Pulmonary Toxicity in Patients Receiving Low-Dose Amiodarone

• Published in: Chest Vol. 123; no. 2; pp. 646 - 651
• Main Authors: Ott, Michael C., Khoor, Andras, Leventhal, Jack P., Paterick, Timothy E., Burger, Charles D.
• Format: Journal Article
• Language: English
• Published: Northbrook, IL Elsevier Inc 01.02.2003; American College of Chest Physicians; Elsevier B.V
• Subjects: Aged; Aged, 80 and over; Amiodarone; Amiodarone - administration & dosage; Amiodarone - adverse effects; antiarrhythmics; Biological and medical sciences; Biopsy; Bronchoscopy; Carbon monoxide; Causes of; Complications and side effects; Coronary vessels; Cryptogenic Organizing Pneumonia - chemically induced; Cryptogenic Organizing Pneumonia - diagnosis; Dose-Response Relationship, Drug; drug toxicity; Drug toxicity and drugs side effects treatment; Dyspnea; Ejection fraction; Female; Heart failure; Heart surgery; Humans; Lung diseases; Male; Medical sciences; Patients; Pharmacology. Drug treatments; Pneumonia; Pneumonia - chemically induced; Pneumonia - diagnosis; Pulmonary Alveoli - drug effects; Pulmonary Alveoli - pathology; pulmonary medicine; Respiratory Distress Syndrome, Adult - chemically induced; Respiratory Distress Syndrome, Adult - diagnosis; Retrospective Studies; Steroids; Toxicity; Toxicity: respiratory system, ent, stomatology; BOOP; amiodarone; Dlco; drug toxicity; pulmonary medicine; TLC; antiarrhythmics; CABG; Human; Lung disease; Arrhythmia; Respiratory disease; Toxicity; Low dose; Cardiovascular disease; Amiodarone; Antiarrhythmic agent; Iodine Organic compounds; amitidartme; Case study; Chemotherapy; Treatment; Respiratory failure; Heart disease; Interstitial pneumonitis
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1378/chest.123.2.646

Although there have been reports of pulmonary toxicity with low-dose amiodarone, it is generally believed that low-dose therapy is safe. The clinical data for eight patients identified from a retrospective chart review are presented. All of the patients were receiving amiodarone, 200 mg/d, for an average of 2 years. The average age was 77 years (range, 65 to 89 years). Seven of the eight patients were male. Seven of the eight patients presented with dyspnea on exertion, and three of the eight patients presented with cough. All of the patients had a clinical diagnosis of amiodarone-induced pulmonary toxicity. Open-lung biopsies were obtained on two patients that were consistent with amiodarone-induced pulmonary toxicity. None of the patients were in congestive heart failure. Treatment involved cessation of amiodarone. In addition, three patients received corticosteroids. Five of the patients improved symptomatically with this conservative approach, and four patients improved radiographically. One patient died with progressive respiratory insufficiency (presumably from amiodarone pulmonary toxicity). One patient was unavailable for follow-up. Amiodarone-induced pulmonary toxicity can occur at a daily dose of 200 mg. Clinicians must remain alert to this possibility even with this low-dose therapy.