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.
Advice in the Perioperative period
Elective and Emergency Surgery
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
Amiodarone can increase the risk of bradycardia when used concomitantly with the following2: -
Levobupivacaine and bupivacaine may increase the risk of cardio-depression when given with amiodarone or dronedarone – manufacturer advises monitor2.
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.
Dronedarone may increase the effect of midazolam – manufacturer advises monitor for adverse effects (such as excessive sedation, respiratory depression) and adjust dose2, 3.
Interaction(s) with other Common Medicines used in the Perioperative Period
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.
Co-administration of amiodarone and dronaderone with medicines known to prolong the QT-interval must be based on a careful assessment of the potential risks and benefits for each patient since the risk of torsade de pointes may increase.
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)
Dronedarone may increase the effects of oxycodone – manufacturer advises monitor for adverse effects (such as excessive sedation, respiratory depression) and adjust dose2, 3.
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.
Amiodarone has a long half-life; there is potential for drug interactions to occur for several weeks (or even months) after treatment has stopped2.