Amiodarone, Dronedarone |
Issues for Surgery |
Risk of cardiac arrhythmias if omitted. Risk of cardiac complications (i.e. bradycardia, hypotension, conduction disturbances and decreased cardiac output) if continued. Risk of QT-interval prolongation if continued (see Interaction(s) with Common Anaesthetic Agents and Interaction(s) with other Common Medicines used in the Perioperative Period). |
Advice in the Perioperative period |
Elective and Emergency Surgery Continue. Amiodarone Post-operative Advice Restart post-operatively as soon as next dose is due, but bear in mind potential drug interactions see Interaction(s) with other Common Medicines used in the Perioperative Period and consult current product literature where necessary. |
Interaction(s) with Common Anaesthetic Agents |
Bradycardia Amiodarone can increase the risk of bradycardia when used concomitantly with the following2: -
Local Anaesthetics Levobupivacaine and bupivacaine may increase the risk of cardio-depression when given with amiodarone or dronedarone – manufacturer advises monitor2. Opioids Dronedarone may increase the effect of alfentanil and fentanyl – manufacturer advises monitor for adverse effects (such as excessive sedation, respiratory depression) and adjust dose2, 3. Midazolam Dronedarone may increase the effect of midazolam – manufacturer advises monitor for adverse effects (such as excessive sedation, respiratory depression) and adjust dose2, 3. QT-Interval Prolongation (see also under Interaction(s) with other Common Medicines used in the Perioperative Period) Anaesthetic agents that may be used in the perioperative period that are known to, or predicted to, prolong the QT-interval include2, 3: -
*monitor ECG if concurrent use unavoidable; if risk factors for QT-prolongation are also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia) use greater caution |
Interaction(s) with other Common Medicines used in the Perioperative Period |
Hypokalaemia Dexamethasone and hydrocortisone may cause hypokalaemia (potentially increasing the risk of torsades de pointes) with amiodarone or dronedarone – use with caution1, 2, 3, 4. If hypokalaemia occurs, corrective action should be taken and QT-interval monitored1, 4. QT-Interval Prolongation (see also under Interaction(s) with Common Anaesthetic Agents) Medicines that may be used in the perioperative period that are known to prolong the QT-interval include1, 2, 3, 4:-
*monitor ECG with concurrent use particularly if risk factors for QT-interval prolongation also present (increasing age, female sex, cardiac disease, and some metabolic disturbances e.g. hypokalaemia) Metronidazole Oxycodone Dronedarone may increase the effects of oxycodone – manufacturer advises monitor for adverse effects (such as excessive sedation, respiratory depression) and adjust dose2, 3. Oxygen There is potential for an interaction between amiodarone and high concentrations of oxygen. A few cases of adult respiratory distress syndrome, sometimes fatal, most often in the period immediately after surgery, have been observed1. |
Further Information |
Amiodarone has a long half-life; there is potential for drug interactions to occur for several weeks (or even months) after treatment has stopped2.
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References |
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