Q: I take 200mg of amiodarone to help regulate my heartbeat because it tends to be too fast. Can you tell me more about this medication? Do I have any alternatives?
A: Amiodarone is one of those rare drugs you hear about that got approval from the U.S. Food and Drug Administration without a lot of testing. Known by the brand names Cordarone or Pacerone, it is reserved for people with life-threatening arrhythmias that can’t be controlled by other drugs or treatments.
In the 1980s, drug companies and doctors pressured the FDA to approve amiodarone in the United States because it had been used successfully overseas since the 1960s. The FDA was hesitant because of dangerous side effects but approved it without the rigorous clinical trials typical of the time.
Drugs that regulate heartbeat are categorized as Class I through V. Amiodarone belongs to Class III, as does sotalol (Betapace).
Many people have benefited with amiodarone; a few have developed side effects, the most feared being pulmonary fibrosis in which scar tissue forms inside the lungs. The condition can occur within months of starting the drug. It causes shortness of breath, fatigue, chest discomfort, weakness and a chronic, dry, hacking cough. It can be fatal. Naturally, these symptoms can indicate other disorders. About 200,000 people in the U.S. and 5 million worldwide have pulmonary fibrosis.
Don’t throw out your medicine after reading my column. This side effect is uncommon, and you should never suddenly stop taking a prescribed medication. But ask your doctor if you are taking the lowest effective dose and investigate other options that have a safer side-effect profile. Sotalol, for example, seems to be much better tolerated.
Only your cardiologist can determine what the most appropriate drug is for you. Other drugs that regulate heartbeat (and control blood pressure) are: procainamide, disopyramide, mexiletine, flecainide, propafenone, propranolol, metoprolol, verapamil, diltiazem and digoxin. Two nutrients that regulate heartbeat are L-carnitine and coenzyme q10.
Write to registered pharmacist Suzy Cohen at dearpharmacist.com.
