibacterial agent.RifampinDecreased amiodarone levels.Monitor amiodarone efficacy; increase dose as needed.Protease inhibitorsElevated amiodarone levels. Delayed onset.Concomitant administration with ritonavir and nelfinavir is contraindicated.Monitor for amiodarone toxicity, and reduce dose as needed.*These are examples only. See current texts and reviews for further information.Table 3 -Amiodarone and GI agents: examples of clinically significant interactions*CholestyramineDecreased amiodarone levelsMonitor amiodarone efficacy; increase dose as needed.Prokinetic agents,Additive effect, which increases risk of QT prolongation and torsades de pointes.Increased cisapride levels. Avoid concomitant use. Use metoclopramide as an alternative.Monitor cardiac function if concurrent use of 5-HTCimetidineCan increase amiodarone levels by about 40%.Avoid concomitant use. Use another H*These are examples only. See current texts and reviews for further information.Table 4 - Amiodarone and neurologic agents: examples of clinically significant interactions*AntipsychoticsAdditive effect, which increases risk of QT prolongation and de pointes.Avoid concomitant use. Monitor closely if use cannot be avoided.Other antipsychotics and
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