Amiodarone (drug interactions)
Amiodarone is a medication commonly used to restore normal heart rhythm, particularly in individuals with irregular heartbeats. However, it is important to be aware of potential drug interactions that can affect its efficacy and safety. Several herbal supplements and natural products, such as chaparral, coltsfoot, comfrey, dong quai, and St. John's wort, may interact with amiodarone, potentially increasing the risk of side effects, particularly regarding liver toxicity and photosensitivity. Additionally, certain medications, especially those used for hepatitis C, azole antifungals, and protease inhibitors, are also known to negatively interact with amiodarone.
Patients should exercise caution when taking other antiarrhythmic medications alongside amiodarone, as this can exacerbate irregular heartbeats. Other drugs, such as Digoxin, Warfarin, and statins, can alter the levels of amiodarone in the body, leading to unintended consequences. Furthermore, lifestyle choices like consuming grapefruit juice or using potassium supplements should be reconsidered during amiodarone therapy. Understanding these interactions is crucial for anyone prescribed amiodarone to ensure safe and effective treatment.
Amiodarone (drug interactions)
TRADE NAMES: Cordarone, Pacerone, Nexterone
DEFINITION: Drug used to restore normal heart rhythm.
INTERACTIONS: Chaparral, coltsfoot, comfrey, dong quai, St. John’s wort, vitamin E, soy products, echinacea, ginkgo biloba, garlic, and potassium supplements
Vitamin E
Effect: May Protect Against Side Effects
One of the problems with amiodarone is that it can cause injury to the lungs. Some evidence suggests that vitamin E supplements might help prevent this side effect.
Chaparral, Comfrey, and Coltsfoot
Effect: Possible Harmful Interaction
Chaparral (Larrea tridentata or L. mexicana), comfrey (Symphytum officinale), and coltsfoot (Tussilago farfara) contain liver-toxic substances. Because amiodarone can also affect the liver, combining these herbs with the medication is not advisable.
Dong Quai, St. John’s Wort
Effect: Possible Harmful Interaction
Amiodarone has been reported to cause increased sensitivity to the sun, amplifying the risk of sunburn or skin rash. Because St. John’s wort and dong quai may also cause this problem, taking these herbal supplements during amiodarone therapy might add to this risk. It may be a good idea to use sunscreen or wear protective clothing during sun exposure if taking one of these herbs while using amiodarone.
Other Interactions
Some drugs that are used to treat hepatitis C—ledipasvir/sofosbuvir, sofosbuvir—may interact negatively with amiodarone. Additionally, azole antifungals, cobicistat, rifamycins, and protease inhibitors are inadvisable when taking amiodarone, as they impact how the body processes the drug.
Amiodarone interacts with several other prescription medications. Taking it with other antiarrhythmic drugs can worsen an irregular heartbeat. Because amiodarone is metabolized in the liver, concurrent use with other drugs that affect liver enzymes should be avoided. Some medications, like Digoxin, Warfarin, and statins, can change the levels of amiodarone in the body. Beta-blockers, calcium channel blockers, and grapefruit juice should also be avoided. Other natural supplements that should be avoided when taking amiodarone include soy products, echinacea, ginkgo biloba, garlic, and potassium supplements.
Bibliography
"Amiodarone – Health Information Library." PeaceHealth, www.peacehealth.org/medical-topics/id/hn-1313002. Accessed 4 Sept. 2024.
"Amiodarone (Oral Route)." Mayo Clinic, 1 Aug. 2023, www.mayoclinic.org/drugs-supplements/amiodarone-oral-route/before-using/drg-20061854. Accessed 15 Aug. 2023.
"Amiodarone - StatPearls." NCBI, www.ncbi.nlm.nih.gov/books/NBK482154. Accessed 4 Sept. 2024.
Kachel, D. L., et al. "Amiodarone-Induced Injury of Human Pulmonary Artery Endothelial Cells: Protection by Alpha-Tocopherol." Journal of Pharmacology and Experimental Therapeutics, vol. 254, 1990, pp. 1107-1112.
Lesko, L J. "Pharmacokinetic Drug Interactions with Amiodarone." Clinical Pharmacokinetics, vol. 17, no. 2, 1989, pp. 130-40, doi:10.2165/00003088-198917020-00005.