LYCOS RETRIEVER 
Cordarone: Patients
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Hyperthyroidism occurs in about 2% of patients receiving Cordarone, but the incidence may be higher among patients with prior inadequate dietary iodine intake. Cordarone-induced hyperthyroidism usually poses a greater hazard to the patient than hypothyroidism because of the possibility of thyrotoxicosis and/or arrhythmia breakthrough or aggravation, all of which may result in death. There have been reports of death associated with amiodarone-induced thyrotoxicosis. IF ANY NEW SIGNS OF ARRHYTHMIA APPEAR, THE POSSIBILITY OF HYPERTHYROIDISM SHOULD BE CONSIDERED.
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Cordarone X can cause some patients to become sensitive to the sun of may cause a discolouration of the skin or a rash. You should avoid exposure of your skin to direct sunlight of sunlamps. If you are sensitive then this may persist for some time after treatment stops. You should take sensible precautions when you are in the sun; wear a wide brimmed hat and keep arms and legs covered; apply a total sun block cream to exposed areas of skin.
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Administration of Cordarone X to a patient already receiving digoxin will bring about an increase in the plasma digoxin concentration and ... precipitate symptoms and signs associated with high digoxin levels. Clinical, ECG and biological monitoring is recommended and digoxin dosage should be halved. A synergistic effect on heart rate and atrioventricular conduction is also possible.
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Cordarone, like other antiarrhythmics, can cause serious exacerbation of the presenting arrhythmia, a risk that may be enhanced by the presence of concomitant antiarrhythmics. Exacerbation has been reported in about 2 to 5% in most series, and has included new ventricular fibrillation, incessant ventricular tachycardia, increased resistance to cardioversion, and polymorphic ventricular tachycardia associated with QTc prolongation (torsades de pointes [TdP]). In addition, Cordarone has caused symptomatic bradycardia or sinus arrest with suppression of escape foci in 2 to 4% of patients.
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It should be emphasized that a cause and effect relationship between Cordarone® use and the development of an optic neuropathy has not been proven to date. However, multiple case reports in the literature have suggested an association between the use of this drug and the development of an optic neuropathy. The new package insert indicates that regular ophthalmic examinations, including dilated fundoscopic evaluations, are recommended for patients using Cordarone®. It is not clear whether the appearance of an optic neuropathy is an absolute indication for discontinuing the drug. This reflects the fact that Cordarone® is usually reserved for treating life-threatening ventricular arrhythmias.
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Adverse reactions have been very common in virtually all series of patients treated with Cordarone for ventricular arrhythmias with relatively large doses of drug (400mg/day and above), occurring in about three-fourths of all patients and causing discontinuation in 7 to 18%. The most serious reactions are pulmonary toxicity, exacerbation of arrhythmia, and rare serious liver injury (see “WARNINGS”), but other adverse effects constitute important problems. They are often reversible with dose reduction or cessation of Cordarone treatment. Most of the adverse effects appear to become more frequent with continued treatment beyond six months, although rates appear to remain relatively constant beyond one year. The time and dose relationships of adverse effects are under continued study.
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